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Archive for the ‘Hormone Physician’ Category

13 Unexpected Reasons Why You Might Have A Fever – HuffPost

Feeling a little heated? Its typically nothing to worry about especially if youre sick. However, other issues can cause your temperature to rise.

A normal body temp is typically around 98.6 degrees Fahrenheit (37 degrees Celsius) but can vary slightly for each individual, and even fluctuate depending on the time of day.

It can be lower in the morning and higher in the late afternoon and evening, said Michael Hall, a physician based in Miami. But when your temperature gets to 100.4 degrees Fahrenheit or higher, and lasts more than a few hours, youre getting into fever territory something that can be caused by a number of conditions.

Most of my patients understand that a fever is a common symptom of cold and flu, said Christopher Dietz, an area medical director at MedExpress Urgent Care. However, what some people might not realize is that a fever isnt always just a sign that youre coming down with something.

Heres what could also be at play, according to medical experts:

PhotoAlto/Frederic Cirou via Getty Images

Infections

If you are looking for the reason behind your elevated temperature, start here. Experts note that infections are commonly associated with a fever.

When the immune system detects a threat such as bacteria or virus, a substance known as pyrogens is released into the bloodstream to reach the hypothalamus, which regulates body temperature, said Diana Gall, a general practitioner with Doctor4U in the U.K. When the hypothalamus detects pyrogens, it raises body temperature and causes fever in an attempt to kill off bacteria and viruses.

She noted that a high fever is one of the ways your body is responding and fighting the infection but a body temperature that is too high can also be dangerous.

If the fever is persistent and isnt coming down with home remedies, you should see a doctor, particularly if the fever is accompanied by a severe headache, difficulty breathing, blood in your urine or stool, redness of the skin or rash, or vomiting, etc. The infection may be serious and your body temperature may not reduce without medical treatment, she said.

Overexerting yourself outdoors

Hot outdoor temperatures and internal heat generation from exercise and mechanical movement of the body can heat you up, said Phil Mitchell, national medical director at DispatchHealth.

Under normal circumstances, your body will function well enough to cool you down through sweating and dilation of blood vessels. But if these basic systems are overcome and you cannot cool down, your body will continue to increase in temperature.

This typically does not happen from exercise alone, but exertion in a hot environment can cause this under the right circumstances, Mitchell said. He noted that you should immediately remove yourself from the heat and try other methods to cool your body down if this is the case.

Heatstroke can occur if heat exhaustion is not treated promptly. You need immediate medical attention if you become confused, lose consciousness or if you have an elevated temperature in this situation, said Steven Reisman, a cardiologist and director of New York Cardiac Diagnostic Center.

Vaccinations

Vaccines to prevent a bacterial or viral infection prepare your body to come in contact with that infection later, said Erik A. Larsen, assistant director of EMS and emergency preparedness at White Plains Hospital in New Yorks Westchester County.

So when you get the vaccine, your bodys immune response is stimulated and the body says, Whoa, what is this? It then mounts a fever, he said.

Larsen added that when you get a vaccine, youre not really invaded by an active infection, but it tips your body off that sometime in the future you may come across this.

tommaso79 via Getty Images

Alcohol withdrawal

Low-grade fevers can occur during the first few days of alcohol withdrawal as the central nervous system, which has been suppressed by alcohol, readjusts, said Holly Phillips, a board-certified general internist in New York and a medical expert for RxSaver.

Alcohol withdrawal also causes tremors, which can affect your heat, Larsen said.

The body is reacting to the loss of not receiving alcohol, which creates muscle contractions. This makes the body shake like a tremor, and it raises the bodys temperature, he said.

Inflammatory conditions

Certain inflammatory conditions, like rheumatoid arthritis and lupus, can cause fevers, said Lisa Alex, a physician at Medical Offices of Manhattan. This also occurs because the body is producing pyrogens, which raises your temperature. So if you have underlying inflammatory conditions and have a flare-up of any sort, the result may be a fever.

Certain medications

Many medications like antibiotics [and] antimalarials can also cause drug-induced fever. Anticonvulsants and some herbal medications can also do the trick, said Soma Mandal, a New Jersey-based physician.

You should monitor your bodys reaction when taking any new medication.

Look for a fever that starts a week after starting a new medication and goes away once you stop taking the drug, said J. David Gatz, an assistant medical director of the emergency department at the University of Maryland Medical Center.

Blood clots

Blood clots are an under-discussed source of fevers, according to Nate Favini, medical lead at preventative primary care service Forward.

If youre experiencing fever along with pain, swelling and redness in your leg or shortness of breath, that could be a sign of a blood clot, he said.

Endometriosis

While rare, several of my patients have had fever and flu-like symptoms every month at the start of their periods, likely due to severe pelvic inflammation caused by chronic bleeding into the stomach from wide-spread endometriosis, said Kenneth Ward, director of Predictive Laboratories and a scientific advisor for Predictive Technology Group in Salt Lake City.

If you experience this, Ward suggested making an appointment with your physician to get screened for the condition. Additional symptoms can include debilitating cramps during your period or pain with sex, urination or bowel movements.

Recent surgery

If youve recently gone under the knife, especially for a chest or abdominal procedure, you may experience an elevation in temperature in the days to follow, known as postoperative fever.

The body produces inflammatory proteins in response to the trauma surgery ... This causes fever as a reaction for the first few days post-operatively, said Laurence Gerlis, CEO and lead clinician at SameDayDoctor in London.

Studies show that this is a common side effect from surgeries, with up to 90% of patients reporting elevated temperature after the fact. In most cases, this resolves on its own.

Fevers could also be a side effect to anesthesia, although thats more rare, said Erin Nance, an orthopedic surgeon and hand and upper extremity specialist in New York. This is called malignant hyperthermia.

When this happens, according to Nance, its because of your bodys response to common anesthetic agents used during surgery. This can present as a high fever, muscle rigidity and rapid heart rate. The condition can be fatal and is treated with a medication called Dantrolene and ice packs.

If you have a family history of malignant hyperthermia, it is critical to tell your anesthesiologist before proceeding with surgery, she said.

STIs

Rina Allawh, a board-certified dermatologist with Montgomery Dermatology LLC in Pennsylvania, said that certain sexually transmitted infections may cause a higher-than-normal temperature.

Initially, syphilis presents with a non-tender chancre (i.e. an ulcer). However, if left untreated, may result in high fevers, joint pain, lymph node enlargement and fatigue, he said.

Gonorrhea, if left untreated, may result in high fevers associated with a rash, Allawh said. To prevent life-threatening consequences, prompt recognition and treatment of the condition is essential, he said. Additionally, practicing safe sexual practices and sexual-transmitted disease testing is equally as important.

Traveling to another country

Depending on the area of travel, a rise in body temperature can often be attributed to tropical bacteria and protozoa not often seen in developed countries, said Amna Husain, a board certified pediatrician and founder of Pure Direct Pediatric in New Jersey.

For this reason, I recommend travelers consult with their physicians and refer to the (Centers for Disease Control) guidelines for safe food and water recommendations, she said.

laflor via Getty Images

Hormone disorders or changes

Hyperthyroidism itself does not cause a fever, but we can see a very dangerous and fatal disorder associated with a large influx of thyroid hormone into the body called a thyroid storm, which does have fever, along with rapid heartbeat, fluctuations in blood pressure, and tremors associated with it, Husain said.

She noted that thyroid storm can occur because of a major stressor such as trauma, heart attack, delivery of a baby or because of an infection in people with uncontrolled hyperthyroidism.

In rare cases, it can be caused by treatment of hyperthyroidism with radioactive iodine therapy for Graves disease, she said.

Hormonal changes that occur during menopause can also cause you to feel warmer than normal, which are typically known as hot flashes.

Cancer

Keep in mind that a fever isnt necessarily the first sign or a major sign of cancer. However, it could be one of many symptoms.

Several cancers are associated with fever, which are most commonly leukemias and lymphomas, although other cancers can cause this as well, said Timothy S. Pardee, chief medical officer at Rafael Pharmaceuticals and an oncologist and director of Leukemia Translational Research at Wake Forest Baptist Health in North Carolina.

Pardee said this occurs because, in some cases, cancer cells create an inflammatory response, which then causes the body to respond with a fever. In other cases, the cancer cells themselves secrete cytokines or substances in the body that can cause a fever. And, according to Pardee, cancers like leukemia can impair your bodys ability to fight off infections resulting in prolonged illnesses and fevers.

Additional symptoms to look for are unintended weight loss and drenching night sweats (where you have to change your shirt or sheets when you wake up). These symptoms should prompt a call to your doctor for further evaluation, he added.

When you should be concerned about a fever

A fever may not be cause for alarm, unless there are some specific situations, said David Cutler, a family medicine physician at Providence Saint Johns Health Center in Santa Monica, California.

He added that medication to reduce fever when there is an infection like a cold, flu or pneumonia can help minimize bothersome symptoms like headache, body aches and dehydration from excessive sweating.

But if the fever is caused by hormonal effects, such as menopausal hot flashes or muscular activity like strenuous exercise, these medications will not be effective. In these instances, Cutler said to use measures like cooling fans to lower the bodys temperature.

According to Amesh A. Adalja, senior scholar at Johns Hopkins Center for Health Security in Maryland, a person should be concerned for fever above 101 degrees Fahrenheit (38.3 degrees Celsius) when it is unremitting, when it is associated with other symptoms such as dehydration, extreme fatigue, shortness of breath and severe rash.

Additionally, someone suffering who has a compromised immune system should have a low threshold for seeking medical attention. Same goes for those who are pregnant, have heart or lung disease, or who are very young, he said.

That said, if youre ever concerned about a fever, its always worth it to call your doctor. Thats what theyre there for, after all.

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13 Unexpected Reasons Why You Might Have A Fever - HuffPost

Russs Ravings: One Slip, And Youre Toast – Westfield, NJ Patch

Editor's note: The following is Patch Field Editor Russ Crespolini's, hopefully, weekly column. It is reflective of his opinion alone.

