Archive for the ‘Hormone Clinic’ Category

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

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

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

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

The actual process usually involves a few procedures:

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

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

1. SRS without vaginal depth

2. SRS with Penile Skin Inversion

3. SRS with Scrotal Skin Graft

4. SRS with Sigmoid Colon by Laparoscopic Technique

Caitlyn Jenner, Possibly the Most Famous Transgender Person Ever

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

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

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

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

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

Possible side effects may also include:

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

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

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

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

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

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

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Your ultimate guide to Sex Reassignment Surgery in Thailand (male to female) - The Thaiger

Medical clinics across the country are advertising a treatment some believe is a fountain of youth. They're selling hormone therapy as a way to make people look and feel younger. But a CBS News investigation finds this may be putting patients at risk.

Last year, at the age of 60, Cindy Kinder-Benge was rushed to a hospital in New Albany, Indiana, with a heart rate four times normal. Two months earlier, she had gone to the emergency room with palpitations.

"A cardiologist walks in and he said, 'Who put you on thyroid medicine?'" Kinder-Binge said.

She had been prescribed a thyroid hormone for menopausal symptoms like hot flashes, even though her thyroid blood levels were normal. She says her cardiologist had her stop taking the hormone because he believed it contributed to her irregular heartbeat.

She was treated by a nurse practitioner at a clinic called 25 Again. Hormone therapy is promoted as a way to help patients lose weight and feel younger. But a CBS News investigation found there are clinics across the country prescribing hormones like thyroid and testosterone to people with normal levels and it's not just 25 Again.

Ultrasound technician Leighann Decker is a former employee of an OB-GYN in Owensboro, Kentucky. The doctor Decker worked for prescribed testosterone to patients with normal testosterone levels looking to turn back the clock.

"More and more practitioners have tried to jump on board and when they've seen the profit that's being made from it. Of course, it's cash pay. It's easy money," Decker said.

The doctor in Kentucky and the practitioner in Indiana both attended seminars given by Dr. Neal Rouzier. He has been promoting hormone replacement therapy for decades and said he's trained thousands of clinicians around the world. During a 2016 deposition, he said he gives testosterone to patients even if their levels are normal.

"I don't care about the number. I treat patients. I treat symptoms," Rouzier said.

Some research suggests testosterone therapy may increase the risk of heart attack or stroke. In 2015, Rouzier dismissed that concern.

"There's thousands of articles to show protection against heart attacks," he said.

But under oath, in that deposition, he was unable to point to any evidence that would back up his claim that his approach to testosterone therapy is safe.

"The problem is that there is no fountain of youth," said Dr. Steven Nissen, a cardiologist at the Cleveland Clinic. Nissen is leading an FDA-mandated study to see if giving testosterone affects the risk of heart attack or stroke in men with low levels."There's no scientific basis for giving hormone therapy to people whose levels are already normal and there's lots of suggestions that it may actually be harmful," Nissen said.

Kinder-Binge is suing 25 Again. The company told CBS News the overall health of their patients is their priority and they make patients aware of any risks. Rouzier declined our request for an interview and did not respond to a list of written questions.

The company 25 Again sent the following statement to CBS News:

We thank CBS News for reaching out to us regarding our company. While we are unable to speak to a particular patient's health because of federal health guidelines (HIPAA), we are eager to discuss the many benefits we provide to our patients and clear up any confusion or false information regarding hormone replacement therapy.

At 25 Again, the overall health of our patients is our priority and our mission. Hormone therapy is only a part of what we do in consideration of a person's health. Many of the patients we see have been turned away by their primary care physician or have not otherwise been able to find help to alleviate symptoms they may be experiencing.

From the start, when a potential patient visits us, we make them fully aware of any possible risks associated with hormone replacement therapy. Patients must sign a consent form before they can participate. Every patient at 25 Again is also required to undergo a physical and blood test, so that our team can first look at each person's health history to decide the best course of action, whether hormone replacement is the best fit for the patient, and the level of hormones needed for the individual patient. Individuals can also opt out at any time, and all patients are directed to, and agree to, remain under the care of another physician for all other medical conditions.

Hormone replacement therapy can be used to alleviate many signs and symptoms known to be associated with certain declining hormones, including inflammation in the body, which is the root cause of many diseases like cardiovascular disease, arthritis, depression, stress and more. Studies show lower hormone levels can cause these symptoms, and hormone replacement therapy can help people reach their optimal hormone levels.

According to the Food and Drug Administration (FDA), normal lab test values are a set of upper and lower limits generally given as a range because normal values vary from person to person. At 25 Again, we treat the patient individually and consider many other factors while addressing hormone levels. We have more than 7,000 customers, many of whom have found relief with this method. If a patient is still experiencing symptoms, additional hormones may be given safely.

Like other forms of medication in the health care industry, before a potential patient signs a consent form, they are informed that this treatment may not be effective for every individual. An individual's lab results are always available upon request, and are often used to show them how wide the range of normal can be for hormone levels.

If you or someone you know have information you'd like to share regarding a hormone therapy clinic, email:investigates@cbsnews.comor contact the CBS News Investigative Unit via one of the methods on ourtips page.

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Hormone therapy clinics could be putting patients in danger - CBS News

Two years ago, federal corrections officer Emmitt Landry was taken to a Houston hospital after having a stroke at age 41. About a month earlier, Landry had been feeling fatigued when coworkers told him about Optimum Wellness, a clinic in Nederland, Texas, that could treat him with hormones.

"I was just looking for something to help me get through the day," Landry told CBS News chief medical correspondent Dr. Jonathan LaPook. At the hospital, doctors tried to figure out why someone so young would have a stroke. The only thing doctors could deduce, according to Landry, was that the testosterone caused a clot.A nurse practitioner at the clinic Landry visited in Nederland had prescribed him testosterone even though his testosterone blood levels were normal. Optimum Wellness is one of a number of medical clinics across the country selling hormone therapy that some believe could provide patients a fountain of youth. A CBS News investigation found there are clinics across the country prescribing hormones like testosterone to people with normal blood levels.

Landry says his nurse practitioner only highlighted the benefits and never discussed a possible risk of heart disease, stroke or any other problems whatsoever.

In Texas, nurse practitioners are not allowed to prescribe hormones without a doctor's approval. Landry's treatment was overseen by Dr. James Kern, an OB/GYN in Houston about 100 miles away. In October 2017, the Optimum clinic was raided by the DEA and shortly after that, Kern withdrew his supervision. The DEA declined to comment.

Amy Townsend, a doctor in southeast Texas, told CBS News, "I'm seeing multiple people that are my friends and my family that are being treated completely inappropriately."

So, she decided to report the clinic to the state nursing board. But according to Townsend, they didn't take action.

Oversight comes from state medical and nursing boards. CBS News reached out to both sets of boards in all 50 states and of the 95% that responded, only seven states have both medical and nursing boards who keep track of incidents related to hormone therapy. "Right now this practice of giving testosterone to people who, in your mind, shouldn't be getting it, it's still going on?" LaPook asked.

"It's widespread throughout the country," Townsend said.

Landry said these clinics prey on people's fears of growing old and that when he walked out of the hospital after suffering a stroke, he felt embarrassed.

"I went to these physicians looking for help and I had a stroke," Landry said. "And I'm supposed to be taking care of my family."In February 2018, the nurse practitioner who treated Landry lost his license for inappropriately prescribing hormones to Landry and others and in August, the clinic closed its doors for good.Landry is now suing Dr. Kern and the nurse practitioner who treated him at the clinic. They've denied Landry's allegations.

CBS News reached out to Dr. Kern and the nurse practitioner, but they declined our request for comment.

If you or someone you know have information you'd like to share regarding a hormone therapy clinic, email:investigates@cbsnews.comor contact the CBS News Investigative Unit via one of the methods on ourtips page.

2019 CBS Interactive Inc. All Rights Reserved.

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A clinic treated a fatigued 41-year-old with testosterone. A month later he had a stroke. - CBS News

Erin Reed was just 13 years old when she first began researching gender transition. It took her another 18years to transition publiclyand access to treatment, or lack thereof, played a big role in the wait.

As a teen, Reed found that in order tobe prescribed hormone therapy, she would need letters from gender specialists and she would have to present as a girl for months (or even longer) prior to her first dose. It just didnt seem like something I could access, she told Rewire.News. Transitioning without hormones terrified Reedalthough many trans people do transition non-medically, she didnt want toso she didnt try at all.

There was no way I could present as female for a year before receiving treatment. The whole process just seemed really daunting to me, Reed said.

It wasnt until adulthood that Reed, now the digital director of the progressive news site Shareblue, discovered informed consent (IC) clinics, where trans people can access hormones without jumping through the various hoops. Reed booked an appointment at one a few hours from her home in Washington, D.C., and began hormone replacement therapy a few months ago. But after herchallenging road to finding the resources she needed, Reed felt inspired to help others. So she created what has become one of the largest repositories of information on IC clinics in the country: a map of clinics all over the United States.

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Conventional medical wisdom holds that hormone therapy treatment should involve a long series of complex steps. Rather than having to consult with a mental health professional and present as their gender for a year, patients at informed consent clinics are educated about the impact of the drugs they are interested in starting therapy with. If they are determined to be of sound mind and fully able to consent, they can sign a form and begin treatment. Patients, who are often still in the early stages of hormone therapy at IC clinics, are then monitored carefully; their hormone levels are checked every few months.

For Reed, this was key: You can just start. That just blew my mind. I wished I could have done it 10 or 15 years ago. Knowing that was an option gave me the confidence to transition.

Informed consent doesnt mean that trans people are receiving medication with any less oversight thanpatients being prescribed any other non-addictive drug. IC clinics just operate the way standard treatment processes should,allowing doctors to treat their patients as they see fit and giving patientsthe right to advocate for themselves. The clinics vary in structure; some are independent facilities, and others, likethe transgender health program at Bostons Fenway Health and the trans health clinic at the University of California, San Francisco (UCSF), are operated by larger medical systems. Some Planned Parenthood clinics offer IC hormone treatment, but not all of them.

A study of 12 informed consent clinics conducted bya UCSF medical professor found minimal risk of regret and no known cases of malpractice suits. UCSF also noted that most providers are already familiar with the hormones used for gender-affirming hormone therapy because the medications areused for conditions ranging from male pattern baldness to menopause.

Some people have criticized IC clinics forpotentiallytreating patients who arent actually trans or who later change their minds. Statistically, however, thatseems to be incredibly rare. A 2018 study of surgeons that had treated more than 22,000 transgender patients in total found that, between them, the providers could only recall62 patientsthat had ever expressed regret about transitioning.

I always hear that the big concern is that: What if you are letting people through that are just going to de-transition, or what if you are letting people through who arent transgender? I can tell you from my personal life and from everyone I have spoken to . If youre looking into transitioning, chances are youre transgender, Reed said.

Generally speaking, patients have to be 18 to accesshormone therapy and related treatment through informed consent, although advocates are pushing for that limitation to be dropped in certain cases. For adult trans folks, though, IC can streamline the process significantly.

Considering all of this, Reed decided to share the word about informed consent. I spent probably 20 to 25 straight hours in front of my laptop, just looking up clinics, she explained. Reed scoured the internet and also crowdsourced info on clinics from other trans folks, asking people to send in the names and locations of clinics they had used. Once she found them, Reed compiled the clinics into a map she shared on social media, which has now been viewed more than 88,000 times.

Reeds map shows a serious dearth of informed consent clinics in certain areas of the country, like Montana, North and South Dakota, and Wyoming. Overall, the Rocky Mountain, Southeast, and Midwest regions have far fewer clinics than the Northeast and the West Coast. Clinics are also concentrated near major metropolitan areas.

Informed consent clinicscannot necessarily guarantee that a patients medication will be covered by their insurance; Reed is still paying out pocket for hers because of the slow process of approval through Kaiser.

Informed consent isnt a complete or perfect solution, but the IC map has still been a powerful tool for transpeople.

I have gotten private messages from people saying stuff like that: that they wouldnt have been able to do it without the map,Reed said. And I wouldnt have been able to transition without [knowing about informed consent], so I understand.

Reed hopes that her map will not only be a resource for other transpeople, but potentially serve as an example for policymakers, health-care practitioners, and other decision-makersboth trans and cisabout the importance of informed consent. Ideally, Reed said, projects like hers will eventually be replicated by others, taking some of the pressure off of trans people to constantly produce their own resources in the absence of information.

If we didnt have to take all the burden on ourselves, that would be great, she said.

For many transpeople, access to hormone therapy is an important aspect of being able to live on their own terms and feel comfortable in their bodies. Being able to begin treatment without the trauma and expense of being forced to see gender specialists can be radically liberating.

Moving from transition being a theoretical thing, to an actual concrete thing, being able to make a plan, knowing that there is a physical place you can go, and seeing it on the mappotentially not far from youI think it gives people a little bit of courage to be themselves, Reed said.

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Meet the Woman Making It Easier for Trans People Around the Country to Get Hormones - Rewire.News

Do you sometimes run through all your childrens names first when trying to call the dog? (Amy! Dave! Brian oh, for the love of Beanie!) Recalling whats-her-name who did that thing with that guy in that movie? (You know who, that guy who also did the thing?) If you are a postmenopausal woman, you might be able to blame your fogginess on the length of time your body produced estrogen naturally and how long you took hormone replacement therapy (HRT), also known ashormone therapy (HT).

Related: Perimenopause and Menopause: Whats the Difference?

Men and women have different sex hormones that have different effects on the brain as we age. A study published online October 16, 2019,in thejournal Menopausehas found that the longer a woman has been exposed to estrogen (from onset of menstruation to menopause or through early use of HT after menopause), the better her brain health and mental flexibility as she enters her sixties.