"One slip, and you're toast."

A doctor said this to describe a test my endocrinologist said I needed to get more answers about my brain tumor.

For those of you who have been following along at home, I have been documenting in my column my ongoing medical issue that included a myriad of tests all leading to the conclusion that I have a pair of tumors. One in my brain, attached to my pituitary gland and one somewhere else in the body, most likely in my lungs.

It, or they, are causing a biochemical imbalance known as cushing syndrome or disease.

The next step for me is an inferior petrosal sinus sampling (IPSS). The IPSS is an invasive procedure in which adrenocorticotropic hormone (ACTH) levels are sampled from the veins that drain the pituitary gland. This is done through what is apparently a really painful catheterization process. So, good times. They send the probes up into the brain through the groin to grab the samples.

They then compare the ACTH levels in the peripheral blood to determine whether the pituitary tumor is causing my issues. If it is NOT the culprit and it is an incidental finding, then we begin a hunt for an ectopic (mostly benign) tumor...or a malignancy.

In the interim, I went to my primary care physician for a physical and they suggested that I get a second opinion. So I went to see a second endocrinologist who reviewed my results, and described the IPSS test to me and followed it up by telling me that the test is dangerous because one slip and I am toast.

As in dead.

Cool.

He said it with no malice, he was just trying to make a point of the seriousness of what I was facing. Which I appreciate. But what he didn't appreciate was one of the things that had kept me sane over the past few weeks was the thought I was heading towards some kind of consensus and some kind of a resolution. Having that questioned left me feeling more lost and hopeless than I can remember feeling in a very long time.

Because now I was being torn between two completely different schools of thought. One was saying I needed to undergo this test, which came with risks and the other was that I just needed to keep repeating more conservatives tests every month.

In neither plan, was a path to treating my symptoms.

So I spent the weekend trying to figure out what to do next. My first endocrinologist was trying to find me a place to get the IPSS and the second doctor had me second-guessing the wisdom of that decision. And not matter how hard I tried to rationalize and explain it away, "one slip and you're toast" still kept repeating over in my internal monologue.

And then I made an accidental discovery. One of my earlier columns, a couple in fact, had been picked up by the an organization called the Pituitary Network Association. The PNA is an international non-profit organization for patients with pituitary tumors and disorders, their families, loved ones, and the physicians and health care providers who treat them.

PNA was founded in 1992 by a group of acromegalic patients in order to communicate and share their experiences and concerns. PNA has rapidly grown to become the world's largest and fastest growing patient advocacy organization devoted to the treatment and cure of pituitary disorders. This was a nice discovery because my thoughts were being shared with other people who were going through something similar. It also showed me the power of this Patch network. But I also discovered that their network included experts.

I reached out to them and immediately got a response back that walked me through why I needed to find a specialist in this area and then gave me the name of one at Sloan Kettering in New York. The next morning, my doctor messaged me to tell me she found a specialist that can help me with this test and what comes after.

It was the same name.

So now I know where I am headed next. Sure, one slip and I might be toast. But I need to trust that these specialists won't slip.

Russ Crespolini is a Field Editor for Patch Media, adjunct professor and college newspaper advisor. His columns have won awards from the National Newspaper Association and the New Jersey Press Association.

He writes them in hopes of connecting with readers and engaging with them. And because it is cheaper than therapy. He can be reached at russ.crespolini@patch.com

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Russs Ravings: One Slip, And Youre Toast - Westfield, NJ Patch

Nutrition Break: Take diabetes to heart | Advice – Grand Island Independent

November is National Diabetes Month.

Diabetes is a serious condition that happens when your body cannot make enough of a hormone called insulin or cannot properly use the insulin it has. Insulin helps your body digest sugars that come from what you eat and drink. Without enough insulin, sugar builds up in your blood. Over time, having too much sugar or glucose in your blood can cause health problems.

More than 30.3 million Americans have diabetes, or about 9.4 percent of the population. About 1 in 4 people with diabetes do not know they have the disease. Another 84.1 million have pre-diabetes, a condition in which a persons blood sugar is high, but not high enough to trigger diabetes.

According to the National Heart, Lung and Blood Institute, adults with diabetes are nearly twice as likely to die from heart disease or stroke as people without diabetes. This is because over time, high blood glucose from diabetes can damage your blood vessels and the nerves that control your heart. The good news is that steps taken to manage diabetes can also help lower the risk of having heart disease or a stroke.

Manage your A1C, blood pressure and cholesterol levels. Ask your health care team what your goals should be.

Develop or maintain healthy lifestyle habits. Follow a healthy eating plan and make physical activity part of your routine. To reduce stress, try gardening, taking a walk or listening to favorite music.

Stop smoking or using other tobacco products. If you have diabetes and use tobacco, your risk of heart problems is even greater. Both tobacco use and diabetes narrow blood vessels, so your heart has to work harder.

Take medicine as directed. It is important that those with diabetes take any medicine as prescribed by a physician. Talk with your doctor if you have questions about your medicines and do not stop taking them without checking with your doctor first.

Skillet Zucchini and Mushrooms

In a large skillet, heat oil. Saut green pepper and onion. Add zucchini and cook, covered until tender. Add mushrooms and heat through.

Spoon into a 2-quart baking dish. Sprinkle with cheese. Cover and let stand for 5 minutes or until cheese is melted. Serve hot.

Makes 6 servings.

Nutrition information per serving: 70 calories, 4g fat, 60 mg sodium, 5 g carbohydrates 1 g fiber.

Cami Wells is an Extension Educator for Nebraska Extension in Hall County. Contact her at (308) 385-5088 or at cwells2@unl.edu. Visit the Hall County website at http://www.hall.unl.edu

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Nutrition Break: Take diabetes to heart | Advice - Grand Island Independent

Households are awash in ‘forever chemicals’ – Press Herald

AUGUSTA As Maine compiles thousands of test results for soil and water contamination from an emerging class of toxic substances, consumers need look no further than their own homes for the most immediate and persistent exposure to these forever chemicals.

You wont find them listed on many labels, but the chemicals known as PFAS are literally everywhere in the modern household.

From the moment that we wake up in the morning to the moment we go to bed, we are encountering products that contain these chemicals, said Mike Schade, who tracks PFAS and other chemicals in consumer products for the nonprofit Safer Chemicals, Healthy Families Mind the Store campaign.

They are in cosmetics, shampoos and dental floss. Grabbing pizza, a burger or hot-and-ready dinner from a grocery store? Your food may come with a side order of PFAS-laced packaging.

From the Gore-Tex jacket or boots that keep you cozy in winter, to the stain-resistant couches and nonstick cookware that make life less messy, many of the modern products so common in American households are made with a diverse class of chemical now at the center of a growing health concern.

Studies have linked two specific types of the chemical PFOA and PFOS to cancer, kidney disease and other serious aliments. But while the chemical industry says newer varieties are safer, medical and public health experts say the developing science strongly suggests otherwise.

These are serious concerns about human health across the population, said Dr. Leonardo Trasande, director of New York University School of Medicines environmental pediatrics program and author of the book Sicker Fatter Poorer on hormone-disrupting chemicals. The reality is we always have gaps in our understanding, but at the same time there is enough data for us to take action.

WHAT ARE PFAS?

The term PFAS refers generally to a broad category of synthetic chemicals, per- and polyfluoroalkyl substances, the first of which were developed in the 1940s by companies such as Dupont and 3M.

The chemicals helped usher in a new era of consumer convenience, perhaps best illustrated by the revolutionary nonstick cookware coated by Teflon. Dubbed the slickest substance known to man, the key chemical component in Teflon, polytetrafluoroethylene or PTFE, and another chemical PFOA work by essentially preventing water and water-based substances from penetrating.

Those hydrophobic qualities have made the two chemicals and thousands of subsequent varieties extremely popular with manufacturers. In addition to creating nonstick surfaces on frying pans, types of PFAS make ski jackets water-repellent, help prevent spilled wine from immediately staining carpet or upholstery, and keep fast food wrappers or takeout containers from becoming soggy, greasy messes before you can finish the food.

But their function goes beyond consumer convenience. These chemicals also serve lifesaving roles.

A type of PFAS is the critical ingredient in the foam that airport and military firefighters use and are required by the Federal Aviation Administration to keep in supply to smother the ferociously hot fires created by burning jet fuel. Dozens of municipal fire departments in Maine as well as petroleum companies also keep PFAS foam on hand.

Fluoropolymers that are part of the PFAS family are also commonly used in lifesaving medical devices such as stents and pacemakers as well as some brands of dental floss.

EMERGING HEALTH CONCERNS

The complex and hardy chemical compounds that make PFAS so useful in consumer products also mean, however, that the chemicals do not easily break down in the environment or the body. Some compounds are believed to linger for decades centuries, even in soils and take years to exit the body after exposure, hence the nickname forever chemicals.

Concerns over the health effects of PFOA began surfacing in the 1980s among workers at a DuPont factory in West Virginia that produced Teflon products. But the company kept quiet about the growing evidence of PFOAs toxicity even after workers began being diagnosed with higher rates of leukemia and kidney cancer, as well as birth defects among the children of female workers.

Then in 1998, a neighboring farmer whose livestock were mysteriously dying sued the company in a landmark environmental lawsuit that showed DuPont knew for years about the health risks of the chemical. The farmer won that lawsuit, and a subsequent class-action case targeted the company for contaminating local drinking water.

Both PFOA and another toxic chemical cousin, PFOS, are no longer allowed to be manufactured in the U.S., Europe or Japan or used in products made here, although the compounds are still reportedly used in some foreign manufacturing.

The primary manufacturers of PFAS in the U.S. 3M, DuPont and its spinoff, Chemours are also facing dozens of lawsuits filed by plaintiffs claiming the chemicals have caused cancer or other health problems.

CHEMICAL WHACK-A-MOLE

Chemical companies have since switched to differently structured forms of PFAS (chemically speaking, six-chain compounds versus the eight-chain versions in PFOS and PFOA) that manufacturers say break down faster and avoid the toxicity problems of their predecessors.