Related: Hormones and Your Health: An Essential Guide

The study looked at more than 2,000 postmenopausal women over 12 years to discover what, if any, association there is between estrogen and brain health. They focused on how long the woman had been exposed to estrogen, adjusting for pregnancies (when they would be exposed to more hormones), breastfeeding (when they would have produced less estrogen), and if they took HT for any length of time.(Use of hormonal birth control was not considered because thiscontraception methodregulates, rather than significantly add, estrogen.)

The women were tested at various points on five factors of brain health, including psychomotor skills, memory, identification and association, orientation, and concentration and calculation. It would make sense to define this as broad thinking skills, such as memory, concentration, and being able to make decisions quickly, explainsJoshua M. Matyi,lead study author and doctoral candidate in the department of psychology at Utah State University in Logan.

Related: Stress Can Shrink Your Brain, Study Says

This study found that the longer the estrogen window (when women were naturally producing estrogen), the better the womens brain function was. The brain function of participants who took HT remained the same, but was higher than those who did not take HT. Cumulatively, length of estrogen exposure was associated with how the participants would do on the cognitive measure test, says Matyi.

Related: Treatments for Menopausal and Perimenopausal Symptoms

Many studies on estrogens effect have been conflicting and complex. In 2003, the large Womens Health Initiative Memory Study(WHIMS) showed anincreasein dementia risk for women taking HT. (These are the studies that influenced the application of the black box warning on many HT products.) However," Matyisays, "our results are in contrast to those results. Also, our study shows support for the critical window hypothesis, which suggests that HT should be initiated closer to menopause, rather than later, to reduce any reduce any risks related to thinking and learning abilities.He adds, We also did not see any change in women who started and stopped HT. Thats an indication that the majority of effect occurred years before our study. This means that benefits may potentially continue even after discontinuing.

Some women go into menopause earlier than normal because of cancer treatments or removal of the ovaries.This study shows that for these women (under age 45), early treatment with HT at least until the natural age of menopause (around age 51 in the United States) the benefits will outweigh the risk, unless there is a clear reason to avoid HT, such as breast cancer history.

Related: How to Keep Your Brain Sharp and Healthy as You Age

The decision gets more complicated as you get older. Weve suggested that any woman going through menopause before the age of 45 should use HT, for the protective effect. unless there is a medical reason not to do so. It helps not just the brain but the heart and bones as well. Its never going to be cut and dried; it has to be weighed out in terms of risk and benefits, saysStephanie S. Faubion MD, medical director ofNAMS, and Penny and Bill George Director of the Mayo Clinic Center for Womens Health in Rochester, MInnesota.

The actions described can provide additional benefit even if you are taking hormone therapy. According to Harvard Health Publishing, you can up your chances of finding your glasses, phone, or keys by following these suggestions:

Related: 7 Ways to Move More at Midlife

Further research is needed on the connection between the brain health and estrogen. These are complicated questions but researchers are looking into it. This study brings us one step close to solving the riddle, says Faubion.

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Estrogen May Protect Brain From Cognitive Decline - Everyday Health

Melatonin is a hormone produced by your brains pineal gland, which controls your internal sleep and body clock.

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

The supplements you buy in the store contain a synthetic version of melatonin. They will not increase your sleep drive or put you to sleep, and most research does not show significant benefit in using them as sleeping pills.

But if melatonin is taken at a time and dosage that is appropriate for someones sleep problem, it can help shift the biological sleep clock earlier. This can be helpful for shift workers and people with circadian rhythm disorders.

My general recommendation is less is more, or 0.3 milligrams to 1 milligram taken several hours before bedtime. Unfortunately, most melatonin sold over-the-counter is available in doses ranging from 3 milligrams to 10 milligrams, which is much more than your body needs.

To allow your bodys own melatonin to work best, you should create optimal conditions. Keep lights dim in the evening and avoiding using a computer, smartphone or tablet before bed, as bright light exposure can inhibit the release of melatonin. In addition, getting light exposure in the morning can help keep your sleep-wake cycle on track, so get outside for a morning walk when you wake up, if possible.

Sleep specialist Michelle Drerup, PsyD

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What's the Right Way to Take Melatonin? - Health Essentials from Cleveland Clinic

October 12 2019, 12:01am,The Times

A child gender clinic in London is being threatened with legal action. The question of whether children can agree to life-altering treatment must be carefully weighed

The moment a pregnancy is announced, expectant mothers are asked whether they are awaiting a boy or a girl. As children get older, most have a straightforward relationship with their gender. Yet for a growing minority, the question becomes vexed and can cause immense distress.

In recent years the number of children reporting gender dysphoria the conviction that the sex on their birth certificate is the wrong one has rocketed. Five years ago, 468 children were referred to the Tavistock and Portman NHS trusts gender identity development service in north London, while last year alone, 2,519 children were referred.

Today we report that the clinic is being threatened with legal action by a parent who wants to stop it from prescribing hormone blockers

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The Times view on the Tavistock clinic and hormone-blocking drugs for the young: Informed Consent - The Times

PEORIA UnityPoint Health is offering a new form of birth control.

Long Acting Reversible Contraception (LARC) is a one-time long-term method of birth control that can be easily removed by a doctor. Users have three to ten years of birth control depending on which method they use.

My goal is to improve reproductive health for women. Im always looking for opportunities to increase our communitys access to birth control, especially the under served public insurance population, said Dr. Rahmat NaAllah, UnityPoint Clinic Family Medical Center provider and Family Residency Program faculty member.

In addition to providing the option to women at the UnityPoint Clinic Family Medical Center, the organization is also working to get more physicians trained to dispense LARC.

As a faculty member in our residency program, I want to train the residents to be more competent and confident in contraceptive procedures. Currently less than 20 percent of family physicians nationwide are trained in LARC placement. As a doctor, I want to increase accessibility for our patients, said NaAllah.

UnityPoint Health is offering women two LARC options. Nexplanon is an arm implant. A plastic rod the size of a matchstick is inserted in the arm under the skin. The intrauterine device is a T-shaped plastic device placed inside the uterus. A non-hormone copper IUD alternative is available. Nexplanon and the IUDs release the hormone progestin, which make it difficult for sperm to reach an egg in the uterus.

Women who use LARC dont require any other form of birth control. LARC also reduces menstrual pain, and doesnt interfere with sexual activity. Many women like LARC because it can make periods lighter. And because they dont have to take a pill every day or renew a prescription, its more convenient, said Na'Allah.

LARC is the most effective birth control with a failure rate of less than one percent, said NaAllah. All the major healthcare organizations like the CDC, American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and American Academy of Pediatrics support these findings.

NaAllah notes that contrary to popular belief, the risk of an IUD puncturing the uterus is less than 2 percent. Her team takes extra precaution in measuring the depth of a womans uterus before placing the IUD to ensure it is safely secure.

Every woman has a right to plan their pregnancy, so they can be empowered and productive members of society. To help women reach their best, they need to have access to birth control. I want to help our community and beyond. I want to be able to train more future family physicians so wherever they go to practice they are part of the solution and not part of the problem, said NaAllah.

The Family Medical Center is a UnityPoint Health family medicine and residency clinic with the University of Illinois College of Medicine Peoria partnership. Doctors at the clinic are currently dispensing the LARC devices during a once-a-month clinic, but the program may be expanded to once a week to meet demand.

UnityPoint Clinic Family Medical Center is at 815 Main St. in Downtown Peoria. To schedule a LARC appointment to speak to a provider about different LARC options, call 672-4977.

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UnityPoint Health is offering Long Acting Reversible Contraception - Pekin Daily Times

CRANBURY, N.J.--(BUSINESS WIRE)--OncLive, the nations leading multimedia resource focused on providing oncology professionals with the most current and insightful information they need to offer the best patient care, will host its latest State of the Science Summit on Genitourinary Cancer on Tuesday, Oct. 22, from 5-9 p.m. at the Renaissance Phoenix Downtown Hotel, in Arizona. The chair for the summit will be Alan H. Bryce, M.D., medical director of the genomic oncology clinic, chair of the division of hematology/oncology and associate professor of medicine at Mayo Clinic.

This interactive and educational meeting will analyze and discuss novel treatments for patients with genitourinary cancers. The expert presenters will explore a wide variety of related topics, such as novel imaging in nonmetastatic hormone-sensitive prostate cancer, the role of radiation therapy in prostate cancer, treatment of nonmetastatic castration-resistant prostate cancer, advances in metastatic prostate cancer, advanced urothelial cancer and the role of cytoreductive nephrectomy in renal cell cancer. The presenters will also engage in a peer exchange and address audience questions.

The presenters for the summit include the following:

State of the Science Summit is a premier conference series hosted by OncLive that features medical experts from across the nation discussing treatment options. Each summit integrates academic and community-based physicians and health care professionals across key disciplines, from medical and surgical oncology to hematology.

Registration is free and open to all health care professionals, and food and beverages will be served. For more information and to register, visit https://www.onclive.com/meetings/soss or contact Kayla Collins at kcollins@onclive.com.

About OncLive

A digital platform of resources for practicing oncologists, OncLive offers oncology professionals information they can use to help provide the best patient care. OncLive is a brand of MJH Life Sciences, the largest privately held, independent, full-service medical media company in the U.S. dedicated to delivering trusted health care news across multiple channels.

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OncLive Presents State of the Science Summit on Genitourinary Cancers - Business Wire

You know how some people could eat ice cream every day, and others are satisfied with one cone a month? Your sex drive is like your appetite, according to Sheryl Kingsberg, PhD, the chief of behavioral medicine at University Hospitals Cleveland Medical Center. Some people are in the mood for sex daily, while others are happiest getting action less often. But what might it mean if your sex drive suddenly goes AWOL?

An ebb in sexual appetite is often due to a combination of biological, psychological, and social factors. Here are a few of the reasons you may be less interested in getting it on:

If deadlines, family woes, or spats with friends are weighing on your mind, chances are theyll also put the kibosh on any interest in sex. If there are too many things causing inhibition, those will outweigh your ability to process and respond to a sexual cue, explains Kingsberg.

Obvious alert: Discomfort during sex makes it very difficult to focus on any pleasure that may also be happening. But many women who experience this kind of pain think that what they feel is normal, says Irwin Goldstein, MD, the director of sexual medicine at Alvarado Hospital in San Diego, California.

Pain is never normal, but it is common: Three in four women have pain during sex at some time in their lives, according to the American College of Obstetricians and Gynecologists.

Pharmaceuticals can be a huge help for certain medical conditions, but a side effect of some can be low sexual desire. One biggie: SSRIs (selective serotonin reuptake inhibitors), which can help those living with depression but also increase serotonin, a known inhibitor of desire. About 40 percent of sexual dysfunction in people with depression can be attributed to antidepressants, according to a 2016 paper in the Mayo Clinic Proceedings.

Additionally, some birth control pills can decrease desire because they lower the production of testosterone, Dr. Goldstein explains. Although women have less of this sex hormone than men do, a drop in T can impair womens libido.

Bringing a child into the world impacts, well, everything, and that can definitely include how often youre in the mood. The changes in your hormones during pregnancy, after giving birth, and while breastfeeding may interfere with the hormones that cause sexual drive, Kingsberg explains.

Additionally, if youre breastfeeding, you may think of your bodyand your breasts in particularas maternal and not sexual. Or, you may be touched out by having constant contact with baby. Add to all of that a potential shift in body image and a lack of time, energy, and privacy, and your sex drive can go totally MIA.

Both current and past relationships can take a toll on your sex life. Previous traumas, a partners sexual dysfunction, infidelity, not feeling connected to your partner, trust issues, and more can all make it hard to want to be intimate.

HSDD is the persistent loss of sexual thoughts, feelings, fantasies, and interest in sex that causes distress, Kingsberg explains. You may have HSDD if you know what its like to want to have sex and masturbate, yet you no longer feel that way. If this feeling lasts for at least six months and it bothers you, HSDD might be to blame.

Many women just deal with the disappearance of their sex drive. In one recent survey* of 1,686 women ages 25 to 49, almost half of respondents who said they experienced symptoms of low sexual desire havent discussed them with anyone.

Plus, research shows that the majority of women with desire issues and distressing sexual problems dont mention them to a healthcare provider, often because theyre too embarrassed or uncomfortable. But, your sexual health is important to your overall health and quality of life, and treatments are available, Kingsberg says. You dont need to suffer in silence. So speak up!

Therapy, either alone or in combination with medication, can help you get your mojo back. Psychotherapy can change the dynamic between a couple living with low desire or help a woman change her perception of how and what sex means to her, Kingsberg says. It can also validate your experience, in turn helping you regain your confidence and sexuality.

A physical exam can be the first step to diagnosing conditions that may be causing the issue, such as ovarian cysts or endometriosis. Chatting with your doctor could help you figure out how to relieve pain caused by something more temporary, such as a lack of lubrication or a UTI.

Its def worth talking to to your doctor to see if an alternative treatment option might be available.

Make sure you set aside time for yourself to exercise, eat well, and relaxall things that can help with a shift in body image and low energy levels. And def make time for the occasional date night. This will help you get out of mommy-mode so you can get your sexy back.

If youre still not into the idea of having sex after a few months of taking more time for self care, see your doctor to rule out any other underlying issues.

Your doctor can diagnose you by asking a set of questions about your sex drive. If it turns out thats the cause, they may prescribe medication that raises dopamine and lowers serotonin (desire starts in the brain, not the genitals, Kingsberg explains), or a medication that activates melanocortin receptors, which increase sexual desire.

* Survey was conducted by Women's Health & Cosmopolitan, in partnership with a pharmaceutical company that sells a drug to treat hypoactive sexual desire disorder (HSDD).