The body of evidence reviewed shows they are not carcinogenic, they do not have developmental or reproductive concerns, the toxicity is much approved over the toxicity of PFOA and PFOS that weve spent a lot of time talking about, Renee Lani of FluoroCouncil told members of Maines PFAS task force in September. The dont bioaccumulate and an evidence analysis that was just published last year demonstrates that they are not an endocrine disruptor.

Environmental health groups and medical professionals strongly dispute industry claims that the next-generation, short-chain PFAS compounds are less problematic. And they point to the widespread development and use of new PFAS varieties as evidence of a federal regulatory system that they say is ill-equipped to keep up with industry and failing to protect public health.

This is chemical whack-a-mole in action, said Trasande, who is vice chairman for research in the NYU School of Medicines Pediatric Department. Just because the chemical has a short half-life, that helps if the exposure is a single point in time. But these are ongoing chemicals with consistent, ongoing exposure.

Trasande, who specializes in endocrine-disrupting chemicals in children, said evidence suggests that the newer, shorter-chain PFAS compounds stay in the body long enough to have health impacts. Laboratory animal studies have shown potential liver and kidney toxicity from some of the newer generation of compounds.

And he said there are serious gaps in our knowledge and toxicology in figuring out how PFAS interact with the hundreds of hormones in the body, particularly among children and adolescents.

There is what we know and what we havent studied, Trasande told Maine lawmakers in March during an appearance before the Legislatures Environment and Natural Resources Committee.

Industry representatives have urged Maine lawmakers as well as members of Congress not to group-label all PFAS as potentially hazardous substances. Companies that make PFAS say the newer, most common types of chemicals are safer and less forever than the now-banned versions definitely linked to cancer, kidney disease and other ailments.

My fear is that an overgeneralization is leading to a lot of misinformation, a lot of fear and a lot of confusion over a chemistry that is not even being used anymore, Brady Pitts, an application chemist for PFAS manufacturer Daikin America, told Maine lawmakers at the same March hearing.

And then there is the potential health threat posed by contamination from the legacy, now-banned versions.

Dr. Abby Fleisch, an attending physician in pediatric endocrinology and diabetes at Maine Medical Center, recently received a five-year, $2.2 million federal grant to study whether childhood or pre-birth exposure to PFAS can contribute to development of diabetes or lower bone densities.

Fleisch and her team is still in the earlier stages of that research, but initial findings suggest that children between the ages of 6 and 10 who had higher PFAS levels in the blood also had lower bone density. That is important because adolescence is peak bone-formation time, and low bone mineral density during teenage years may predispose those individuals to osteoporosis later in life, Fleisch said.

The research team also plans to follow up on earlier work examining the same group of women and children that suggested girls exposed to higher PFAS levels in utero could be predisposed to childhood obesity.

Research suggests that PFAS exposure may impact multiple health outcomes, Fleisch said in an interview. However, we dont have all of the answers and I believe it is important to continue exploring these fields.

REGULATORY ACTION AND INACTION

Theres been a flurry of activity at the state and federal level in recent years, spurred initially by the discovery of PFAS hotspots around military bases.

In Maine, high levels of PFAS have been found at the former Brunswick Naval Air Station, former Loring Air Force Base and around the Maine Air National Guard base at Bangor International Airport. But the chemicals have also turned up on an Arundel dairy farm, at former tanneries, near landfills and other industrial sites in Maine.

Congress and the federal government are exploring a variety of actions, ranging from adopting tighter health standards for contamination to adding PFAS to the list of chemicals eligible for federal cleanup under the Superfund program. There is also an effort to add at least some forms of PFAS to the list of chemicals that companies are required to report emitting or discharging under the federal Toxics Release Inventory.

Maines PFAS task force is expected to recommend a host of legislative or administrative actions. Those potential actions include expanded statewide tests for contamination, required reporting whenever a fire department uses PFAS-laden foam and mandatory screening for PFAS among all public water systems.

The Maine Department of Environmental Protection, meanwhile, is seeking legislative authority to order companies to clean up PFAS-contaminated sites, something it currently lacks because the federal government doesnt list PFAS as a hazardous material.

Maine is among the handful of states including Washington, Massachusetts, New Hampshire and Michigan that are leading the regulatory charge on PFAS. For instance, Maine lawmakers passed the nations first phase-out of PFAS in food packaging earlier this year, although the law only takes effect when safer alternatives are available.

We dont anticipate a lot of progress in Washington regulating PFAS in food packaging so it is really up to the states to step up, said Schade, of the Safer Chemicals, Healthy Families nonprofit.

THE CUSTOMER IS ALWAYS RIGHT

Schade is also a firm believer in the power of the consumer. And he says recent decisions by retailers to act on PFAS before the federal government is proof of that power.

Through its Mind the Store campaign, Safer Chemicals, Healthy Families, and like-minded organizations nationwide have tested consumer products and food packaging for the presence of PFAS. They then used those results to attempt to pressure manufacturers or retailers to remove PFAS from products.

For instance, a 2018 report from Mind the Store and the group Toxic-Free Future showed likely PFAS ingredients in many store-brand products and packaging from the major grocery store chains Ahold Delhaize, Whole Foods, Albertsons and Kroger.

Immediately after the report, Whole Foods announced plans to stop using takeout food packaging that contains PFAS. And in September of this year, the owner of Hannaford and Stop & Shop supermarket chains, Ahold Delhaize, announced that it plans to begin removing PFAS from packaging for grocery items, baby products and personal care products.

Both the Lowes and Home Depot home improvement chains also recently announced that they would stop selling carpeting and rugs that contain PFAS. And two weeks ago, Staples announced that it would work with suppliers to begin transitioning to safer alternatives to PFAS and other chemicals in products.

Additionally, the maker of the water-repellent fabric Gore-Tex has committed to eliminate PFAS varieties of environmental concern from 85 percent of its consumer products by the end of next year and from the remaining products by 2023.

So this is really a growing sustainability trend among major retailers and businesses, Schade said. At the same time, we have seen leadership from states such as Maine and Washington in recent years.

PROTECTING YOURSELF

According to the Agency for Toxic Substances and Disease Registry within the U.S. Centers for Disease Control and Prevention, exposure to PFOA and PFOS from todays consumer products is usually low, especially when compared to exposures to contaminated drinking water.

But PFAS awareness advocates say there are steps that consumers can take to educate and potentially protect themselves from exposure. They include:

Organizations such the Environmental Working Group, Safer Chemicals, Healthy Families and Toxic-Free Future recommend avoiding nonstick cookware altogether. Thats because even newer versions marketed as PFOA-free could contain the shorter-chain chemical cousins that they maintain have not been proved safe.

Many of those organizations recommend using cast-iron or stainless steel. But advice to consumers on such topics as nonstick cookware can be contradictory and confusing.

In a 2016 fact sheet on PFOA, the American Cancer Society stated: Other than the possible risk of flu-like symptoms from breathing in fumes from an overheated Teflon-coated pan, there are no known risks to humans from using Teflon-coated cookware. While PFOA is used in making Teflon, it is not present (or is present in extremely small amounts) in Teflon-coated products.

Finding out whether a product was made with PFAS is difficult. But Schade with the Mind the Store campaign said consumers should ask manufacturers or retailers such questions, in part to educate themselves and in part to send a message to businesses.

Consumers really need to be savvy and aware, but at the same time none of us should need to have a Ph.D. in chemistry, which is why we need governments to act, he said.

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Households are awash in 'forever chemicals' - Press Herald

Ohio Senate bills will ‘give more babies a second chance,’ say supporters – The Dialog

COLUMBUS, Ohio The Ohio Senate Nov. 6 passed a bill that would require a child born alive following an abortion receives the same medical care accorded any newborn at the same gestational age.

A second measure OKd the same day would mandate that abortion facilities inform women that chemical abortions can possibly be reversed to save their unborn childs life.

The Born-Alive Infant Protection Act, or S.B. 208, passed with a 24-9 vote, and the Abortion Pill Reversal Act, or S.B. 155, passed with a 23-10 vote.

Called life-affirming by the Catholic Conference of Ohio, the public policy arm of the states Catholic bishops, the two bills will now be taken up by the Ohio House of Representatives. The conference commended the bills sponsors, Republican Sens. Terry Johnson and Peggy Lehner, respectively. Lehner also was a co-sponsor of the Born-Alive bill.

This legislation acknowledges, promotes and preserves the dignity of human life, Johnson said in a statement. Every new born infant deserves our compassion and care, no matter where we stand in the broader abortion debate.

In addition to the medical care provisions, this legislation creates reporting requirements and penalties for the attending physician who fails to report a born-alive baby. While individual cases will remain confidential, the Ohios Department of Health will publish annually the number of babies who survive abortions.

Current federal law recognizes that all infants born at any stage of development, regardless of the circumstances surrounding the birth, are persons. However, supporters of this legislation believe this recognition alone is insufficient to provide protections for infants born alive following an attempted abortion, said a news release from Johnsons office.

The Born-Alive Infant Protection Act is a vital protection of defenseless babies that survive failed abortions, said a statement from Stephanie Ranade Krider, vice president of Ohio Right to Life. This bill would stand ready to protect these helpless infants and require they are given proper medical attention at their most critical moment.

She added, These babies deserve protection under law like infants born under any other circumstance.

Regarding S.B. 155, Lehner said in a statement: Women who decide to take their babies to term should be celebrated and supported. This bill simply gives women more information about the option for a second chance to make an extremely emotional and difficult decision.

The bill would require doctors prescribing abortion-inducing drugs to also provide written information informing the patient of the possibility of reversing the effects of an abortion in the event she changes her mind within the first two days.

According to a news release from Lehners office, the Mifeprex chemical abortion procedure is a two-day regimen used to terminate early pregnancies by blocking the hormone progesterone needed to sustain pregnancy. A second drug, Misoprostol, stimulates uterine contraction to expel the dead baby.