See the original post here:
What It Might Mean If You're Craving Sex Less Often Than You Used To - Women's Health

Patients with life-threatening conditions have been left waiting on the phone to see a doctor at a medical practice in Wokingham.

A woman receiving post-cancer treatment and an 84-year-old man who was subsequently rushed to hospital after waiting outside Wokingham Medical Centre are among those affected by large waiting times and frustrating appointment booking systems.

Hordes of patients registered at the Wokingham Medical Centre (WMC) have contacted The Wokingham Paper this week, most of whom have found it increasingly difficult to book an appointment with a GP.

With over 164,000 people currently registered across the boroughs 13 GP practices, resources are in heavy demand.

Local resident, Jane Thomas (whose name has been changed for privacy), believes that the service provided by WMC isnt set up for patients with ongoing medical needs.

The 35-year-old had breast cancer five years ago, and has since had multiple surgeries alongside a thyroid condition.

She said: I have to have an injection every 12 weeks as part of post-cancer hormone suppression treatment. This is time critical and so has to happen as close as possible to 12 weeks.

However Wokingham Medical Practice doesnt put more than four weeks of appointments on the system at one time, so there is no way of booking my next injection at the time I am having an appointment.

Because the booking system isnt working for thse who need ongoing medical treatment. Ms Thomas sometimes has to use A&E if she cannot get a time-appropriate appointment for her post-cancer hormone suppression treatment.

Dr Helen Rutherford, GP at Wokingham Medical Centre and Medical Director for the Wokingham Division of Modality Partnership said: At Wokingham Medical Centre, patient care is our number one priority.

We appreciate that in certain instances being able to book an appointment three months in advance would be beneficial. For example, where patients need a regular appointment for a time-critical medication to be administered.

However, the reason that we reduced this to four weeks ahead was due to the significant numbers of patients not coming to their advance booked appointments.

The numbers of Did Not Attend were on average 450 appointments a month, and by having a four weekly booking process this number has been reduced to an average of 216 missed appointments a month.

Telephone wait times

Local resident Karen Knight is currently undergoing physiotherapy from a private healthcare provider, and is in need of an MRI scan, for which she requires a GP referral.

She said: I have tried unsuccessfully to get a doctors appointment for over a week, and was looking to book an appointment for up to a months time, all to no avail.

I was religiously calling each morning at 8am on the dot, and my place in the queue varied from 41st to 35th each time.

Sometimes I was holding on the line for over an hour and then before getting through, I was getting cut off on the majority of occasions.

When Mrs Knight eventually got through to reception, she was told that there were no pre-bookable appointments, even for one month in advance.

The reception staffs response to my concern and disappointment with not getting an appointment was to say that I need to call tomorrow, said Mrs Knight. Tomorrow will be no different, as I know from past experience.

The current system in place requires patients to either ring first thing, when the centre opens at 8am, or to queue outside from 7.30am to see a doctor the same day.

Ms Thomas said: No matter how minor the issue, you have to go and stand in person for half an hour before the surgery opens to have any hope of getting seen that day.

Dr Rutherford said: We have reviewed and we are changing our telephone system, so it is more responsive, and will be able to recognise a callers details. This will help speed up the call process, so patients should have less of a wait to speak to someone.

Effect on the elderly

The most common concern that patients of WMC have is the difficulty in obtaining appointments and how this is affecting the elderly.

Expressing concern for her stepfather, Sue Woodason said: My 84-year-old stepfather was very poorly last Tuesday. He phoned the Wokingham Medical Centre at 8am and was 40th in the queue.

He made the decision to get to the practice and was able to get an appointment that day so he waited in the surgery. When he finally saw a GP they immediately phoned for an ambulance to take him to A&E. He then was left sitting in the A&E waiting room for over six hours after initially being accessed, then waiting for results of a blood test.

A spokesperson from Modality Partnership said: We have introduced new ways to ensure any patient who needs a same-day appointment for an urgent need can be seen either in our acute care clinic or can receive an online consultation with a GP via our Push Doctor service, this has helped to alleviate some of the pressure.

However, WMC isnt the only surgery coming under fire for their appointment wait times.

Resident Catherine Smith who attends Brookside Practice, Earley said that she often experienced a four-week wait time to see a named GP, after having a double transplant.

Yet, she attributes the difficulties in getting a GP appointment to failings by the national Government in their provisions for the NHS.

Ms Smith said: Currently, too few GPs are trying to take on ever-increasing numbers of patients to the detriment of their own well being.

I believe the problem is caused by successive governments not training sufficient numbers of doctors nor providing suitable conditions for them to work in when qualified. This includes all hospital doctors, nurses and other health care professionals.

For Ms Smith, not being able to see a named GP had almost life-threatening consequences.

There have been occasions, within the NHS system, where a doctor has tried to give me medications that are banned for me, she said. This is why a named GP is so important.

Not every sick person is able or well enough to inform a strange doctor of all their relevant conditions. And not every doctor has the time to read every patients relevant details due to the increased pressure they are under.

Access to a named GP was also addressed by the Modality Partnership. Dr Rutherford said: The national shortage of GPs also means we have to change the way patients access appointments. This means that seeing your named GP at a time that you request is not always possible.

As a practice we actually offer 4 more appointments per 1,000 patients a week, than the nationally recommended figure of 72 appointments per 1,000 patients, and we recognise we need to respond further to the increasing demand for appointments.

We have started to introduce new alternative healthcare practitioners, who have their own particular areas of expertise. Often these practitioners are better placed to see and treat patients for certain conditions than GPs.

We want to ensure that our patients see the right clinician, the first time. Our new roles at Wokingham Medical Centre include two GP Pharmacists and two Urgent Care Practitioners who work alongside our well-established nursing team that includes two Nurse Practitioners. Two new Physicians Associates are due to start with us in November.

In addition to this, we are continuing to advertise to recruit new GPs, but sadly so far, we have been unable to fill the vacancies.

Stretched NHS

A spokesperson from The Royal Berkshire NHS Foundation Trust said: We are aware of the concerns raised by patients regarding telephone access and waits for appointments and are looking into these issues with the practice concerned.

In Wokingham as elsewhere in the country, demand for GP appointments is rising and there are challenges in recruiting and retaining doctors and practice nurses.

In response to this, practices across Wokingham Borough have been introducing changes to improve access, such as longer opening hours and new on-the-day clinics.

Practices are also working together through new Primary Care Networks (clusters of neighbouring GP surgeries which have grouped together to form a new-style healthcare network in their local neighbourhoods) to bring in new staff such as paramedics and clinical pharmacists.

The CCG is working with the new Primary Care Networks and with Wokingham Borough Council to consider what else can be done to improve access for local residents.

The lucky ones

However, not all residents of the Wokingham Borough are being hit equally by demands on their local GP.

Wargrave resident Marjie Thorn has a positive experience at her surgery.

I can call at 8am, Monday to Friday and almost always get an appointment for the same day, she said. For appointments that arent urgent, theres usually a waiting time of a week or two, depending on what its for.

Mary Perkins Crowthorne resident, said: We are lucky in Crowthorne. If youre at Ringmead Medical Practice you can use the extended hours service run by Berkshire Primary Care which operates 365 days a year.

Currently, Wargrave surgery has 7,113 registered patients. This is compared to WMC which has 22,872, Brookside, with 27,373 and Ringmead, which has 22,584 registered patients.

Dr Rutherford said: We are listening carefully to the feedback about access and availability of appointments. However, like many other GP practices up and down the country, we are struggling with an ongoing national shortage of doctors. This is unfortunately not a unique issue for Wokingham; nor a new problem in primary care, and sadly cannot be instantly resolved. Our teams are working very hard, under extreme pressure to respond to the demand for appointments.

As the population of Wokingham Borough grows year on year, a question arises as to whether the 13 GP practices are able to match the patient demand, and how this issue can be addressed on a national level.

View post:
Wokingham patients frustrated by wait times at GPs - The Wokingham Paper

A FORMER soldier transitioned to female after having gender reassignment surgery admits it was a mistake which was "making me ill".

Peter Benjamin, 60, is back living as a man, but has been unable to reverse the surgery.

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He began taking hormones from unlicensed vendors and read transgender websites, after starting cross-dressing when he was in his teens.

But after changing gender he started having panic attacks and drinking heavily and realised he wanted to be a man again.

Peter told The Sunday Times: "My anxiety levels were sky high.

"I was seeing the doctors for all sorts of problems. My drinking was going up because I couldn't cope any more with being transgender. I just had to get out of it."

Peter served in the British Army from the age of 16 to 20, but his career ended when he wore a skirt to his barracks after a heavy drinking session.

The ex-squaddie married three times, but was diagnosed with gender dysphoria after his third wife died in 2011.

A female lodger began calling him Victoria, saying: "You're a posh bird. You need a posh name."

In 2015, Peter had surgery to remove his male genitalia.

He said the NHS paid a private London hospital 10,000 to operate on him, but his doctor would not recommend him for breast augmentation surgery.

My drinking was going up because I couldn't cope any more with being transgender. I just had to get out of it

But after surgery he realised he had made a mistake after his son and daughter drove him home and he was left alone.

Peter said: "They took my suitcase upstairs and then my daughter gave me a hug and then they left. That was the only support I had. There was no follow-up psychiatry nothing."

He also said he didn't look much a like a woman and struggled to be accepted by female friends.

"I hoped to have more female friends but the opposite happened. I thought, 'Ladies who lunch, go on holiday, have friends around for coffee,' but it just didn't happen."

The ex-squaddie was also scared bigots would attack him after he transitioned.

Peter said: "It's easy, isn't it, being a man? I can just put on a pair of trousers and a top and go out. Being a woman, people ridicule it.

"People were staring. I had to watch my back."

He added: "Travelling on the train, I'd be absolutely dripping when I came up to London because I was scared I would be attacked or assaulted.

"I'm not scared where I am living, but for a simple thing like leaving for the shops, I'd be having panic attacks."

Peter said he binned seven bags of women's clothing, wigs and make up after deciding to switch back to being a man

But he hasn't updated a birth certificate issued on August 31, 2016, which said he was born a girl and is now warning that children are encouraged to transition too quickly.

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It comes after it was revealed a former psychotherapist at England's first NHS child gender clinic called for judges to stop children from having hormone-blocking treatment unless it is in their interests.

Peter added: "We're going to have mental health hospitals full, dealing with these children who have decided that they are not transgender as they grow older.

"The NHS is going to have such a big burden on it over what's happening. I am so worried."

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Read the rest here:
Ex-soldier, 60, who transitioned to female then switched back admits gender reassignment surgery was mistake - The Sun

The author aged 10, playing Hamlet in a school play.

One hundred and sixty days ago, one Friday afternoon in May, I went to my doctor.

Im transgender, I told him, and I want to be referred to a gender clinic.

His response was perfect: apologising for not knowing much about trans healthcare, he pulled up the referral form on his computer and asked if I would stay so that we could fill it in together.

When prompted by the form, I explained that I identify as non-binary, and he said hed come across the term before but didnt know much about what it meant. He ran through the form twice, checking every response with me, and then sent it off to the gender clinic in London.

The whole process took less than 10 minutes. I walked out of the GP surgery ecstatic; immediately called my sister to tell her, happy and shaky and relieved, what Id done.

And then the wait began.

As a reporter at PinkNews, I write about trans healthcare pretty often.

Sometimes its about the length of time trans people have to wait for an appointment at a gender clinic in different parts of the UK. In Devon, it currently takes three years between going to your GP for the first time, like I did, and going for your first appointment with a gender specialist.

Sometimes I write about how few gender clinics there are. There are just eight, in the whole of England and Wales, for who knows how many trans people half a million? A million? We dont know, because no one counts us.

Ive written about trans peoples joy at getting their gender legally recognised; about the gender recognition act in the UK that the government has promised to reform, again and again, but keeps delaying; about non-binary gender markers on driving licenses; and people crowdfunding for their top surgery or buying hormone treatment on the internet because the wait for the gender clinic is just too long to bear.

Mostly, the separation between myself as a journalist covering these issues and myself as someone directly affected by them is a boundary that, while fluid and permeable, I manage to maintain to some degree.

But its when trans children are pulled into the mainstream medias transphobic narrative that I think about the number of days it has been since I went to my doctor and asked to be referred to a gender clinic.

Im 29, and I can tell you without a single drop of doubt that I would be happier today had I been able to explore my gender identity, with the support of qualified professionals, as a teenager when the rest of society, cisgender society, explores theirs.

That opportunity is lost for me now, but it is not too late for trans kids. But instead of supporting them instead of campaigning for more gender clinics (there is only one gender clinic for under 18s in the entire country) and better support for them the UK media uses faux concern for trans kids to tell trans people like me, whove been where they are, that we are the powerful trans lobby seeking to do them harm. It paints the few organisations that exist to support these children and their parents as child mutilators, and says offering them counselling and peer support is child abuse.

Most of the time, when I write about these stories stories that come out predominantly in two or three UK papers, written by a handful of journalists, none of whom are trans I can remain, if not dispassionate, then at least calm. Writing from a trans-inclusive, LGBT+ perspective on trans issues the gift given to me by PinkNews is useful, I tell myself. Every time a transphobic journalist writes a column attacking trans people in a major newspaper, I can write a piece discrediting it, if I choose.

Sometimes, though, when the onslaught of outright transphobia in the UK not directed at me, necessarily, but directed at whichever trans person or organisation is the villain in the right-wing press that week feels particularly intense, I catch myself thinking about how many days its been since I was referred to the gender clinic.

I catch myself with my toes too close to the edge of the Tube platform with a train approaching, and I think about the awful statistics about how many trans people try to kill themselves, and I take a step back.