Women who choose a chemical abortion and regret it within the first two days of taking the first drug have a chance to save their baby, as long as they have not taken the second drug, it said.

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Ohio Senate bills will 'give more babies a second chance,' say supporters - The Dialog

39,000 people in NJ are diagnosed with diabetes every year – New Jersey 101.5 FM Radio

Close to half of New Jersey's adult population either has diabetes or is one step away from the irreversible diagnosis.

And most of these folks don't even know it.

According to 2019 figures from the American Diabetes Association, approximately 862,000 people in New Jersey have the chronic disease, which affects a body's ability to produce or use the hormone insulin. More than 2.4 million other Garden State residents, meanwhile, have prediabetes blood glucose levels are higher than normal, but not yet high enough to be counted as a full-blown diabetes diagnosis.

It's believed that a little more than a quarter of diabetic adults are not aware of their condition, along with 90% of folks living with prediabetes.

"The key to really being able to prevent or manage diabetes is understanding your risk," said Lauren Grosz, executive director of the association's New Jersey and New York City markets. "If people are at high risk, we encourage them to see their doctor and get a blood test."

Every year in New Jersey, the association said, an estimated 39,000 people are diagnosed with diabetes.

With the diagnosis, individuals are at greater risk for other serious complications such as heart disease, stroke, end-stage kidney disease and blindness.

As part of American Diabetes Month, the association launched a campaign called Count Me In, which encourages those impacted by the disease to "get involved in the fight" by volunteering, becoming advocates and donating to the cause, and urges those who may be at risk to speak with their physician.

People with diabetes incur medical expenses more than two times higher than those who do not have diabetes, the association said. In New Jersey, total direct medical costs related to diagnosed diabetes were estimated at $6.7 billion in 2017.

Affordability is the biggest barrier to care for suffering individuals who do not have health insurance, according to the Diabetes Foundation. And whether or not someone has insurance, the foundation said, insulin is expensive.

"Depending on the type of insulin, the costs could be overwhelming," said Ginine Cilente, executive director of the Hackensack-based foundation, which helps people manage the disease and provides short-term medication for those who can't afford it.

The foundation's youngest participant last year was 3 years old. The oldest was 95.

"Diabetes is hard, and we think getting help shouldn't be," Cilente said. "We have come across a lot of people who say they are rationing their insulin."

Diabetes is the eighth leading cause of death in the Garden State, and the rate of new adult cases is increasing, according to the Department of Health.

The state says it is making progress in reducing the diabetes death rate, and increasing the percentage of diabetic adults who get an A1C test at least twice a year.

More from New Jersey 101.5:

Contact reporter Dino Flammia at dino.flammia@townsquaremedia.com.

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39,000 people in NJ are diagnosed with diabetes every year - New Jersey 101.5 FM Radio

Exclusive interview: DSD athlete Annet Negesa – ‘My family miss me, but if I go back to Uganda I may lose my life’ – The Telegraph

She did so a safe distance from her homeland, where LGBTIQ+ (Lesbian, Gay, Bisexual, Transgender/Transsexual, Intersex and Queer/Questioning) people regularly face persecution that is actively encouraged by political and religious leaders.

Just last month, a gender nonconforming LGBTIQ+ activist was brutally murdered in his own home. Hacked in the head with a gardening tool, according to Sexual Minorities Uganda.

Negesa is not exaggerating when she says: I cant go back home. I may lose my life.

So, the 27-year-old has become an asylum seeker, applying for indefinite leave to remain in Germany. She has been housed in a LGBTIQ+-friendly shelter while her case is considered. A decision is expected on Friday.

It has been several weeks since she said goodbye to her family and headed to Berlin. If her application is granted, there is no telling when she will see them again. They are missing me a lot, she says of those for whom her athletics career had been a route out of poverty. When they call me, they are asking when Im coming back.

But Negesa is defiant about her decision to end seven years of silence about how she was told just weeks before the London Olympics that she produced too much testosterone to compete fairly as a woman, how she found herself with one option for reducing it, how what she thought would be a simple procedure resulted in her internal testes being cut out, and how she felt so unwell afterwards that she feared she would die.

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Exclusive interview: DSD athlete Annet Negesa - 'My family miss me, but if I go back to Uganda I may lose my life' - The Telegraph

Continuing Medical Education on Trans Health: Addressing the HUD’s Proposed Rule (Part 2 of 2) – Pager Publications, Inc.

Homelessness is a prominent concern among LGBT+ people, particularly the transgender community. Nearly one-third of the respondents who completed the 2015 U.S. Transgender Survey reported homelessness at some point in their lives, with even higher rates (74%) among individuals whose families had rejected them. Additionally, at the time the survey data was collected, the number of respondents who were concurrently homeless (0.53%) was three times that of the general U.S. adult population (0.18% according to the Department of Housing and Urban Development). This prevalence demonstrates the pervasiveness of home insecurity in the transgender community, which is partially caused by the transphobic socioeconomic discrimination mentioned in the first part of this series.

Homelessness can create a multitude of risks that directly cause health problems, exacerbate existing illness and make conditions more difficult to treat or manage. Therefore, housing insecurity may create complicated clinical scenarios that cannot be readily resolved by our standard health care system. As stated by the National Health Care for the Homeless Council (NHCHC) in the Homelessness & Health Fact Sheet, The best, most coordinated, medical services are not very effective if the patients health is continually compromised by street and shelter conditions. Even inpatient hospitalization, or residential drug treatment and mental health care (when available), do not have lasting impacts if a client has to return to the streets upon discharge.

Transgender individuals health may be more severely impacted by homelessness because of the decreased availability of supportive public services. In Transitioning Our Shelters: A Guide to Making Homeless Shelters Safe for Transgender People, the National Gay and Lesbian Task Force and the National Coalition for the Homeless assert that transgender people have a greater need for shelter and other social services because of lack of education, discrimination, increased ejection from homes, inability to access quality health care and inability to pay for transgender-specific health services such as hormones, counseling and gender-affirming procedures. Lifelong, systemic discrimination against transgender individuals can cause them to have an increased need for institutional support while also denying them access to such assistance.

Services available to cisgender individuals are also not always accessible to transgender persons. Homeless shelters are often thought of as a step towards escaping homelessness, but shelters can be especially unsafe for this patient subset. In the 2015 U.S. Transgender Survey, 26% of respondents who were homeless in the past year avoided shelters for fear of maltreatment. Of those who did stay in a shelter, 70% experienced this identity-based mistreatment. Both staff members and residents were responsible for the discrimination. Shelter staff ejected some respondents (9%) after they became aware of the participants identity and forced even more (14%) to present as the wrong gender. Transphobia from shelter staff also prevented some individuals (4%) from being initially approved as residents. Forty-four percent of the respondents who lived at a shelter eventually left because of poor treatment or unsafe conditions.

A 2016 telephone test conducted by the Center for American Progress (CAP) and Equal Rights Center also illustrates the prevalence of discrimination from shelter staff. Only 30% of the shelters contacted by the study indicated that were willing to accommodate transgender women, with 13% stating that the resident must be placed in isolation or with men and 21% refusing shelter entirely. Instances of discrimination from shelter staff in this test and other surveys by CAP were not localized to a specific area, but were reported across the country. Rather than being a site of stability, homeless shelters are a place of targeted harassment and anxiety for transgender residents. By increasing their experiences of discrimination and hostility, shelters might contribute to transgender individuals negative health outcomes and decreased health service utilization. However, avoiding or not being able to access a shelter may also cause transgender individuals to face unsafe conditions on the streets. If providers are not aware of specific programs policies towards transgender people, they may risk recommending unaccepting housing rehabilitation or shelter programs to their homeless transgender patients.

A new proposal from the Department of Housing and Urban Development (HUD) would risk making this patient subgroup even more susceptible to discrimination when seeking shelter services. The proposal would allow for HUD-funded shelters to refuse admission based on factors such as religious beliefs. Religious freedom has frequently been cited as a tactic to avoid providing services to LGBT+ individuals, including health care services. Sasha Buchert, a senior attorney with Lambda Legal, said of the proposal, This would be absolutely devastating in the sense that it would send a message to shelter providers that they can turn away trans people with impunity. Theyre wrong. The law is the law and the federal housing Title VII [of The Civil Rights Act] prohibits discrimination based on sex and that would encompass gender identity.

However, Bucherts statement does not take into account the difficulties that rejected applicants would have in filing such discrimination claims and the current federal deliberations on whether laws prohibiting discrimination on the basis of sex apply in cases of transphobia. Allowing for refusal of shelter admission may further reduce the small number of services transgender people can and are willing to access, and sets a precedent for discrimination from shelter and governmental staff. Both results will cause homeless transgender individuals to experience more shelter-based and street-based instances of discrimination and violence. Such experiences can contribute to diminished physical and emotional wellness among this population. Additionally, homeless transgender people may avoid other organizations that they perceive to be discriminative or religiously intolerant, such as religiously-affiliated hospitals.

The HUDs proposal would also federally define an individuals sex as the sex listed in their governmental documents. This definition of sex specifically targets the transgender community by invalidating their gender. Although some states allow for a person to change the sex listed on their governmental documents, many transgender individuals are unable to update their gender marker because of legal, cost and time restraints. Additionally, altering legal documents may necessitate listing a location of residence, a catch-22 for homeless transgender individuals. This definition of sex may force transgender individuals to misgender themselves, unwillingly disclose their transgender identity to shelter staff or reside at sex-specific shelters that do not match their gender. These actions of misgendering may lead to diminished self-esteem and make transgender individuals more susceptible to discrimination, judgment and violence at shelter facilities.