And I keep taking antidepressants, and going to therapy, and I keep waiting.

If I wasnt a journalist, I might not know that it will be at least another 19 months until I go to the gender clinic for the first time, but I do. And every time I see a gender-critical feminist talk about the powerful trans lobby, I think about this. If were so powerful, how come it takes years, literally, to get to a doctor? How come the press can openly call us predators and child molesters and freaks? How come trans children cant always get the help that they need in time?

Were there a powerful trans lobby, the first thing I would want it to do would be to put Piers Morgan on a planet very far away. And then, Id like for trans children to be unreservedly loved and affirmed. And Id like everyone waiting for an appointment at a gender clinic to get one, so that no trans person reaches the point where life becomes unbearable. Weve waited long enough.

Original post:
This World Mental Health Day, spare a thought for the trans children whose lives have become unbearable - PinkNews

Resisting over-consumption of our favorite high-calorie treats is about more than mere willpower for the severely obese.

LOS ANGELES (PRWEB) October 10, 2019

An October 1 article on Medical Xpress reports on the evermore evident fact that failed weight-loss attempts are not the result of weak willpower. Severely obese individuals who are attempting to lose weight may be extremely motivated and determined, and quite disciplined in most areas of their lives, but they are fighting against their own bodys innate biological processes. In some cases, these individuals may be able to rapidly lose significant amounts of weight, but thats when the real challenge starts. As the body recognizes that it is deviating from its normal state, complex chemical processes start to encourage overeating in a number of ways largely involving the production of hormones. The feelings of appetite these hormones stimulate are essentially indistinguishable from hunger and are extremely difficult to ignore even for the most determined individual. Worse, they only increase as more weight is lost. Southern California weight loss clinic West Medical says weight loss surgery is the one proven method of short-circuiting this metabolic catch-22.

West Medical notes that there are a number of ways to take advantage of this kind of medicine. For severely obese individuals, the clinic continues, sleeve gastrectomy surgery may be the most effective method of fighting hunger hormone production. The weight loss clinic notes that, during the surgery, the patients stomach is reconfigured into a pouch-like chamber that is reduced to about one-tenth of its original size. West Medical explains that, as the remaining portion of the stomach is removed, production centers for most hunger hormones are either removed or significantly hampered. The clinic says that by hindering this biological process, patients are much less likely to splurge their way back to obesity after they have lost significant weight although, of course, having a much smaller stomach also makes overeating far more unpleasant.

The weight loss specialists acknowledge that serious lifestyle changes must occur after any weight loss procedure for it to be a long-term success but the surgery makes them easier. Of course, as the benefits of weight loss accrue, life can become a lot more enjoyable. Moreover, the weight loss clinic notes that a wealth of studies have provided an exceptional amount of evidence stating that patients are far less likely to suffer premature death and the serious health problems that cause it. While medical science has reduced the mortality rate on many of these illnesses significantly, most of them can also greatly reduce an individuals overall quality of life. West Medical concludes that the benefits of weight loss operations such as sleeve gastrectomy surgery are more than worth the effort.

Patients who qualify for a sleeve gastrectomy typically have a body mass index (BMI) of 40 or more or 35 or more with related health problems such as type 2 diabetes. Other patients may take advantage of a growing number of alternative procedures. For more information about West Medical and all of its weight loss services visit their website at https://westmedical.com/ or call (855) 690-0565.

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Weight Loss Surgery Gives Willpower the Help it Needs to Defeat Obesity, says West Medical - PR Web

According to a new study, an additional 1.7 million Canadians will be living with obesity by 2023.

Our growing girth is already at historic levels, and were among the heaviest countries in the world. Over the past decade, rates of overweight and obesity have increased in Canada, France, Mexico, Switzerland and the U.S., according to a 2017 report by the Organization for Economic Co-operation and Development. More than one in four adults is obese in Canada. Within three years, there will be a total of 8.5 million people in a weight class considered a serious threat to health.

All of this leaves virtually no chance of meeting World Health Organization targets for a zero increase in obesity from 2010 to 2025, a global goal set to address the health impacts of weight gain (such as high blood pressure, type 2 diabetes, heart disease, stroke and certain cancers) as well as the cost to health-care systems, estimated at $5 to $7 billion in Canada alone.

The burden surprised me, says Laura Rosella, co-author of the modelling study and an associate professor in epidemiology at the University of Torontos Dalla Lana School of Public Health. I thought, optimistically, that we have actually been making progress in terms of awareness and efforts to reduce obesity.

Its going to get worse before it gets better.

Why?

Its not, as comedian Bill Maher recently put it,because people are eating like aholes.

Try to lose weight and the brain fights back, aggressively. Higher levels of the hunger hormone ghrelin are released, sending a single-minded message to the nerves in the hypothalamus: Get food. At the same time, the brain blocks satiety, or Im full, signals from the gut and slows downthe rate at which calories are burned.

This famine effect can last a year or longer as people struggle to keep the lost weight off.

It is an incredible and efficient response to weight loss, obesity specialist Dr. David Macklin says with awe.

But Mahers fat-shaming quip taps into acommon misperception: that obesity comes down to some kind of moral failing, a lack of discipline and self-control, and that the solution is as simple as finding the right diet and working out a ton, Macklin says.

In fact, it goes much deeper.

We now have great clarity that obesity is a chronic and complex, progressive, primarily genetically conferred, centred-in-the-brain, environmentally influenced, real medical condition, sums up Macklin, the medical director of a weight management program for high-risk pregnancies at Torontos Mount Sinai Hospital.

The DNA of obesity

The tendency is to blame obesity primarily on poor food choices sugary drinks, salty, greasy processed foods, staggering portion sizes.

But a growing body of research suggests that the appeal of these foods, as well as the drive to overeat, is rooted in our DNA.

Genome-wide studies have identified hundreds of genes associated with body mass index, waist-to-hip ratios and other traits of obesity, most of them expressed meaning whether theyre turned on or off in the brain.

Many of these genes evolved over millions of years to collect and store excess calories as fat whenever food was available, and to keep early humans from starving whenever food was scarce. Except as weve shifted from hunter-gatherers to farmers, then farmers to factory workers, food is no longer so scarce.

In this part of the world, for most people, we dont have famine anymore, we have only a feast, says Dr. Sue Pedersen, of the C-ENDO Diabetes and Endocrinology Clinic in Calgary.

Instead of a survival mechanism, gaining excess weight is now a liability. And as scientists are discovering, some of us are more genetically vulnerable to packing on the pounds than others, says Macklin.

Part of this is how the brain responds to the hunger hormone ghrelin. In people with a genetic predisposition to obesity, the gut also tends to release fewer quantities of the hormones tied to fullness.

Either way, If you take people who are the same weight and they have the same metabolic rate and you put everyone on (a) diet, people will lose weight unequally, based on their genetics, says Macklin.

Furthermore, some people who consume excess calories gain fat. Other people, their body responds by burning more, by increasing their metabolic rate and taking anything extra and putting it into muscle.

Even more frustrating for those less prone to burning fat, the further people get from their highest weight, Macklin says, the harder the body fights against losing it.

How strongly we respond to cues in the environment that generate the fundamental drive to eat the psychological state known as wanting and our ability to control that wanting, Macklin says, is heritable as well.

The gut microbiome

The environment inside our digestive tract may also play a critical role in weight gain.

Each of us plays host to trillions of different bacteria, which colonize our intestines immediately after birth and continue to evolve as we age based on what we eat and where we live. These bacteria impact our digestion, the production of certain vitamins and our immune system.

Theres now evidence that people living with obesity have different gut flora than those who are not. According to some scientists, it may be that mircobiota not just our genes are reducing the expression of gut satiety hormones.

Although researchers are still exploring exactly how gut bacteria interact with our intestines and the brain, the link appears clear:When mice free of intestinal bugs are fed stool from either obese mice or humans, they put on more weight and body fat than those fed bacteria from the guts of lean mice or humans.

The chemical context

Some antidepressants and newer generation anti-psychotics, drugs Canadians are being prescribed in record numbers,may be behind ourrapid and dramatic weight gaintoo.

Antipsychotics can trigger hedonic hyperphagia eating to excess for pleasure, not hunger. Two years ago, Montreal researchers reported that, after 24 months of treatment, the mean weight of children prescribed antipsychotics for ADHD and other behavioural problems increased by 12.8 kg.

One study published last year in the British Medical Journal found people taking any of the 12 most commonly used antidepressants had an increased risk of weight gain that persisted over at least five years of follow-up. Its not clear why. Depression, in and of itself, can cause weight gain. And people might eat more as their mood improves. Some believe the drugs may affect metabolism or trigger cravings for carbohydrates. But there are options, Pedersen says. Some anti-depressants are weight neutral or even induce weight loss.

The chemicals in our food particularly artificial sweeteners may also react with taste receptors or gut bacteria in ways that stimulate more food intake, Pedersen adds.

Recent studies suggest theres something about the sheer textural and sensory properties of ultra-processed foods that make us eat more of them, and more quickly. (Again, it could be that foods with hyper-palatable amounts of sugar, fat and salt are irresistible to the ancient brain.)

Obesityultimately still comes down to physics, Pedersen says. If calories in are higher than calories out, weight will go up.But managing the factors that contribute to that equation is much more complicated than simply sticking to a diet. And a lack of education means that fat-shaming and weight discrimination are as prevalent in medicine as everywhere else.

Why are obesity rates getting worse? says Macklin. When youre talking about a real disease, and youre only offering up advice like, Eat less, move more, its like saying, Listen, I see you have asthma, and its severe asthma, but just breathe deeper. Just pull yourself up by your bootstraps and I dont want to see you back here wheezing.

Not only is obesity real, but treatments exist. That should be the messaging to someone with obesity.

Read the National Posts ongoing focus on Canadas obesity epidemic at nationalpost.com/obesity.

Subscribe to our podcast, 10/3, on Apple Podcasts or Spotify

Read more from the original source:
The biology of obesity: How our ancient brain conspires to make us overeat - National Post

Photo: Anh Nguyen

To mark World Mental Health Day, HONG KONG BUZZ takes a look at depression. It is a serious matter when you see that one in three Hong Kong youngsters suffers from stress, anxiety or depression (Hong Kong Playground Association) and the suicide rate for people aged 15 to 24 is 9.5 per 100,000 (Centre for Suicide Research and Prevention). Depression can strike at any age.

On medical matters go to a reputable source. Here is the USAs Mayo Clinic on depression:

SYMPTOMS:

The illness is also called major depressive disorder or clinical depression, the Mayo Clinic says. Most people with depression will feel better with medicine or psychotherapy or both.

CAUSES

People with depression appear to have physical changes in their brains. Neuro-transmitters are naturally occurring chemicals in the brain that effect mood. Changes in the bodys hormone balance can trigger depression, such as pregnancy or after giving birth. Other causes: thyroid problems, menopause and others. People are more likely to develop depression if their relatives have suffered from it.

RISK FACTORS

Still with the Mayo Clinic they include:

PREVENTION AND TREATMENT

The clinic says you can prevent depression by controlling your life and avoiding anything that will cause you stress. Reach out to family or friends and get treatment. The safest medicine with the least side effects is a serotonin reuptake inhibitor such as Celexa or Prozac. These must be prescribed by a medical professional. Other medicines include serotonin-norepinephrine reuptake inhibitors, atypical anti-depressants, tricyclic anti-depressants and monoamine oxidase inhibitors.

HOME REMEDIES

Study the illness by reading reputable books and websites, so you will understand what is happening to you. Pay attention to warning signs such as the onset of symptoms (above). Avoid alcohol and drugs. Eat healthily and be physically active, walking, running or swimming. You may use supplements but be careful because they can interfere with medicines and dont overdose. Mayo Clinic mentions two, St Johns Wort and Omega 3 fatty acids.

Read more from the original source:
A terrible illness: Who do you know who looks melancholic, feels worthless and hopeless, and often thinks of death? - Hong Kong Buzz

Greta Thunberg, Sir Paul McCartney, Woody Harrelson, Lewis Hamilton, Pamela Anderson, RZA, Miley Cyrus, John Salley, and Cory Booker. These high-profile names have at least one thing in common: theyre thriving on the benefits of a vegan lifestlye.

Veganism is everywhere nowadays, and the people ditching animal products in favor of a vegan diet are doing so for a handful of reasons.

Those who follow a vegan diet, also called a plant-based diet, do not eat animal products. This includes meat, dairy, eggs, honey, and gelatin. But veganism expands further than diet. Per the Vegan Society, the definition is as follows: Veganism is a way of living which seeks to exclude, as far as is possible and practicable, all forms of exploitation of, and cruelty to, animals for food, clothing or any other purpose.

For instance, vegans dont wear clothing made with animal materials (like leather and wool), buy cosmetics that were tested on animals, or support entertainment that relies on the exploitation of animals, like bullfighting or SeaWorld.

Sixteen-year-old climate activist Thunberg follows a plant-based diet and even persuaded her parents to do the same. She said in an interview that those who support animal agriculture are stealing her generations future. You cannot stand up for human rights while you are living that lifestyle, she added.

Beatles frontman McCartney famously said, If slaughterhouses had glass walls, everyone would be vegetarian. Now the 77-year-old rockstar is vegan and still a vocal advocate for the lifestyle. In a short film called One Day a Week, which encourages people to eat less meat, McCartney said, [If] we all join together in this effort, we can help improve the environment, reduce the negative impacts of climate change, and even improve peoples health.

Vegan New Jersey Senator Booker who is running for president in 2021 recently announced his animal welfare plan. It would see the end of animal testing for cosmetics, snares, people keeping big cats as pets, and the sale of shark fins. Booker said, Our treatment of animals is a test of our character and a measure of the compassion of our society.

Veganism has reached the sporting world, too. Formula One champion Hamilton says his plant-based diet has helped him feel the best Ive ever felt in my life.Wesley Woodyard, linebacker for the Tennessee Titans, experienced increased energy levels after going vegan because he began putting good fuel into his body. Quarterback for the Carolina Panthers Cam Newton credits his vegan diet for his quickened recovery. Im loving how Im feeling,he said.

Other high-profile vegan names include: A$AP Rocky, will.i.am, Alan Cumming, Ne-Yo, Ruby Rose, Ted Deutch, James Cameron, Benedict Cumberbatch, Jenna Marbles, Kyrie Irving, Nathalie Emmanuel, Natalie Portman, Craig Robinson, Eric Adams, Sia, Mayim Bialik, Tia Blanco, and Kevin Smith.

An ever-growing bank of research is highlighting the health risks linked to meat, dairy, and eggs, and the benefits associated with a plant-based diet. Many experts agree that going vegan could help you live a longer life.

In 2015, the World Health Organization (WHO) named red meat a Group 2 carcinogen, meaning it probably causes cancer in humans. WHO put processed meat (like bacon and pepperoni) in the Group 1 category, meaning it is carcinogenic to humans. Tobacco smoking and asbestos are also in the Group 1 category.

Even small amounts of meat could increase the risk of cancer. An Oxford Universitystudyfrom earlier this year found that eating just three rashers of bacon a day could increase cancer risk by 20 percent.

Professor Jane Plant, a geochemist who has survived cancer six times, maintains that dairy is also a carcinogen. She believes her plant-based diet helped put her breast cancer into remission twice.

Meat typically contains high amounts of saturated and trans fats, which can increase blood cholesterol. Cholesterol can cause fatty deposits in the blood vessels which increases the risk of stroke, peripheral artery disease, and heart disease. Plant-based foods, by nature, contain no dietary cholesterol. A diet high in fat and cholesterol can raise blood pressure, too, which also makes cardiovascular diseases more likely.

A2018 studyby the Cleveland Clinic found that eating red meat could increase the risk of heart disease 1,000 percent more than a plant-based diet.

More and more research is finding that a plant-based diet could reduce the risk of developing diabetes or even reverse the disease altogether.

A recentstudy, which included than 2,000 adults, found that individuals who increased the number of fruits, vegetables, and nuts in their diet over the course of 20 years lowered their risk of developing type 2 diabetes by 60 percent more than those who didnt.

Brooklyn Borough President Adams says he reversed his diabetes diagnosis by adopting a plant-based diet. This concept is backed up by research. The American College of Lifestyle Medicine (ACLM) recommends an online program that helps diabetes sufferers adopt a plant-based diet to reverse their condition. The National Institute for Diabetes and Endocrinology in Slovakia is trialing a whole-food, plant-based program to help reverse the condition.

The Physicians Committee for Responsible Medicine (PCRM) highlights a study on its website that looks at the eating habits and moods of 3,486 people over a five-year period. The study found that participants who ate whole, plant foods reported fewer symptoms of depression.

A different study found that vegetarians typically experience more positive moods than meat-eaters. Nutritionist Geeta Sidhu-Robb spoke toCosmopolitan about the study, which was published in Nutrition Journal. The elimination of long chain fatty acids, predominantly arachidonic acid which is present in meat and is associated with symptoms of depression, means you are less at risk of suffering from it,she said.Vegan diets also have more complex carbohydrates present which increase the feel good hormone serotonin in the brain.

Products that are made with plant-based ingredients but also processes that dont involve animals are considered vegan. Beeswax, honey, lanolin, collagen, and keratin are some common non-vegan ingredients to look out for.

Most people are against experiments on animals. A survey by Naturewatch Foundation found that 99.5 percent of Brits support a ban on cosmetic animal testing. While most are against the practice due to the stance that it is cruel to animals, animal testing is also unreliable.

Many experts agree that tests on animals cannot accurately predict human response to a product. More than 95 percent of pharmaceutical drugs test as safe and effective on animals but then fail in human trials, according to PETA.

Yet the practice is still common in the beauty industry. Since veganism does not allow for the exploitation of animals, buying vegan beauty products guarantees that youre not supporting animal testing.

Up to 60 percent of the products we apply to our bodies are absorbed by the skin and end up in the bloodstream. Many cosmetics brands use phthalates and parabens in their recipes. These ingredients can interfere with development and reproduction, and cause neurological issues. The nervous and immune systems can also be affected.

While not all vegan beauty brands use natural ingredients, a growing number of them do. Companies like Zuii Organic use real flowers, essential oils, and plant extracts to make their vegan cosmetic products.

As well as sidestepping the health risks linked to chemical ingredients, natural ingredients can provide health benefits. Oats have anti-inflammatory properties and can treat skin irritations like eczema. Witch hazel hydrates the skin, and green tea contains high levels of antioxidants, which can help repair sun damage.

A plant-based diet could boost your beauty regime by helping your skin stay healthy. An increasing number of studies are linking dairy to skin problems like acne. Dairy products contain growth hormones and are also treated with artificial hormones, which can interfere with the human bodys hormone system. Some experts also believe that dairy can disrupt insulin levels, making acne more likely.

Many celebrities credit veganism for their youthful looks. American singer-songwriter Ma says that her vegan lifestyle is to thank for her fountain of youth. Fifty-eight-year-old actor Woody Harrelson said his plant-based diet is crucial for his youthful appearance, and 77-year-old rock n roll legend Paul McCartney not only looks younger than he is but completes his solo world tours which see him playing more than 30 songs per show over the span of two and a half hours on a vegan diet.

Following a vegan lifestyle means not buying items featuring leather, suede, wool, or silk. But dont be fooled, the vegan fashion industry is bursting at the seams with innovation and style.

Wearing vegan fashion means you wont be supporting the leather industry. Besides the animal welfare issues linked to the livestock trade, raising animals for leather (and food) leaves a large mark on the planet. Raising livestock accounts for 14.5 percent of all human-caused greenhouse gas emissions. The United Nations Environment Programme (UNEP) said in September 2018 that the greenhouse gas footprint of animal agriculture rivals that of every car, truck, bus, ship, airplane, and rocket ship combined.

Leather is treated with 250 different substances including cyanide, arsenic, chromium, and formaldehyde. These substances pollute waterways and raise the risk of disease for workers and local communities.

Vegan leather is just as durable and stylish as its animal-based counterpart. It can be made from

Its easy to believe that wool can be collected without harming the animal. However, exposs reveal that animal cruelty is rampant in the woold sector. Shearers are paid by the volume of wool collected, not by the hour. This often encourages the aggressive handling of sheep. The animals are beaten and when injured, their wounds are sewn up without pain relief. To prevent flystrike, workers will mule sheep cut off pieces of the sheeps hindquarter skin. This often has the opposite of the desired effect since flies are attracted to the open wound.

Vegan alternatives to wool include hemp, linen, and organic cotton. Bamboo, seaweed, and wood are also used to make cruelty-free clothing.

Many vegan fashion brands prioritize sustainability in their designs. Footwear brand No Saints uses food waste to make its vegan leather sneakers. The companys pineapple leather, called Piatex, is made from pineapple leaf fibers, which are a by-product of pineapple harvests and would otherwise go to waste. Using these fibers offers extra income to farming communities and saves the waste from being incinerated, which creates toxic emissions. No Saints also uses apple peels thrown out by the juicing industry to make apple leather shoes.

German footwear brand thies and Brazilian brand Insecta make vegan fashion items out of plastic waste. Adidas teamed up with Parley for the Oceans to produce a vegan shoe with plastic pulled from the ocean. Each shoe contains 12 plastic bottles worth of waste, with some of this coming from discarded fishing nets.

Animal agriculture is one of the major generators of greenhouse gas emissions, which worsens climate change. UNEP hasnamed meatthe worlds most urgent problem, saying that, Our use of animals as a food-production technology has brought us to the verge of catastrophe.

Producing half a pound of beef generates the same amount of emissions as driving a car 9.8 miles. Producing half a pound of potatoes is only equal to driving a car 0.17 miles.

A 2016 report found that if the world went vegan, the planets food-related emissions would drop by 70 percent by 2050.

Animal-based diets are extremely water-intensive. According to UNEP, a bacon cheeseburger requires more than 3,000 liters of water to produce. In contrast, a vegan meat burger requires 75 to 95 percent less water.

Major meat publication Global Meat News admitted to animal agricultures impact on the planet last year. It stated that 92 percent of the planets water footprint is linked to agriculture, with livestock making up one-third of the figure. On a per gram of protein basis, beefs water footprint is six times that of pulses,Global Meat News wrote.

According to Water Calculator, someone following a vegan diet has half the total water footprint as a meat-eater.

Raising animals for food requires vast amounts of land and deforestation. The beef industry was blamed for the current Amazon fires since farmers intentionally burn down sections of the rainforest to make room for herds.

Oxford University researchers completed the most comprehensive analysis of farmings impact on the planet earlier this year. They looked at data from approximately 40,000 farms in 119 countries and found that beef production requires 36 times more land than plant-based protein like peas.

The researchers stated that if everyone were to go vegan, global farmland use would drop by 75 percent, freeing up landmass the size of Australia, China, the EU, and the U.S. combined.

A 2018 report published in the journalCurrent Biologydiscovered that 87 percent of the worlds oceans are dying.

Many people are doing their part to save the seas ditching plastic straws, bringing their own shopping bag to the supermarket, and choosing plastic-free produce. However, your diet could have more to do with the ocean; half of the plastic found in the ocean comes from fishing nets.

Overfishing is also impacting the oceans fish stocks. Some experts agree that the worlds oceans could be empty of fish by 2048. Even land-raised meat can harm the oceans. The pesticides, herbicides, and fertilizers used on feed crops enter and pollute waterways. Factory farm runoff and livestock grazing is also a major contributor to river and lake pollution. According to Cowspiracy, animal agriculture creates 70 to 90 percent of freshwater pollution in western countries.

Often forgotten about but ever-important is honey. Following a vegan lifestyle means going without this ingredient, and this could have an impact on bee populations. Bees are widely considered to be the most important species on the planet. Approximately 250,000 species of flowering plants rely on bees for pollination. Without bees, fruit and vegetable stocks would deplete.

It takes more than 550 bees to gather 1 pound of honey from roughly 2 million flowers, according to the Apex Bee Company. Bees will fly 55,000 miles to make a gallon of honey. The average bee will make only 1/12 of a teaspoon of honey in its life, and bees rely on this as their primary food source.

Thankfully for honey-lovers, there are plenty of vegan alternatives out there. Bee Free Honee makes ethical honey out of organic apples.Dvash Organics is the producer of what it claims is the worlds first sweet potato honey. You can also use maple syrup or agave nectar.

Not sure where (or when) to start? How about Monday? Ditching meat for one day a week can help make the transition seem a little less intimidating. It allows you to try new foods and reduce your impact on the planet. The more Mondays you have meatless, the easier it may be to add more days each week.

Its 2019, so the media we consume has a large impact on the choices we make. Documentaries are some of the most popular mechanisms for motivating people to go vegan. It took just 15 minutes of Dominion to convince a caf owner in Idaho to turn her business vegan. Called the scariest movie ever made, the 2018 film features hidden camera footage and uncovers the dark side of animal agriculture.

Kip Andersens What the Health looks at the link between diet and disease, and his 2014 documentary Cowspiracy unravels the environmental issues tied to animal agriculture.

Theres a vegan-focused documentary to suit everyone. You can check out a list of them here.

Not a film buff? A thought-provoking book could be your ticket. How Not To Die by Michael Greger considers food medicine. The New York Times bestseller studies how diet can cause or prevent disease.

The China Study by T. Colin Campbell and Thomas M. Campbell II also highlights the health benefits of healthy, plant-based eating. Jonathon Safran Foers Eating Animals looks at what it means to eat animals in a modern, industrialized world.

The Sexual Politics of Meat by Carol J. Adams explores the role of feminism within the meaty, dairy, and egg industries. Gristle: From Factory Farms to Food Safety (Thinking Twice About the Meat We Eat) by Moby and Miyun Park opens a conversation about how our food choices impact the world around us, including animals, workers, public health, and the planet.

Theres no need to go hungry on a plant-based diet. For every food you loved as a non-vegan, you can make or buy an animal-free version. Get your hands on some plant-powered cookbooks, like So Vegan in 5 by Roxy Pope and Ben Pook. This book has more than 100 cheap and simple recipes, including jerk tofu burgers.

But I Could Never Go Vegan! by Kristy Turner smashes the stereotype that vegan food is bland and boring. Cathy Fishers Straight Up Food is bursting with plant-based and gluten-free recipes, made with whole, unprocessed ingredients.

You could also invest in a meal planner. LIVEKINDLYs vegan meal planner offers nutrition tips, chef-inspired recipes, guidance from expert food coaches, smart grocery lists, and grocery delivery in select areas, so all youll have to focus on is enjoying great-tasting food.

Surrounding yourself with supportive, likeminded people is a great way to keep motivated during your vegan journey. Jump online and join some local vegan Facebook groups, which are perfect for recipes, tips on vegan living, and sharing memes.

Subscribing to a plant-based publication is a great way to stay in the loop and hear about the latest vegan news. It could also offer you daily reminders on why going vegan is important to you and how your choices can have a ripple effect, helping the planet and those inhabit it.

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15 Vegan Lifestyle Benefits That Will Make You Never Look Back

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What is a vegan lifestlye? We take an in-depth look at celebrities who follow the diet, the benefits of going plant-based, and some tips to get you started.