In a statement on the proposal, Mara Kiesling, the executive director for the National Center for Transgender Equality, stated that, The programs impacted by this rule are life-saving for transgender people, particularly youth rejected by their families, and a lack of stable housing fuels the violence and abuse that takes the lives of many transgender people of color across the country. The press release further details that transgender people who have experienced homelessness are more likely to face physical and sexual violence than those who have not. By denying homeless transgender individuals the opportunity to escape unsafe environments, the HUDs proposal may increase homeless transgender peoples need for supportive services while causing them to be more fearful of seeking assistance. To prevent harm to patients and avoidance of care, physicians must address the impacts of proposals such as this, even though they may seem outside the realm of the medical community. Without being aware of current policies, physicians will continue to create treatment plans that are impossible for patients to follow or will inadequately address their needs.

Although changing homeless services may seem outside the realm of physician practice, the authors of Transitioning Our Shelters have previously made several recommendations on how health care practitioners could make clinical decisions that would improve transgender patients experiences in shelters. Transgender people need advocates for their continued access to hormone treatments while in shelters because of the undesirable mental and physical effects that cessation can have on their bodies. Therefore, transgender shelter residents may need protection from shelters syringe bans so that they can continue their hormonal injections. Without defending these needs, transgender individuals mental and physical health could worsen despite the best clinical visits. Physicians could provide statements asserting the medical necessity of gender-affirming medications and further work with transgender individuals in their community to dismantle the existing barriers at shelters. To truly care for vulnerable patients, physicians must be willing to partner with them to think of innovative ways to counteract cisnormative and transphobic practices.

If physicians advocate for transgender patients right to access medical services, such as hormone treatments in homeless shelters, they could also challenge the dehumanization and discrimination that these individuals face. With the societal and scientific authority granted to physicians for their title and training, they could lend validity to transgender individuals existing acts of advocacy through partnerships with transgender advocates and patients. Such efforts could help bridge the divide between health care providers and transgender individuals and improve societal acceptance of transgender people. By addressing larger political, social and economic barriers to health for oppressed patients and by partnering with them, physicians could prevent harm altogether and avoid searching for a cure to complex social problems during their brief clinical visits.

Image Credit: Trans Solidarity Rally and March 55401(CC BY-SA 2.0)bytedeytan

Writer-in-Training

University of South Carolina School of Medicine - Columbia

Lexi Dickson is a second year medical student at the University of South Carolina School of Medicine in Columbia, South Carolina class of 2022. In 2018, she graduated from the University of South Carolina Honors College with a Bachelor of Science in biochemistry and molecular biology. She enjoys trying new restaurants, dancing, and traveling in her free time. Lexi is undecided on what specialty she would like to pursue after graduating medical school, but is interested in emergency medicine.

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Continuing Medical Education on Trans Health: Addressing the HUD's Proposed Rule (Part 2 of 2) - Pager Publications, Inc.

Let’s Talk Cancer and Controversy – Thrive Global

Im going to start this postthe same way Ill end it reminding you that each persons cancer journey isjust that their own journey. Its unique to each individual there is noright or wrong way to get through a cancer diagnosis. Trust me on this one.

So why are we talking aboutcancer today? Because Ive been asked a lot lately about why I chose to avoidchemo and radiation. Especially working in the health care industry, I thinkpeople expected me to take a more traditional route. But instead, I opted totake a naturopathic approach WITH some traditional methods.

This is where it starts gettingheated. As soon as I say naturopathic, I start getting slammed forperpetuating myths or not admitting to the truth, or my personal favoritebeing a hippy-dippy Indian. True statement, I am a bit of a hippy dippyNative American I mean, I live in nature, I believe Mother Nature and all ofthe elements help us in the various facets of our lives and I do believe the wereturn to the earth from which we live on. But Im not sure thats what thesepeople mean when they say that.

Having two kinds of cancer is acomplete double whammy!

Before I go too far down thispath though, I want to acknowledge that this journey is mine and mine alone.And that although many of you know that when I say #effcancer it usually refersto my breast cancer, but what a lot of you dont know is that late last year Iwas told I have early stage cervical cancer. It was a shock. A hit to the gut or lower as the case may be. And Im not afraid to talk about it, though I dontexactly love having my vajay-jay be the topic of public fodder, it was more menot sharing because when I did tell those closest to me, I saw the deep way itimpacted them. Hearing me say I have ANOTHER form of cancer was like twisting aknife. There were tears, there were swear words, there were gasps, there were are you fuc$king kidding memoments. So, I opted to process this one with those closest to me and now,after having had a couple of surgeries and having changed my naturopathicapproach again, Im ready to talk about it.

Now that Im ready to talkabout it, why am I talking about it here? Because Ive been sharing my methodswith people individually for a while now and frankly, Im getting a littletired of repeating my message each time when I could just put it all here andpoint people to it. So, Im going to share a bit about the approach I took andwhy.

So, what do I mean by anaturopathic approach that combines with traditional methods? I mean that forboth my breast and cervical cancer, I opted to have masses removed. I opted tohave the damaged and cancerous tissues surgically removed from my body but notto move into chemotherapy drugs or radiation as the next step. I didnt want topotentially damage healthy tissue just to combat damaged tissue. I consultedmany an osteopath, naturopath, traditional Chinese medicine practitioners, etc.I asked a lot of questions, talked to a lot of people who had chosen theseoptions and made a plan.

That plan is always evolving,optimizing, changing based on research and what seems to work for me. I stillsee my primary care physician (who is an amazingProvidenceSt. Joseph Health doc), I see a naturopath and I see my oncologistspecialist (also amazing PSJH docs), and we all work together. Its part of whyI love my traditional clinical experts, they know its my choice, they arewilling to answer my questions and work with my non-traditional docs. Side note if your doctor wont answer your questions, you need a new doctor.

Youre probably thinking were seven paragraphs in and I dont know what you mean by naturopathicapproach to cancer. So here goes this is what my journey consists of:

B12 injections can take a littlegetting used to

Full cocoon red light therapy feelsamazing!

There you have it, thats beenmy path as Ive gone on this journey. There are also a lot of naturopathicoptions Ive considered but havent tried yet. Mostly because I havent neededthem, but if youre doing the research, certainly take the time to look atchelation, regenerative peptide treatment, halo therapy, biomagnetic therapy,hyperbaric oxygen therapy and more.

With so many options toconsider, make your journey the one you want it to be. Because, as I said atthe beginning, each persons cancer journey is their own to determine how andwhat they make it. I wish you all the best of luck as you go on your personalpath.

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Let's Talk Cancer and Controversy - Thrive Global

Chris Willis: Diabetes and nutrition – Galesburg Register-Mail

November is National Diabetes Awareness Month; therefore, I chose to focus on the nutritional aspect of this very serious, yet manageable disease.

When you have diabetes, your body cant use the food you eat in the proper way. Normally, when you eat food, namely carbohydrates, they are digested and changed into glucose, a sugar the body uses for fuel. The glucose is carried by the bloodstream, where it waits to be picked up by insulin to be taken to individual cells of the body. The pancreas is an organ in your body that houses the cells that make the hormone insulin. Insulin helps the glucose enter the cells of your body, much like the key that opens the door to let the blood sugar out so you can have energy to work and play.

In the case of diabetes, you may not be making any insulin at all, known as Type 1 diabetes. This type is typically seen in newborns up to young adults. The only way to manage this type is through insulin injections.

Type 2 diabetes is when the individual is still able to produce insulin, but not enough to manage a normal blood glucose level, or is unable to use the insulin he/she makes, called insulin resistance. This type generally occurs in adulthood, but is becoming more common in childhood. Treatment generally includes medication management along with lifestyle changes such as increased physical activity, weight loss and diet changes.

A meal plan should be designed to meet individual needs. It should consist of regular meals, with or without snacks to help control the amount of sugar (glucose) in your blood. A diabetics medical regimen may determine dietary modifications. In either case, the basic premise all foods can fit into a plan is taught. Some exceptions might include sugar-loaded beverages.

Learning how to carb count can make it easier to manipulate a diet plan. In order to master this, it will be helpful to have the education from a diabetes care and education specialist (DCES), formally known as a certified diabetes educator, who has had the training and passed the exam for the credentials. A physician referral is needed for this education.

A helpful tool to start using when first learning to count carbs is knowing the portion size of the food you are eating just as in weight management strategies. Make use of measuring cups and spoons for increasing awareness of the amount of food and beverage to be consumed.

Making use of the food labels is also helpful. Pay attention to the serving size listed along with the total grams of carbohydrate. This will make sense once a carbohydrate spending allowance is given. For instance, an average adult male might do well with 60 to 75 grams of carb per meal, while a female would do better with 30 to 45 grams per meal. An example of a 45-gram carb meal would be equivalent to a sandwich on two slices of bread and a fresh fruit. The carbohydrate spending allowance will be assigned based on the individuals needs using age, activity, height and weight.

Carbohydrate foods include natural sugars such as lactose, found in milk and yogurts; fructose, found in fruits; and starch, found in grains, potatoes, pastas, rice, etc. Sugar is a simple carb that is more readily broken down and can spike blood sugars. Its use should be minimized as possible.

Sugar alcohols such as mannitol, xylitol, sorbitol, isomalt, erythritol, isomalt and maltitol come from plant products such as fruits and berries. The carbohydrate in these plant products is altered through a chemical process. These sugar substitutes provide somewhat fewer calories than table sugar (sucrose), mainly because they are not well absorbed and may even have a small laxative effect. Therefore, they have little to no effect on raising blood glucose levels.

Artificial sweeteners are alternatives to giving sweetness to foods without adding calories and minimal to no added carbs. They include:

1. Saccharin: SweetN Low (pink packages)

2. Aspartame: Nutrasweet/Equal (blue packages)

3. Acesulfame-K: Sunett, Sweet One

4. Sucralose: Splenda (yellow packages)

5. Stevia: Sweet Leaf (green packages). This is the only all-natural, zero-calorie sweetener derived from a plant.

It is important to note that just because a food is listed as sugar-free does not make it carbohydrate-free, as it may contain other sources of carbs. You still need to check the labels and count the carbs.

Once carb counting is understood, it is important to learn to add protein (fish, skinless poultry, beef or pork), and heart healthy fats (olive oil, nuts) to meals and snacks to help balance out blood sugars. For example, when choosing to eat an apple, it may be beneficial to pair it with some peanut butter, nuts or cheese. Proteins and fats do not generally produce a glucose load. They can also help to provide satiety over a longer time frame.