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Jemima Webber

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LIVEKINDLY

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Originally posted here:
15 Vegan Lifestyle Benefits That Will Make You Never Look Back - LIVEKINDLY

ALTAMONT The door to Keegan Prue and Olivia Cohen-Prues nursery, on the second floor of their Altamont home next to their master bedroom, is open.

It was closed for a while last year, after their first effort at in vitro fertilization ended in miscarriage right around Thanksgiving, about eight weeks into Cohen-Prues pregnancy.

A lot of people just close that door, and have it be like a symbol of the sadness, said Cohen-Prues husband, Keegan Prue, 32, who works for the State University of New York Charter Schools Institute.

After our first miscarriage, we had closed the door. It had become that sad door, he said.

Right before they tried IVF a second time, earlier this year, the couple made a conscious decision to change the energy, to open the door and move forward.

Your parents came and painted the walls, Olivia Cohen-Prue, 34, a paralegal, reminds her husband. We began to get furniture and to finish the room, little by little. The babys room is now about 75 percent complete, she said.

The door was also closed for about a day, Cohen-Prue said, after she miscarried for the second time, this time at 12 weeks, in the beginning of May.

The couple is now preparing for their third round of IVF.

The nursery walls are painted a pale blue and decorated with framed illustrations from a childrens book, a map of the United States, and a vintage railway travel poster featuring a bold illustration of a train. In the center of the room is an oval Scandinavian convertible crib they found secondhand that they explained is meant to grow with the child, going from crib to toddler bed and beyond.

The nursery is almost ready now for the child they are sure will come someday, one way or another.

If this third IVF cycle doesnt work, they have decided to stop trying for their own biological child and focus on adopting. They have already spoken to private agencies, where they would apply to adopt a baby; they are sure they would also be happy to become parents that way.

Either way, said Prue, even if the third cycle should work, they might still like to bring a second or third child into their family through adoption.

Having a crib and a carseat are requirements for adoptive parents hoping to get the call about an available baby, Cohen-Prue said.

What we recommend to people, Prue said, is to research what the choices are and figure out whats right for them. Some people say, If I cant have my own child, I dont want to do it, and then thats the right choice for them.

Along with the open door, the couple explained, they also decided to be open about telling people about their struggles. They had learned that about one in eight couples deal with infertility. Maybe hearing about the difficulties they had had would make someone else feel less alone, they decided. He wrote a letter to the Enterprise editor, published this week.

Its such a common experience, but people dont talk about it enough, said Prue.

He and Cohen-Prue also want people to know about a change that will come when the New York State budget enacted this year goes into effect on Jan. 1, 2020. From that time, Large Group insurance plans serving companies with 100 or more employees will be required to cover up to three cycles of IVF.

In addition, insurers in all commercial markets will be required to cover medically necessary fertility preservation medical treatments for people facing infertility caused by a medical intervention such as radiation, medication, or surgery. Presumably, this could cover banking sperm or freezing eggs.

Not everyone will be helped by this new requirement, said Prue. People who will not be helped include those at smaller companies and those at companies with more than 1,000 employees, as well as gay male couples. Gay male couples wont be helped because surrogacy remains illegal in New York State. Prue called the change in the law not perfect, but a step forward.

He and his wife both have good health insurance, Prue said, adding, I give both our workplaces a lot of credit for being so supportive and saying, Whatever you need, in terms of time off for doctors appointments and things.

The couple have friends whose insurance does not cover fertility treatments, who have paid $30,000 or $40,000 out of pocket for multiple IVF cycles, Prue said, and there are many people without insurance for whom IVF would not be an option, because of the cost.

The new law gives people one more option for trying to fulfill this most basic function, he said, and he and his wife want to raise awareness so more people know there is hope out there.

He has heard people undergoing fertility treatment compare it to The Hunger Games, Prue said with a knowing laugh, because there are so many steps at which the weakest eggs and embryos can be winnowed away.

The couple started seeing a fertility doctor after about a year of trying on their own. I was 31 when we got married. I wasnt old, but I knew time wasnt on our side, said Cohen-Prue.

After doing testing, the doctor told them that Cohen-Prues egg reserve was low. The doctor explained, she recalled, that if a woman has a lower egg reserve, the eggs are also not good quality.

When I first found out, she said, Your eggs arent what they should be for your age, its like a knife in your gut.

When she says that, her husband quietly reaches out a hand to touch hers.

Unlike men, who continue to produce sperm throughout their lives, a woman is born with all the egg-containing follicles in her ovaries that she will ever have. According to the American Society for Reproductive Medicine, at birth a female has about a million follicles. By the time she reaches puberty, that number will have dropped to about 300,000. Of the follicles remaining at puberty, only about 300 will be ovulated during the reproductive years, with most deteriorating and being reabsorbed by the body and effectively lost. As the number of eggs diminishes, so does the average quality.

A womans best reproductive years are in her 20s. Fertility gradually declines in the 30s, particularly after age 35, according to the society. As a woman gets older, more and more of her eggs have either too few or too many chromosomes.

That means that, if fertilization occurs, the embryo also will have too many or too few chromosomes. Most people are familiar with Down syndrome, a condition that results when the embryo has an extra chromosome 21. Most embryos with too many or too few chromosomes do not result in pregnancy at all or result in miscarriage. This helps explain the lower chance of pregnancy and higher chance of miscarriage in older women.

A complete IVF cycle starts with hyperstimulation of the womans ovaries, so that she will produce a large number of eggs; this stage can be skipped, as the couple did in their second cycle, if there are frozen embryos left over from an earlier cycle.

The womans uterus is prepared for weeks by giving her estrogen to create a lining that is as thick as possible, to increase the chances that an embryo will implant there and grow. In addition, in the days leading up to the transfer, she takes shots of the hormone progesterone, meant to protect and maintain pregnancy.

Throughout this process, Cohen-Prue said, youre kind of an emotional basket case, full of anticipation, drugs known for their ability to produce rapid mood swings, and, leading up to the egg retrieval, eggs.

You actually have a bunch of eggs, you look pregnant, and feel awful, she said.

Egg retrieval following hyperstimulation might yield anywhere from about 2 to 40 eggs, Prue explained. This is followed by a process of combining the mature eggs with sperm and waiting to see if they fertilize and begin to develop.

The healthiest-looking embryo is then selected for transfer with a catheter through the womans cervix, into her uterus, in hopes that it will implant there. It is possible, the couple said, to do genetic testing of the embryos to discover which might have chromosomal abnormalities likely to produce miscarriage, but they did not do that testing before their earlier tries.

Cohen-Prue spent the days before and after last Thanksgiving in painful and unproductive contractions after being prescribed misoprostol. She was to take the drug to induce a miscarriage, since there was no heartbeat; her pregnancy was over at eight weeks. Because of the holiday, the clinic was unable to schedule a dilation-and-curettage surgery to scrape the uterus until about a week later, she said.

She wasnt burned by it, she said, adding, I was like, Lets get back on it. The silver lining was, the doctors were like, Well, we know you can get pregnant.

The couple started again with estrogen in January and did another transfer at the end of February, using an embryo they had frozen from the first round. At the nine-week ultrasound they saw a little embryo moving around, Prue recalled. We saw the arms, Cohen-Prue said, raising her hands near her face and waving her fingers.

At that point, their close friends and family knew. We were more cautiously optimistic than the first time, Prue said.

If all went well at the 12-week ultrasound, they planned to announce it more generally.

Twelve weeks is such a marker, said Prue.

Almost right away, Prue said, the ultrasound technician had been saying, I dont see a heartbeat; I dont see blood flow.

The baby had died the week before, Cohen-Prue said.

That was the worst day, she continued. You go from going to the doctor in the morning, to your world falling apart. She got an appointment for a dilation-and-curettage that same night, and, while waiting for it, told her husband, We have to talk to an adoption agency. I cant go through this again.

Fetal testing after Olivia Cohen-Prues second miscarriage showed Down syndrome. Her fertility doctor said that the presence of a chromosomal abnormality was a relief, since it would provide a potential reason for the miscarriage, and chromosomal testing of an embryo could be done next time, prior to transfer, to lessen the chance of a miscarriage.

We had a concrete reason this happened, Prue said.

They have had their embryos tested now, and have two chromosomally normal ones. One is from their recent egg retrieval, done in August, and the other the last remaining embryo from their earlier efforts.

The couple did look into private adoption and met with some really helpful adoptive parents from Adoptive Families of the Capital Region, Prue said, but decided after a three-month break to try IVF once more.

Weve heard of people whove done 10 rounds of IVF, 14 rounds, he said.

His wife added, You have to know your own limits, I think.

At about the end of October, they will transfer the more recent embryo, Prue said, because freezing embryos twice is thought to decrease the chance of implantation a tiny bit.

What are they doing, meanwhile, to keep calm?

Were no longer having conversations around, What if we dont have children? What if we dont become parents? said Prue. They take walks in the evening around Altamont, see close friends and go on little trips, and cook and bake their favorite foods.

Theyll find out by mid-November if they are at the beginning of a pregnancy.

If it doesnt work this time, they plan to start doing the paperwork for adoption by the end of the year.

See the original post here:
Keeping the door open to welcome a baby - The Altamont Enterprise

Feeling tapped out. Foggy. Just not all that into sex. Gotta be your testosterone, ads would have you believe. And were believing it, too, with the number of T-supplement users tripling from the early 2000s through 2016.

Dont get us wrong: Testosterone is one critical hormone. Babies first encounter it in utero, when it triggers the differentiation of boys from girls. In puberty, it contributes to your bone growth and muscle mass, and continues to affect functions including your red-blood-cell production and mood stability.

But the message those ads are sending plays right into the economic and social anxieties men are facing. Its like when anti-anxiety meds such as Valium first came onto the scene, says urologist and MH advisor Elizabeth Kavaler, M.D. All these middle-aged women were addicted to Valium, because that was the solution to everything. Testosterone has become the new answer for a life of quiet desperation. More and more of us are feeling the exhaustion of uneasiness. We are being asked to do more with less. Were just trying to get through the day alive. Men think, Well, if I just get a little testosterone, Im going to feel great! Dr. Kavaler says. And thats not the case.

Theres so much information out there about Tmuch of it speculation and lorethat leads us to jump to conclusions about it. Men put all kinds of psychological weight on their testosterone numbera low one makes you think youre somehow less manly; a high one means youre basically LeBron Jamesand thats where we get things wrong. Theres little evidence for those stereotypes. Low doesnt automatically imply youre weak or retiring; high doesnt guarantee you muscles, aggressiveness, or MVP athletic performance.

A low number might not even be a low number for very long. It might just indicate that you havent been treating yourself very well. As long as your T is in the normal range, theres nothing about a high number thats better than a low one, or vice versa.

In the name of science and good journalism, I got my testosterone tested twice while writing this story. It put my assumptions up against a pretty big test, too (more on that later).

What do you really know about this famous hormone? Here, we break down the best and latest information to give you the clearest picture yet of what T means for you. And whether, maybe, you should be taking testosterone after all.

As many as 5 million men in the U.S. (generally older men) do actually have low levels of the hormone. To know if your testosterone is low, first see if you have any symptoms, which include: erectile problems, lack of energy (never feeling rested, no matter what you do; having a paunch; an AWOL libido (not just not wanting to have sex on a Thursday night after a crushing week, but lack of the kind of base-level sex drive wherein you get turned on by the sexy person you spot on the street, explains Tobias Kohler, M.D., of the Mayo Clinic).

With testosterone, as with life, normal is nuanced. And fraught (but shouldnt be). To get an accurate reading, you should have at least two tests, since testosterone is constantly in flux. It peaks in the morning, so if youre young and on a typical sleeping schedule, aim to be tested by 10:00 a.m. If youre over 50, it doesnt matter as much.

Be aware that your level can be affected by certain social factors and health habits. In the new book Testosterone: An Unauthorized Biography, scientists Rebecca M. Jordan-Young and Katrina Karkazis point out that T levels even respond to social factors like feedback. For instance, rugby players who watched video of good game plays and got positive feedback had up to a 50 percent increase in T compared with guys who were shown their mistakes and received critical assessments.

Resistance training can also give you a short-term boost in testosterone. Cardio doesnt elevate T levels as much in normal-weight men, says Jesse Mills, M.D., the director of the Mens Clinic at UCLA. But heres the thing: Jordan-Young and Karkazis dug through the research to find that T levels alone dont deserve the credit when it comes to an athletes performance. And cutting sleep short and taking multivitamins with biotin can push testosterone levels down (skip the vitamins for three days before testing).

So get your tests on days that are typical for you. And when you get your number, dont read too much into it. A T level of 264 to 916 nanograms per deciliter of blood is generally considered normal. If you are close to 264 and you feel fine, then youre no less healthy than a guy whose level is 700 and also feels fine. (Theres an exception to that, though: If your T level is below 300 and you have low-T symptoms, then docs would consider you in a low-T category)

Not reading into it is harder than it sounds. I got my first test at the tail end of a busy week. Id slept less than five hours the night before, then scrambled to the phlebotomist in a daze. My number: 287. Thats in the normal range, but just barely. I have no symptoms of low T, but it was hard to shake the feeling that there was something wrong with me, even though I know that normal is normal, no matter where it is in that range. Eleven days later, I was tested again. My number was 429. Why such a dramatic change? It might be because Id slept better and cut out my multivitamins.

Irrational or not, I felt like more of a man. The whole experience was a microcosm of our relationship with T. We act like its destiny, but its just biologyeasily misunderstood and more varied than we think.