Personal food preferences should be taken into account when planning meals. Here is an example of a generalized, healthy meal plan that we all can strive for, diabetic or not. It includes the Mediterranean style.

BREAKFAST

Greek-style yogurt mixed with walnuts and berries of choice

1 whole-grain slice of toast spread with avocado or nut butter

LUNCH

Tuna Salad on whole-grain bun or in mixed Lettuce greens; add almonds and toss with balsamic vinegar and olive oil

Orange slices and tomato and feta cheese marinated in olive oil

SNACK

Grapes and goat cheese

SUPPER

Broiled fish or skinless chicken or turkey

Brown rice, quinoa or sweet potato

Tossed greens with tomatoes, olives, avocado and olive oil-based dressing

SNACK

Mixed nuts and apple slices

Note: Beverages may include teas, coffee or other non-sugar drinks.

As with any upcoming holiday, please be mindful while you enjoy the family traditions you have.

Chris Willis is a clinical dietitian/certified diabetes educator at OSF HealthCare St. Mary Medical Center in Galesburg.

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Chris Willis: Diabetes and nutrition - Galesburg Register-Mail

I know we did the right thing – Mom and dad reverse chemical abortion, rescue their unborn baby – Pregnancy Help News

Ivette had just taken the first dose of the chemical abortion pill protocol when she began to feel the pangs of regret. Sitting in the abortion facility, she felt emotion wash over her.

I knew it was wrong, and as soon and the doctor walked out, I started crying. I asked my boyfriend, Why are we doing this? and he just hugged me, she wrote in a reflection sent to Heartbeat International several months later.

The abortion facility hadnt let Ivette see her unborn baby on the ultrasound screen, but they estimated her child to be about four weeks old. Just a day before, the couple had believed abortion was their only way forward. With an almost-two-year-old daughter at home, they didnt believe that bringing another child into the world was financially feasible.

That belief was about to be challenged in a major way.

On the drive back home from the abortion facility, the full force of Ivettes regret came rushing through her.

I started arguing with my boyfriend, asking him why he had convinced me to do it. That I didnt want to, that I hated him, she wrote. And he was just looking at me, and I was crying and crying.

Struck by her words, her boyfriend pulled the car over.

He started telling me I was right, that he was dumb for even talking me into it, that we shouldve done the right thing, she recalled.

Thats when her boyfriend decided to take action. Grabbing his phone, he began searching the internet for a way to save their unborn baby. He came across Abortion Pill Rescue, a 24/7 helpline (877-558-0333) backed by a network of 800 medical professionals offering Abortion Pill Reversal.

Otherwise known as the abortion pill or RU-486, chemical abortions typically involve two drugs: mifepristone and misoprostol. Mifepristone, the first drug, destabilizes a pregnancy by blocking progesterone, the natural hormone needed to sustain a healthy pregnancy. To finish the abortion, misoprostol induces labor, forcing a womans body to deliver the baby.

The reversal protocol, which was developed by physicians George Delgado and Matt Harrison more than a decade ago, works by giving a woman extra progesterone up to 72 hours after she takes the first chemical abortion drug.

Now operated by Heartbeat International, the Abortion Pill Rescue Network (APRN) has saved more than 900 babies to date.

Women who are facing the immediate regret of abortion call the APRN helpline every day seeking hope and options, said Christa Brown, director of Medical Impact for Heartbeat International. They dont give up the right to other choices when they seek an abortion and we are here to help.

For Brown, a womans courage to call the helpline and try to rescue her baby is nothing short of heroic.

One of APRNs main goals is to help ensure that women like Ivette have the opportunity to choose life for their children every step of the way, she said. We are so thankful for the courage and strength of our clients who choose life often under many pressures to continue the abortion. All of our 900 moms are true heroes.

Despite whatever glimmer of hope the helpline offered, Ivette was convinced it was too late for their baby.

I told (my boyfriend), Hang up. This is ridiculous. Theres nothing we can do. What is done is done, and took away his phone as we drove back home, she wrote. I felt sad. I felt mad. I hated myself. I couldnt stop thinking about my daughter I already had and what a beautiful blessing she was coming into our lives.

Tears overwhelmed Ivette for the rest of the day. She could hardly sleep that night. Early the next morning, she searched the internet once more for the Abortion Pill Rescue number.

A really nice nurse answered, Ivette wrote. I will never forget her. She started asking me questions and told me we were still in time to reverse the abortion.

The nurse connected Ivette to a local doctor who provides the Abortion Pill Reversal protocol and advised her not to take the rest of the chemical abortion regimen. The doctors office set Ivette up with an appointment immediately. Together, she and her boyfriend drove 45 minutes to the pro-life clinic.

I felt so much peace as I entered his clinic, Ivette wrote. It had a really big Virgin Mary and a little place for people to pray. I felt hope.

While waiting to be seen, she slipped into the bathroom. Her hope faltered as she saw how much she was bleeding.

I was bleeding so much, and I said to myself, Im losing the baby, she wrote.

But the doctor was still willing to fight for her and her unborn baby. He administered progesterone to her and prescribed more for her to take over the course of the next two weeks when she was to return to the clinic for a follow-up appointment.

Ivettes worries werent gone just yet. The same day she began the reversal treatment, she received a dire voicemail from the abortion facility she had visited. The staff reminded her to take the other four chemical abortion pills the facility had given her and warned that if she continued the pregnancy, her baby would be born with birth defects.

Once more, Ivette turned to the kind nurse from the Abortion Pill Rescue helpline for guidance. Using the research performed by physician George Delgado, the nurse assured her that her baby was at no greater risk of being born with a defect than any other baby.

As the days passed by, Ivette continued to bleed heavily. Nevertheless, she continued to take the progesterone, and after two weeks, she returned to the pro-life clinic.

Ivette nervously watched the screen as the doctor performed the ultrasound. Then, he gave her the news she was longing to hear.

He told me, Theres a heartbeat!!! she said. And there it was on the screen, a little flickering. We couldnt believe it. I looked over at my boyfriend as he smiled and said, We did the right thing.

Ivette continued to take progesterone for the rest of the first trimester. Then, late last year, she met the tiny baby she and her boyfriend rescued all those months ago.

I delivered my baby boy by c-section, and let me tell you, he is the cutest little guy, she wrote. I couldnt imagine my life without my daughter and my son. I love them so much and I know we did the right thing. Thank you, Abortion Pill Reversal, for this second chance.

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I know we did the right thing - Mom and dad reverse chemical abortion, rescue their unborn baby - Pregnancy Help News

Local News Blood tests are all that’s needed to detect thyroid disease Roland Rodriguez 6:33 – KRIS Corpus Christi News

More than 20 million Americans have some form of thyroid disease, according to the American Thyroid Association, but up to 60 percent don't know it.

A simple blood test to check your thyroid's hormone levels is all that's needed to find out if you have this disease.

The thyroid is a butterfly-shaped gland in the neck that can have a dramatic impact on your body. It controls your metabolism, regulates your body temperature, keeps your heart pumping, and so much more.

So thyroid disease can occur in one of two ways: you can either have a high-functioning thyroid or hyperthyroidism, or you can have a slow-functioning thyroid or hypothyroidism, said Amistad Community Health Center internal medicine physician Dr. Jacqueline Phillips.

Dr. Phillips said more than 12 percent of Americans will develop an underactive thyroid or an overactive thyroid.

Symptoms you will have if you have hyperthyroid is a rapid weight loss; you will feel nervous, you will have palpitations, or you will feel your heart beating irregular," Dr. Phillips said. "You will also have some diarrhea, and be hot all the time.

"Hypothyroidism is when your thyroid is acting slow and will have opposite symptoms. So people with hypothyroidism will tend to gain weight, feel cold most of the time, you will have hair loss, dry skin, and you will just overall feel tired and fatigued."

People of all ages and races can get thyroid disease. However, women are five to eight times more likely than men to have thyroid problems. In fact, 1 in 8 women will develop thyroid problems during her lifetime.

Your doctor will check two labs, the first lab is TSH and the second lab is a free T4," Dr. Phillips said. "Based off your levels, you will either be diagnosed of having too much thyroid or too little thyroid. If you have too little thyroid (hypothyroidism), it is replaced with a small tablet that contains thyroid hormone. If you have too much thyroid (hyperthyroidism) then what you will need to do is take a medication that will help your thyroid stop making hormone, and then they will refer you to an endocrinologist for further treatment."

Thyroid disorders are fairly common in adults. Fortunately, nearly all thyroid problems can be managed successfully when identified early.

Prevention would be with regular screening, and especially if you are having any symptoms of either hyperthyroidism or hypothyroidism, that you talk to your doctor, and you get the appropriate blood work done, said Phillips.

Dr. Phillips says you should really see your doctor if you are having rapid weight gain or rapid weight loss.

Consider seeing your primary care provider if signs and symptoms of hypothyroidism or hyperthyroidism are present, or if a nodule is noted in the lower front sides of your neck. Your provider will perform a detailed medical history and physical exam.

Workup may include lab tests, X-rays and referral to an endocrinologist. If surgery is needed, you will be referred to an ear, nose and throat, or general, surgeon with expertise in performing thyroid procedures to evaluate and talk with you about your options.

The following are symptoms for hypothyroidism:

The following are symptoms for hyperthyroidism:

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Local News Blood tests are all that's needed to detect thyroid disease Roland Rodriguez 6:33 - KRIS Corpus Christi News

Nurse’s View Column: Health care system failing the women in our families – Duluth News Tribune

The population of women in Duluth over 45 is estimated by the U.S. Census Bureau at 28,000.

Women most affected by menopausal symptoms are between 45 and 64. My mother, aunts, and grandmother are all of this age and all have weathered their menopausal changes, some with the aid of prescription hormone replacement therapy.