The single best thing you can do to improve your level is be healthier. Avoid stress, get more sleep, and lose weightan enzyme in fat tissue converts testosterone to estrogen. Thats one reason flab can lower your T. Its also why overweight guys can develop man boobs, and why bodybuilders who juice can also develop man boobsthey dont have much fat, but theyve jacked their T levels so high that theres a lot of it available to be turned into estrogen. Thinking of T strictly as the male sex hormone oversimplifies the complex hormonal interactions that make our bodies work. Which is also why, if you can avoid it, you dont want to go with the needle-in-the-butt routine to raise your T.

But that might not work. If your level is low enough to warrant more aggressive treatment, your doctor can prescribe a drug that causes your pituitary to tell your gonads to make more testosterone. The typical choice is clomiphene citrate (Clomid), a common fertility drug for women. Using it doesnt exempt you from needing to get healthy, though, as it doesnt diminish the risk of losing T to bad sleep and a beer belly.

Then theres always testosterone-replacement therapy, which should be your last resort. (When you give your body T, it stops making its own, and theres no guarantee it can start again.) If, though, you and your doctor decide its the way to go, youve got options. You can try a testosterone replacement gel, a topical thats easy to use but can rub off on your partner or kids. There are pills, which are even easier to use than the gel and can deliver higher levels. Theres subcutaneous pellets, or rice-sized inserts that live directly under your skin. And then theres that needle in the butt, which can provide a major boost but is generally only used by docs who specialize in testosterone therapies.

Whatever you choose, be glad that weve moved past the early days of replacement therapies, like one in the 1920s that involved transplanting goat testicles into patients. Believe it or not, it didnt work, and it also didnt make anyone feel like more of a man.

Read the original here:
The Truth About Low Testosterone Levels, According to Experts - menshealth.com

BURLINGTON At the Womens Health and Cancer Conference, one workshop gave a behind-the-scenes look at breast cancer diagnosis, treatment, and care from the perspectives of the different doctors involved on a breast cancer team.

The speakers at the Oct. 4 workshop included a breast surgeon, a radiation oncologist, a medical oncologist, a radiologist, and a pathologist. The team walked through the timeline of a patient with breast cancer, how they diagnosed the cancer, and what their roles as doctors were through treatment.

Diagnosis

Radiologist Erin Tsai spoke about her primary role in diagnosing breast cancer through images. As a radiologist, Tsai interacts frequently with patients to conduct screenings, mammograms, MRIs, and ultrasounds. The patient that the team discussed was diagnosed through screening, meaning that during the patients annual mammograms, the radiologist detected an abnormality. The patients masses were visible via imaging, but Tsai also emphasized how comparing yearly exam results was important in judging its irregularity.

Since she detected a mass, Tsai said the next step was to go immediately to ultrasound which would give a better picture of the inside of the breast. She also noted that ultrasounds are cheaper and more comfortable for the patient. Affirming that the mass was highly suspicious, Tsai said that the next step was to perform a biopsy and send samples of the mass to the pathologist to study and diagnose.

A big key, she said, was how the mass did not appear to respect tissue plains of the breast. This characteristic, among others, implied that the mass was highly suspicious.

Uyen Phyong Vietje, a pathologist, emphasized this point as well. She described her job as intimately familiar with tissues, as her work on the team is to study tissue samples and diagnose the cancer. Vietje noted how, in a magnified image of the sample, the cells stuck together but did not form any architecture. They clearly had no respect for surrounding tissue, she said, indicating that this sort of haphazard array of cellsstructureless with no awareness of surrounding tissuewas evidence of an invasive malignant cancer.

Vietje also noted that the patient was Estrogen receptor (ER) and Progesterone receptor (PR) positive. ER and PR are two types of breast cancer that are fueled by hormones, estrogen and progesterone. Knowing the type of breast cancer can help in shaping what treatment looks like.

What are the different types of breast cancer?

According to the Mayo Clinic, there are four main groups used to categorize breast cancer, including: luminal A, luminal B, HER2 positive, and triple-negative. Luminal A, the first group, includes tumors that are ER and PR positive, but negative for HER2. This means that the tumor is fueled by estrogen and progesterone hormones in the body and can often be treated with chemotherapy and hormone therapy.

Luminal B includes tumors that are ER positive, PR negative, and HER2 positive. HER2 positive means that the cancer cells have an excess of a certain growth factor protein--HER2 for short. Luminal B treatment often includes chemotherapy, hormone therapy, and treatment targeted directly at HER2.

HER2 positive is negative for ER and PR hormones. According to Mayo, this strain of breast cancer is often more aggressive than other types, however prognosis is actually quite good. Treatment often includes chemotherapy and treatment targeted directly at HER2.

Triple-negative breast cancer is negative for ER, PR, and HER2. This type of breast cancer is one of the most difficult to treat, since typical treatments like hormone therapy or drugs that target the first three groups are ineffective. In this case, chemotherapy is frequently used. According to John Hopkins Medicine, triple-negative occurs in 10 to 20 percent of diagnosed breast cancers and is more likely to spread and recur than other forms of breast cancer.

Treatment

As a breast surgeon, Mary Stanley is often the first person to participate in treatment. According to her, surgery is often the first step when tumors are small and there is uncertainty about whether chemotherapy is required. Stanley stated that often, if a tumor is large, the team plans to do chemo first to shrink the tumor and then proceed with surgery.

In the case of this patient, Stanley performed a lumpectomy to remove only the mass. Another surgical option is mastectomy, which removes the whole breast including the mass. According to Stanley, the choice between a lumpectomy and mastectomy are personal to each patient, and the difference in survival is often similar, although lumpectomies can leave the door open for cancer to recur.

Once the lumpectomy was conducted, Stanley sent the tissue to Vietje in pathology again where she measured the tumor size and scored it on a scale. This information helps oncologists in determining post-surgical treatment.

After surgery often comes chemotherapy and radiation.

Medical oncologist Hibba Rehman participates in chemotherapy and hormone treatment. Decades ago, everyone would get chemotherapy because we didnt know how tumors would behave, she said. Now we have a test to determine how tumors will behave. Certain markers tell us whether tumor cells will develop more rapidly.

Patients with ER and PR positive breast cancer are considered low-risk and often receive hormone treatment. Patients with a higher risk type of breast cancer, like HER2 positive or triple negative, often need chemotherapy. According to Rehman, the patient had a high risk of recurrence, not only in the breast, but anywhere else in the body. [There was] a small risk of tumor cells breaking off and going into blood circulation. That is why systemic treatment is so important, why chemo is so important, she said.

As a radiation oncologist, Ruth Heimann also works with patients to advise whether someone is a candidate for radiation. In the case of a lumpectomy, Heimann examines the margins of the cancer and Vietjes measurements of the tumor to decide whether radiation is necessary.

Margins are exceedingly important because they decrease the chance of cancer returning in the breast, she said. Now we know that radiation can take care of the surrounding possible disease in the breast without performing a mastectomy. If the patient is young, Heimann said that radiation often takes about six weeks, followed by chemotherapy. Older patients often have a slightly shorter radiation, about four and a half weeks.

Its like a job, she saidpatients receive radiation daily, five days a week. Without radiation, patients who have lumpectomies have a higher chance of recurrence. According to Heimann, with radiation treatment, there is less than a five percent chance of recurrence.

Ultimately, the patient underwent a lumpectomy, four cycles of chemotherapy, hormonal treatment, and finally radiation.

Continued here:
Breast cancer diagnosis and treatment | News | samessenger.com - St. Albans Messenger

This transcript has been edited for clarity.

Thomas Allison, PhD: Greetings! I'm Tom Allison, cardiovascular specialist at Mayo Clinic. During today's roundtable, we'll be discussing lipoprotein(a). I'm joined by my colleague, Dr Steve Kopecky, who specializes in this area. Steve, what is lipoprotein(a) and why do we have it? What role does it play?

Stephen L. Kopecky, MD: Lipoprotein(a) is a combination of a couple of standard molecules that we all know about. One is an LDL cholesterol-type molecule or low-density lipoprotein. The second is an apolipoprotein(a) which is bound to the LDL-like molecule at the ApoB receptor with a disulfide bond. Now, what does that mean? Lp(a) is a cholesterol-type molecule, basically.

Allison: I understand that there are different sizes of these Lp(a)s.

Kopecky: Yes, there are different sizes because the apolipoprotein portion can have different kringles. Some are very big, some are very small. The smaller ones seem to be more atherogenic or cause more problems.

Allison: Like the small dense LDL.

Kopecky: Like the small dense LDL. One question that comes up is, why do we even have this molecule? It seems to promote clotting, which may not be a good thing, although years ago if you had trauma, it may have helped with wound healing or clotting. It may have helped prevent excessive bleeding in childbirth, so there may be a reason why we have it in our bloodstream.

Allison: What evidence do we have that this causes heart disease or contributes to our risk for heart disease? And I presume that we're talking about coronary artery disease, right?

Kopecky: Ischemic stroke also could be involved.

First, what is it about this molecule that may be causing problems? The LDL particle can actually promote atherosclerosis. We also know that the apolipoprotein particle is similar to plasminogen, so it can promote clotting. It inhibits fibrinolysis. And the third factor is that it is an inflammatory molecule.

So it does three things: causes atherosclerosis, causes the plaque rupture with inflammation, and then causes clotting at the site of plaque rupture. Large observational studies, such as the INTERHEART study, which involved many nations, show that individuals with elevated lipoprotein(a) have an increased risk for myocardial infarction (MI).[1]Mendelian randomization studies in large numbers of patients/subjects suggest that if you have an elevated lipoprotein(a), you also have an increased risk for MI and stroke.[2]

Allison: Am I correct that some recent trials have shown that the on-treatment level of Lp(a) in a clinical trial actually correlates with the event risk?

Kopecky: Yes. If you look at LDL cholesterol trials where they gave statins to control LDL, the best predictor at that point of recurrent events was actually the lipoprotein(a) level, not the LDL level.[3,4]

Allison: What is the cut point? At what level do we see the increased risk? I know there's some controversy about what the cut point is.

Kopecky: Yes, because a lot of it's observational, and [approximately] 80% of individuals globally have normal levels of less than 50 mg/dL. In the US, we have an average of about 20 mg/dL. If you look at certain ethnic groups, Asians and Caucasians are very similar; African Americans and Arabs also have higher levels, maybe two or three times higher. The question is, how much of that goes into risk? And that's not quite clear. Is an African American's risk higher because they have a higher Lp(a)? That has not been worked out.

Allison: So 50 mg/dLis that the number?

Kopecky: In general, the average number is 20 mg/dL. Over 50 mg/dL, we start to call it increased risk; that's what most guidelines have said. If you're using nmol/L, 100 or 125 is elevated risk.

Allison: In the prevention clinic at Mayo, do you measure Lp(a) on everybody, or are there specific groups for whom you think it's more important?

Kopecky: People have said that we should measure it in everybody. I don't think we're quite there, mainly because we don't have a treatment yet. But also because the people who may benefit the most are the ones who come in with early atherosclerosis or they have a family history, and they say, "My older brother just had a heart attack at age 48." That may be a good time to check it.

Patients who have recurrent atherosclerotic events in spite of optimal treatmenta case has been made to check those patients. And then there are patients who have FH, familial hypercholesterolemia. About 1 in 5 people (or 1 in 3) with FH have elevated lipoprotein(a). It increases risk, so we check.

The last group is aortic stenosis; bicuspid aortic valve is probably the prototype of that. There's evidence that individuals with elevated lipoprotein(a) and bicuspid aortic valve have more rapid progression of aortic stenosis.

Allison: That's new, right?

Kopecky: That's fairly new. We're starting to think of that when we look at patients with the bicuspid aortic valve.

Allison: So now you have lipoprotein(a) and it's over 50. What do you do?

Kopecky: First off, you make sure that when we're talking about over 50, we're talking about over 50 mg/dL versus like 125 nmol/L. The reason why that's important to differentiate is because the mg/dL is the mass concentration whereas nmol/L is the particle concentration. And as you implied, the particles are different sizes, so we can't convert one to the other like we can with LDL or HDL. It has to be a completely different measurement. There's a push right now to have a single way of measuringthe nmol/L, which would take into account the particle size.

Allison: And that's 125 nmol/L.

Kopecky: It would be like 125 nmol/L. So if it's high, what do we do? Well, lifestyle is always very important, although 80%-90% of your Lp(a) level is genetically determined. It's a codominant inheritance, meaning you can get a gene from each parent, and both will raise it more.

You can give things like niacin or hormone replacement therapy. We know that can lower it, but it doesn't lower events; in fact, it may increase cardiovascular events, so it's not recommended. Statins don't affect it. The PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors lower it by maybe 25%, but they're not indicated for high lipoprotein(a).

Lipoprotein apheresis can be helpful in a very small percentage of patients. So we have some treatments, the PCSK9 inhibitor, but it's not yet indicated for lowering it.

Allison: Am I correct that there is a new drug under development that was presented at the American Heart Association scientific sessions, that has shown a significant (ie, 80%) lowering effect, but it's not available? Is that right?

Kopecky: Right. It's an antisense oligonucleotide that actually lowers Lp(a) significantly. It's undergoing clinical studies and we don't know the outcomes yet. It sounds like it's a good idea, but we would need the outcome studies to show that it benefits patients.

Allison: No dietary therapies?

Kopecky: Lifestyle is important, but it doesn't lower your lipoprotein(a). It lowers your risk, but that's separate from the Lp(a).

Allison: Steve, any other points we should make about this?

Kopecky: It's always good to look at the guidelines. The recent ACC/AHA lipid guidelines say you should consider lipoprotein(a) over 50 mg/dL or 125 nmol/L as a risk enhancer ,so be a little more aggressive in treating those patients.[5]

It may be the risk enhancer you use with some patients in primary or secondary prevention, and it's something worth checking, especially if you have patients who have recurrent events or early events, or a family history of early events, because it helps you be more aggressive in treating the patients.