A shared experience is of a healthy, shift-working woman, 45 years old, struggling with significant night sweats and insomnia for three months. She makes an appointment with her primary-care provider, who has been seeing her regularly for health care for the last few years, since after the birth of her daughter. She previously had regular care with her OB/GYN doctor but felt too old for her follow-up routine visits. So she transitioned to a local primary-care provider. At this visit, she hoped to receive some aid for her bothersome symptoms.

I dont have the luxury to be this tired all the time from not sleeping due to these horrible night sweats, she said to her doctor. I need to be efficient at work so I can provide for my family. Is there something I can take or do?

Her primary replied, I have to refer you to an OB/GYN, because I do not have the expertise to manage patients with hormone replacement therapy, which is a treatment that can help you.

She is frustrated because she took off work for this visit and now has to make another visit in the OB/GYN office in three weeks and has an additional drive of 35 minutes. But she complies.

At her next visit, she is struck with how old she feels, surrounded in the waiting room by young expecting mothers and their buzzing children. She meets with the OB/GYN provider, who spends a brief seven minutes with her, and she leaves feeling very comfortable with a new prescription of hormone replacement therapy.

The problem is this common treatment of hormone replacement therapy, or HRT, is not routinely instructed to primary-care providers in their mandatory continuing-education requirements, particularly in low-risk women. Primary-care providers are required to have continued education as part of their licensure to practice medicine.

These providers serving female patients include medical doctors, nurse practitioners, advanced-practice registered nurses, and physician assistants. This problem leads to increased costs and referrals for low-risk patients and a loss of revenue for providers who have the capacity to manage this highly effective and safe therapy for close to half of their patient population.

As a womens-health nurse practitioner, I have heard this common story from many female patients, and it is time for the health care system to listen. All primary-care providers need regular, mandatory continuing education on hormone replacement therapy treatments. This mandatory education should include the large body of evidence that supports the safe use of HRT in menopausal women and the important risk factors when HRT is not appropriate.

HRT can be counseled, prescribed, and managed in low-risk women by primary-care providers.

Regionally, the practice of managing HRT is diverse and is very typical practice in urban settings while much less common practice in rural areas where primary-care providers are pivotal.

My primary-care colleagues continue to ask how to treat female patients who have multiple high-risk factors and who shouldnt be on HRT. My rebuttal is that their keen knowledge is correct: HRT is likely not the treatment for these female patients. A referral to an expert in womens health is highly encouraged for high-risk women. The population of high-risk women is typically amongst younger ages or is found during pregnancy or through routine surveillance in all care settings.

With mandatory continuing education for primary-care providers in managing safe hormone replacement therapy for women, their confidence in the medications and the management of these low-risk women will increase, along with provider satisfaction from patients.

Kelsey Thompson of Duluth is a womens-health nurse practitioner in Minneapolis. She received a bachelors degree in nursing from the College of St. Scholastica. She earned a masters in womens health and a doctorate in nursing from Duke University in North Carolina.

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Nurse's View Column: Health care system failing the women in our families - Duluth News Tribune

We asked experts how to dodge the flu this year – Salon

Though we associate chilly fall temperatures with flu season, the two are not mutually inclusive.The time in which the flu virus is most contagious is widely known as the "season," and though that time of year usually starts in October and peaks from December to February, flu deaths have already been reported in the United States. While it remains difficult to predict how severe this season will be, it's not too late to create a plan of attack.

Dr. Nodar James, medical director at Upper East Side Rehabilitation and Nursing Center, told Salon that because flu symptoms can develop days after the virus enters the body, it's possible to spread the flu to someone else before know you are sick, as well as while you are sick.

"The flu is spread in a few different ways.One way is through contact with bodily fluid, so if someone with the flu coughs or sneezes and doesn't cover their mouth or nose, anyone who comes in contact is at risk of getting sick," James explained."Most people are most contagious 34 days after the flu begins. However, in some cases you can also infect people even before symptoms begin."

Here are some tips on how to prepare for the flu season.

Get your flu vaccine.

The best way to protect against serious outcomes of the flu virus is to get vaccinated,according to nearly every medical professional or health care expert Salon spoke with for this article.

The effectiveness of the influenza vaccine, which combines four different inactive flu strains, varies from person to person. Recent studies show that flu vaccination reduces the risk of flu illness between 40% and 60% of people.

The flu vaccine is not perfect, mostly because of the number of strains of the virus that circulate, but it can provide some cover. Because flu virus strains evolve every year, medical experts recommend getting vaccinated annually.

Nasal spray is also an option for patients who are needle-averse. In previous years, the American Academy of Pediatrics recommended children be vaccinated with a shot, as some studies showed it was more effective. There is no such suggestion this year.

Wash your hands.

TheCenters for Disease Control and Prevention (CDC)recommends washing your hands frequently and for at least 20 seconds at a time (perhaps sing the "Happy Birthday" song from beginning to end.) When washing your hands, "be sure to lather the backs of your hands, between the fingers, and under your nails," the CDC notes.

"People are more germ-conscious these days so avoiding a handshake is not as rude as once thought, especially during flu season. If you must do it,washor sanitize with yourhands immediately,"Dr. Benjamin Barlow, chief medical officer of American Family Care, told Salon.

Keep your distance.

It's easy to spread germs whenliving in close quarters, especially during the winter months when more people tend to stay indoors. However, doctors recommend avoiding close contact and sharing during the season.

"Since viruses like the flu spread through droplets secreted through coughing, sneezing and breathing, spending hours in close proximity to a person who is sick, breathing in the droplets, is a sure-fire way to get sick,"Dr. Anna Cabeca, a physician and author of "The Hormone Fix" told Salon. "A good combo is to regularly wash your hands, carry a scarf when traveling and perhaps to wear a face mask, especially if you are susceptible, or if you're sick yourself and don't want to contaminate others."

Get enough sleep.

Sleep is critical to maintaining and strengthening our immune system, which is constantly working to quash various kinds of viruses and bacteria. During flu season, doctors advise making sleep a priority and trying to get the recommended 8 hours of sleep each night.

Reduce stress levels.

Relieving stress and anxiety levels is key to increasing your overall health and sense of well-being.Dr. Steve Silvestro, a pediatrician in the Washington, D.C., area and the host of The Child Repair Guide Podcast, said managing mental stress is "one of thebest ways to keep healthy during flu season."

"It has to do with the effects of cortisol on our immune system," he explained to Salon. "We know that a short burst of cortisol say, going on a short run can help the immune system by briefly decreasing inflammation. But when cortisol is chronically elevated, like when we are feeling stressed at work or home for long stretches of time, inflammation in our bodies increases, and our immune system has a harder time fighting off infection."

In that way, taking care of your metal health perhaps by doing something you love, such as spending time in nature can help your immune system stay strong.

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We asked experts how to dodge the flu this year - Salon

What The Health? Brain tumour causes woman’s nose, chin to grow – Yahoo News Canada

Can leftover spaghetti really kill you? Can you actually cough up a blood clot in the shape of your lung? In Yahoo Lifestyle Canadas newest series, What The Health?!, we ask doctors to weigh in on odd health news stories and set the record straight. Be sure to check back every Friday for the latest.

A Sudbury, Ont. woman who spent years in tears as her nose, chin, hands and feet gradually kept getting bigger was shocked to learn that changes to her physical features were caused by a brain tumour.

Rebecca Churan says she couldnt understand why she was inexplicably getting uglier as her jawline and chin continued to grow and her feet went from size 8.5 to 10.

ALSO SEE: Saskatchewan curler dies from rare childbirth condition: What is amniotic fluid embolism?

Over the span of at least a decade, doctors diagnosed the now 29-year-old with a range of conditions including borderline diabetes, polycystic ovary syndrome, anxiety and depression. As her body kept changing, Churan became increasingly desperate for help, visiting another physician earlier this year.

I told this doctor that my face was changing, and I was getting uglier, and that I didn't understand why I was gaining weight since I was barely eating, Churantoldthe Daily Mail. She issued me a blood test and then called me back in and told me I had a pituitary tumour based on the results of that test.

That test measured insulin-like growth factor, or IGF1, which controls tissue and bone growth. Depending on a persons age, a typical reading ranges from 97 to 297; Churans was 1015. Further examination found that she had a benign tumour in her brain on her pituitary gland, which releases hormones that control human growth.

It causedacromegaly, a rare condition in which the body produces excessive amounts of the growth hormone, causing body parts to become abnormally large. The condition gets its name from the Greek words for extremities and enlargement.

When acromegaly begins in childhood, it can lead to giantism, as seen in Andr the Giant and the late actor Richard Kiel, who played the steel-tooth villain Jaws in two James Bond films. When it develops after someone has reached their full height and their bones are already fused, different parts of the body will being to grow and tissue becomes thicker, says DrAli Imran, a professor of medicine in the division of endocrinology at Dalhousie University.

ALSO SEE: What The Health?! British teenager paralyzed after falling from his couch

Acromegaly affects approximately three to five people in a million, with about 2,000 Canadians living with the condition. However, those numbers are likely low.

Many people remain, unfortunately, undiagnosed forever, Imran tells Yahoo Canada. The actual prevalence of disease is much higher what is currently being reported.

The reason is that many of the features of acromegaly are very nonspecific, and others are slow to develop, he explains. For instance, one common feature is the hands and feet begin to enlarge and the facial features begin to enlarge, but the change is so subtle and so slow, it may take many years before somebody notices. If a doctor has not seen a patient for a number of years they can see the difference, but on a day to day level the difference is very hard to notice until it becomes really obvious. Many of the other features like excessive sweating, weight gain, aching joints, and sleep apnea are so common in the general population that most people wont put two and two together. As a result, diagnoses can be delayed from up to 10 years or even more.

ALSO SEE: What The Health?! Woman's ruptured brain cyst originally misdiagnosed as migraines

Other symptoms include skin tags, enlarged tongue, deepening of voice due to enlarged sinuses and vocal cords, headaches, impaired vision, decreased libido, abnormalities in menstrual cycle and erectile dysfunction.