Allison: Do you ever bring in a patient's family members and check them? If, for example, you're 40 years old and you have an MI, should your brother and your kids get checked?

Kopecky: The cascade screening. Yes, we actually have a letter that we give patients. Once we check them and it's elevated, we say, "Give this letter to your first-degree relatives. You don't have to talk to them; the letter explains everything." It says the patient had this elevated lipoprotein(a), which can be associated with increased risk for heart disease, and the relative should take this letter to their primary care provider to check [lipoprotein(a)].

Allison: Steve, thanks for this update and for your insights. I want to thank everyone for joining us on the heart.org | Medscape Cardiology.

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More here:
The Lowdown on Lipoprotein(a) - Medscape

THE PILL may be the most popular method of contraception in Dorset but more women in the county are turning to longer-lasting contraceptive methods such as the coil, implants and injections, figures reveal.

NHS Digital data shows 3,605 women with a preferred main method of contraception attended a sexual health clinic in Dorset to obtain the method they required in 2018-19.

Of these, 57 per cent chose long-acting reversible contraception, up from 53 per cent the year before.

However, nearly 35 per cent of all women using contraception in Dorset chose the pill, figures reveal, although this was down from 38 per cent one year ago. NHS guidelines say the pill is more than 99 per cent effective at preventing pregnancy if it's taken according to instructions.

But with sexually transmitted-infection rates rising, the British Association for Sexual Health and HIV says people should consider if their contraceptive choices were protecting them from STIs.

And the contraceptive method with the highest rate of success in this direction, condoms, are only being used by seven per cent of women, although this is up one percentage point from six a year ago.

The new stats also reveal that when it comes to contraception, more women are looking at the most modern methods.

Those wanting a more permanent method can get a copper-emitting intrauterine device more commonly known as the coil which can last for up to 10 years, or a hormone-based intrauterine system, for up to five years.

The implant, which is put into the upper arm, lasts three years and is easier to remove than the coil. A contraceptive injection covers a shorter period, lasting eight to 13 weeks.

In Dorset, 22 per cent of women said they were using the coil or intrauterine system as their main method of contraception, while 27 per cent opted for the implant and eight per cent for the injection.

Across England, fewer people are getting contraception from their local sexual health clinic, dropping from 1.87 million in 2014-15 to 1.40 million in 2018-19.

President of the Faculty of Sexual and Reproductive Healthcare, Dr Asha Kasliwal, said the 25 per cent drop shows that women and girls appear to be finding it harder and harder to access essential contraceptive services.

This is evidenced in worsening indicators in womens reproductive health almost half of pregnancies in Britain are unplanned or ambivalent," she said. "Abortion rates for women over 30 have been steadily increasing for the last 10 years.

Across England, 311,000 women requested the pill at sexual and reproductive health services last year, down from 427,000 in 2014-15.

A total of 352,000 women now use long-acting reversible methods, up from 346,000 four years ago.

A spokesman for the Department of Health and Social Care said: We have a strong track record on sexual health with teenage pregnancies at an all-time low. Contraception is the best way to avoid unintended pregnancy and we are pleased to see uptake of long-acting reversible contraceptives has increased.

Prevention is at the heart of the NHS Long Term Plan, and comes alongside the 3 billion we are giving to councils to fund

Go here to see the original:
Women still prefer the pill to any other contraceptive - Bournemouth Echo

When should we treat subclinical hypothyroidism? Once levothyroxine is started, it often becomes a lifelong medication that requires lifelong monitoring. Clinicians often use a thyroid-stimulating hormone (TSH) level cutoff of 10 mU/L, but one recent set of clinical practice guidelines from Europe recommend against treatment in adults with a TSH level < 20 mU/L except in women trying to become pregnant or in patients aged 30 years and younger.[1]

The American Thyroid Association and American Association of Clinical Endocrinologists maintain the view that whilemost nonpregnant patients with subclinical hypothyroidism with TSH levels >10 mU/L should be treated,health benefits for those with TSH levels ranging from 4.5 to 10 mU/Lare less clear.

I recommend considering the possibility of subclinical hypothyroidism progressing to overt hypothyroidism and thinking of the underlying pathologic conditions causing the abnormal laboratory values to decide if the hypothyroidism is a permanent or temporary condition.

Permanent pathologic causes of hypothyroidism include autoimmune thyroid disease (ie, Hashimoto disease), postsurgical hypothyroidism, and postablative hypothyroidism. In the setting of subclinical hypothyroidism, it will almost exclusively be due to autoimmune thyroid disease.

Temporary causes include pathologic conditions such as recovering subacute thyroiditis, euthyroid sick syndrome, and medication-induced hypothyroidism (eg, amiodarone and lithium), as well as nonpathologic conditions such as normal physiologic changes with aging and TSH assay interference.

Do you know how to balance the potential benefits of treatment against the harms and costs of initiating a lifelong therapy? Check your knowledge with these three cases.

A 70-year-old man comes to a primary care clinic for a routine health examination. He has a history of hypertension and type 2 diabetes, and he is taking metformin, atorvastatin, and lisinopril. He reports some mild fatigue and feeling cold in the winter but denies constipation. He has no family history of autoimmune diseases. His blood work reveals an elevated TSH level of 7.2 mU/L (normal range, 0.4-4.5 mU/L) and a normal free T4 result. Two years ago, his TSH level was 6.5 mU/L.

See more here:
Subclinical Hypothyroidism Balancing Act: Knowing When to Treat - Medscape

FOOD ALLERGIES have plagued humans for thousands of years. In the fifth century BC Hippocrates noted that although some people could eat their fill of cheese without the slightest hurtothers come off badly. The difference, he observed, lies in the constitution of the body.

Nearly all foods are capable of triggering allergic reactions in humans, and today these are more prevalent than ever, for reasons that are poorly understood. In America, as many as one in 12 children is reckoned to have one. None is more feared than the peanut. A paper by researchers at the Mayo Clinic in Minnesota found that the number of emergency-room visits by American children suffering allergic reactions to nuts, seeds and other food has tripled in ten years (see chart, left panel). Peanuts topped the list, sending nearly six in 100,000 children to hospital in 2014. More than one child in 50 is allergic to peanuts; among one-year-olds, one in 20. This figure has tripled since 2001 (see chart, right panel).

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Makers of packaged foods cover their products with warnings about peanuts. (Many schools and airlines now ban all nuts outright.) Allergy sufferers must monitor their diets with clinical precision. The only way to prevent severe, potentially life-threatening reactions is to avoid peanuts altogether. Anaphylaxisa severe allergic reaction that can cause death, not least by asphyxiation or low blood pressureis the biggest worry. Most such reactions can be treated with epinephrine, a hormone commonly known as adrenaline, but some require a rush to hospital.

This may be about to change. In September an expert advisory panel at Americas Food and Drug Administration (FDA) voted to approve a new treatment for peanut allergies in childrenthe first of its kind. Called Palforzia, the drug seeks to treat peanut-allergy sufferers by exposing them to the very thing that could kill them. Getting the body used to the allergen, by consuming it first in tiny amounts and then in ever-larger portions, can help. Palforzia does this with pharmaceutical-grade peanut protein. A clinical trial found that after six months, more than two-thirds of allergic children could tolerate 600 milligrams of the stuff, equivalent to about two peanut kernels. The FDA is expected to make a final decision on Palforzia early next year. Until then, may contain nuts will remain a threat not a promise.

View original post here:
The prevalence of peanut allergy has trebled in 15 years - The Economist

Uterine fibroids are dense, muscular, benign tumors that grow for no known reason in the wall of the uterus. They are not cancerous; they wont become cancerous; and they dont increase risk of uterine cancer. But uterine fibroids can significantly limit the lifestyles and comfort of people who have them.

This is not a small number of individuals. While the prevalence of uterine fibroids officially known as leiomyomas, or myomas is unknown, various expert sources suggest anywhere from 20% to 80% of all women will have at least one of these masses at some point in life, if not more.

In light of the potentially staggering number of people affected, uterine fibroids dont feel like theyre discussed enough. (They certainly havent been researched enough.) So, lets dive in.

No one knows what triggers the initial growth of uterine fibroids. Experts suspect genes play a role, as fibroids tend to run in families. And they know hormones play a role, even if theyre not sure how. Fibroids grow under the effect of estrogen and progesterone, and shrink when the supply of those hormones ebbs in response to hormone suppressant medication or menopause. In fact, uterine fibroids either stop growing or shrink once a person hits menopause.

Experts also believe fibroids are influenced by other substances that prompt tissue growth such as insulin-like growth factor as well as the extracellular matrix, the material that helps cells stick together to form tissue. Extracellular matrix stores growth substances, and is known to be thicker in fibroid tissue, according to the Mayo Clinic.

Nothing else neither diet nor lifestyle has been proven to prompt fibroid growth.

Uterine fibroids come in as many varieties as the people who have them from the size of a pea to the size of a watermelon, according to UCLA Health. Fibroids also grow at different rates, even within the same person. Its impossible to predict how big a fibroid will grow. However, the bigger the fibroid(s), the more likely a person is to experience symptoms that inhibit their quality of life.

Related on The Swaddle:

Why Women Are More Prone to Urinary Tract Infections Than Men

Many people who have fibroids have no symptoms and may never know they have one or more until a gynecologist performing a routine check-up discovers the growths.

However, according to multiple sources, other people with uterine fibroids may experience the following symptoms:

These symptoms, depending on their severity, can make life very difficult and painful for people who experience them. In a 2018 survey of French women who had uterine fibroids, 64% of respondents reported fibroid symptoms had a moderate to very important effect on their quality of life.

Anyone with a uterus is at risk for uterine fibroids but some more than others. The likelihood of developing uterine fibroids increases with age, until menopause; due to hormone changes, developing new uterine fibroids after menopause, while possible, is less common.

Uterine fibroids are also more common among people with relatives who have had uterine fibroids, suggesting a genetic component. Uterine fibroids are also more common among African-American women than other ethnicities, including South Asian.

Some research suggests people whose first period came at an earlier age may be more at risk for uterine fibroids.

Finally, other studies suggest repeat pregnancy offers a protective effect, as risk of fibroids lowers across each pregnancy.

Several other lifestyle factors from obesity to use of hormonal contraception have been linked to higher or lower risk of uterine fibroids, but research in these areas has been inconclusive.

Related on The Swaddle:

Its common to develop uterine fibroids for the first time, or develop a new growth, during pregnancy, a time when hormones are fluctuating wildly. This doesnt mean there will be problems. Most women with fibroids have normal pregnancies, according to the U.S. Department of Health and Human Services Office on Womens Health.

That said, people with fibroids during pregnancy are six times more likely to require a C-section delivery. Other potential pregnancy complications related to fibroids include: restricted fetal growth, placental abruption (when the placenta detaches from the uterus before delivery, threatening the babys supply of oxygen and nutrients), and preterm birth.

Its unlikely. Uterine fibroids can affect fertility, but its a rare occurrence, and seems to be related to location of the growths than anything else. A 2016 review of research into uterine fibroids and fertility suggests submucosal fibroids fibroids that bulge or hang into the uterine cavity may affect conception; intramural fibroids (growths within the uterine wall) and subserosal fibroids (growths that bulge or hang toward the exterior of the uterus) had little-to-no relation to fertility. Ultimately, however, the evidence regarding effect of fibroids on infertility and reproductive outcomes is weak and mostly inconclusive, concluded the review.

Aside from the potential impairment to quality of life, there are few health risks or complications from fibroids. For people who experience heavy bleeding related to fibroids, anemia could be a health risk. And in the rare case that a fibroid grows very large, pressure on the bladder and urethra can cause kidney damage, according to UCLA Health.

No. Uterine fibroids have no association with the risk of any cancer.

However, while uterine fibroids are benign tumors, very rarely, a cancerous growth in the uterine wall may occur. This is called a leiomyosarcoma, a type of malignant tumor that could develop in any of the bodys muscle or fat tissues or blood vessels, not just in the uterine wall. Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid, according to the U.S. Office on Womens Health.

Most people dont know they have fibroids until they visit a gynecologist for a routine physical check-up, or undergo a prenatal ultrasound. Confirmation may come via other tests, such as: a transvaginal ultrasound (sometimes with saline pumped into the uterus), an MRI, or a hysteroscopy, a surgical procedure in which a scope is inserted into the uterus.

If you have uterine fibroids, but no-to-few/light symptoms, most doctors will say no treatment is necessary.

I consider the severity of symptoms and the impact of those symptoms on a womans quality of life to be the foundation of treatment decision making, Dr. Aaron Styer, an obstetrician-gynecologist at Harvard-affiliated Massachusetts General Hospital, told Harvard Health Publishing. For example, is the woman missing work, requiring frequent hospitalizations, or missing out on normal, daily life? If so, that information will guide the treatment I recommend.

However, most doctors will also advise Watchful Waiting in best-case scenarios with no symptoms that is, monitoring fibroid growth and symptoms through regular abdominal and/or pelvic exams.

For anyone with more severe and impairing fibroid symptoms, there are a few options for fibroid management and/or removal. The only total and lasting cure for fibroids, however, is a hysterectomy. Since a hysterectomy is a major surgery that removes the uterus, it carries its own risks, and its not a first-line treatment for fibroids; many experts do not consider it a treatment at all, unless a person has already had children and/or is past childbearing age.

People with severe uterine fibroids, then, have several treatment options, per UCLA Health:

A doctor can advise on which line of treatment is most suitable and available.

See the article here:
What Are Uterine Fibroids? Very Common, Benign Reproductive Tumors - The Swaddle