Overgrowth of bone and cartilage can lead to arthritis, while thickening tissue can cause carpal tunnel syndrome. Even organs, including the heart, can enlarge.

Story continues

The most common treatment is surgery to remove the tumour, with the pituitary gland reached through an incision in the noise or upper lip. Sometimes, unfortunately, not all of the tumour can be excised; they can also recur. Radiation and medications are other options, though Imran notes that drugs are expensivein some cases, up to several thousands of dollars a month.

Churan had her tumour removed through her nose. Her hands, feet, and facial features shrunk down to a normal size within months.

Shes going public with her story to raise awareness of acromegaly and encourage people who may be having similar symptoms without explanation to seek medical help. The Canadian Pituitary Patient Association has marked November 1 asAcromegaly Awareness Day.

ALSO SEE: What the Health?! Can you really die from burning your throat on hot foods?

There really is no information other than extreme cases online, Churan said. There's barely any awareness or tools to help people recognize the signs, so many cases are diagnosed as hormonal disorders. I saw the scariest photos of Andr the Giant and others who had not been treated early on during the process. I was mortified, scared, and hopeless.

I had this tumour for over 15 years based on the photos I've looked back over, but I just thought it was the way I was ageing at the time, she said. You must stay positive and find hope in any way you can while fighting. I want people to understand that a simple blood test can often diagnose a pituitary tumour. Dont just accept any diagnosis without digging deeper and asking if something else could be causing it.

Besides the physical effects of the condition, theres the severe mental and emotional toll it can take.

Churan post surgery. Image via Facebook.

What is important is for people to understand is that these rare disorders can be devastating for the people who suffer from them, Imran says, urging people with acromegaly to seek specialist care, such as that available in Nova Scotia. Caregivers and the public need to know how these affect the lives of a small number of people in a very bad way. The major problem which we find is chronic pain, ongoing arthritis, and nerve problems. Even after treatment, many dont feel better.

The psychological impact is just immense, he adds. People who have gone through a lot of health issues end up very frustrated that they havent been able to find an answer and realize their condition was missed for 10 or 15 years and sadly they have to live with this for years. This is not an easy problem; theres no easy fix, but were fortunate to be living in a country where treatment is available.

Let us know what you think by commenting below and tweeting @YahooStyleCA! Follow us on Twitter and Instagram.

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What The Health? Brain tumour causes woman's nose, chin to grow - Yahoo News Canada

FDA panel recommends withdrawing approval of Makena drug, used to prevent preterm births – KEYT

A committee for the US Food and Drug Administration now recommends that the approval of Makena, a drug used to reduce the risk of preterm births, should be withdrawn and some women who have used the medication are sounding the alarm.

The 9-7 vote, which took place at a meeting of the Bone, Reproductive and Urologic Drugs Advisory Committee on Tuesday, came in response to evidence suggesting that the drug was not effective.

The committee serves as an advisory group to the FDA and the voting results are not binding, said Dr. Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, who was not involved in the committee meeting.

Most of the time the FDA will make a decision that aligns with the committee, but not always, Gellad said.

One study showed FDA will go against the committee about 20% of the time. But the committee did vote that removal of the drug from the market was warranted, which is relevant for supporting any FDA decision about withdrawal, he said.

An FDA spokesperson confirmed in an email on Thursday that the committee voted 13-3 that there is not substantial evidence of effectiveness of Makena in reducing the risk of recurrent preterm birth, based on findings from two trials that were part of a study called PROLONG, published last week in the American Journal of Perinatology.

Nine members of the committee voted to pursue withdrawal of approval for Makena, and seven members voted to leave Makena on the market under accelerated approval and require a new confirmatory trial.

None voted to leave the drug on the market without requiring a new confirmatory trial.

Makena, sold by AMAG Pharmaceuticals, is a progestin hormone that gets delivered to a patient as an injection. In 2011, the FDA approved the medicine to reduce the risk of preterm birth in women who have a history of spontaneous preterm birth under the provisions of accelerated approval regulations.

Accelerated approval is a mechanism for drugs to be approved by FDA before they have proven benefit. They need to address a high need clinical condition for which there are no or few other therapies, like premature birth, and they have to show some effect on a surrogate outcome an outcome that is reasonably expected to be related to clinical benefit, Gellad said.

As a requirement for a drug that is approved through accelerated approval, the company must perform a confirmatory trial to show clinical benefit. In this case, it took eight years, and the confirmatory trial showed no benefit, he said, adding that many of the patients in the trial were not from the United States.

So one argument from the company is that the trial does not represent effectiveness in the US, and because there are no other drugs available, and a prior study showed effectiveness, and its recommended by various OB/GYN groups, that it should stay on the market and be evaluated in another trial, he said. The caveat is that this treatment existed even before accelerated approval because pharmacies could compound or make the therapy themselves so if the drug leaves the market, there is still an option to use the drug.

Current guidelines in the United States recommend the use of progesterone supplementation, such as Makena, in women with prior spontaneous preterm births.

Last week, when the results of the PROLONG study were published, the Society for Maternal-Fetal Medicine released updated clinical guidance for providers to discuss important factors with patients, including uncertainty regarding the benefit of the drug.

Meanwhile, the American College of Obstetricians and Gynecologists released a statement from its Vice President for Practice Activities, Dr. Christopher Zahn, indicating that ACOGs clinical guidance on the use of the medication will remain in effect.

ACOGs guidance is based on a review of the best available literature. As such, we will continue to monitor this topic, evaluate additional literature and any further analyses as published, and address findings as needed in relevant clinical guidance, Zahn said in the statement.

Danielle Boyce, a mother of four and research consultant based in Philadelphia, had significant preterm labor issues with her first two children, including her eldest son, Charlie. He was born preterm at 34 weeks, developed a seizure disorder as a baby and now has Lennox-Gastaut syndrome, severe intellectual disability and autism, Boyce said.

When Boyce became pregnant for a third time at age 42, she was very concerned about having another preterm birth and made the shared decision with her physician to start using Makena. Her third and fourth children came home from the hospital and did not require a NICU stay. They are both healthy and developing normally, Boyce said.

I am glad that I had the opportunity to use Makena while it was still available because it worked for me, Boyce said in an email on Thursday.

Boyce added that she respects the decision the members of the FDA panel made since it was based on evidence presented to them but noted that studies can be flawed.

As someone trained in epidemiology and statistics, as well as someone who has served on FDA panels myself, I can appreciate the difficult decision that the panel had to make given the evidence presented, Boyce said.

I agree that the study design could have been better and the statistical endpoints were not achieved, she said about the evidence. However, this is a rare case where the stakes are so high and the side effect profile is so low that an additional layer of scrutiny is warranted beyond the statistical evidence presented before a decision is made to pull this effective medication from the market.

Boyce said that she would ask the FDA panel to consider ACOGs judgment.

Meanwhile, there also have been calls for the FDA to ban Makena.

Earlier this month, the consumer advocacy nonprofit Public Citizen submitted a petition to request that the FDA immediately withdraw the approval of all medications containing hydroxyprogesterone caproate (Makena).

Meena Aladdin, a health researcher at Public Citizens Health Research Group, testified during the FDA committee on Tuesday, arguing that maintaining approval of Makena in the absence of any clinical benefits being demonstrated by Trial 002 or Trial 003 would make a mockery of the more than 50-year FDA legal standard requiring substantial evidence of a drugs effectiveness.

In response to the FDA vote, AMAG Pharmaceuticals Chief Medical Officer Dr. Julie Krop said in a statement that the company was disappointed.

We are committed to working with the FDA to identify feasible ways to generate additional efficacy data on Makena while retaining current access to the therapy for at-risk pregnant women, Krop said in the statement.

For more than a decade, health care providers have relied on hydroxyprogesterone caproate (Makena) to reduce preterm delivery in high-risk patients, which aligns with recently updated treatment recommendations of the American College of Obstetricians and Gynecologists, as well as the Society for Maternal-Fetal Medicine, she said.

The medication now remains in limbo until the FDA makes a final decision based on its committees new recommendations.

I predict FDA will remove the drug from the market, since the confirmatory trial showed no benefit, and removing the drug does not necessarily completely eliminate the opportunity for some women to receive the therapy, Gellad said. There is an 80% chance I will be right.

Continued here:
FDA panel recommends withdrawing approval of Makena drug, used to prevent preterm births - KEYT

What Foods Are Good For Helping Depression? – The Health Eaducation

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There is not any specific diet to treat melancholy , but ingesting more of some foods and less or none of others can help some people handle their symptoms.

In this guide, we look at a few foods and nutrients that may be valuable and a few that individuals must avoid.

Many nutrients are available to purchase, but their should be asked by people Because they may occasionally interfere with other medications, Physicians advice before using any supplements.

One factor that may contribute to depression is.

A 2017 research Found that people with moderate-to-severe depressions signs improved when they ate a much more healthful diet for 12 weeks and received nutritional counselling sessions.

The diet centered on whole and fresh foods that are high in Nutrients. It limited sweets, refined foods, and food, including junk food.

Depressive symptoms, including mood and anxiety, improved enough to achieve remission criteria in more than 32 percent of the participants.

The researchers reasoned that people could help manage by fixing their diet, or enhance their symptoms of depression.

Selenium

Some scientists have suggested that raising selenium intake may help improve mood and reduce stress, which might help to make depression more manageable.

Selenium is found in Many Different foods, including:

Entire grainsBrazil nutsa few fishorgan meats, such as liver.

Vitamin D

Vitamin D might help improve the symptoms of depression, according to a 2019 meta-analysis.

Individuals obtain most of their vitamin D through sun exposure, but dietary sources are also important.

Foods that can supply vitamin D comprise :

Fatty fishfortified dairy productsbeef liveregg

Omega-3 fatty acids

The results of some studies have suggested that omega-3 fatty acids might assist with depressive disorders.

On the other hand, the writers of a 2015 review concluded that more studies are required to confirm this.

Eating omega-3 fatty acids may reduce the risk of mood disorders and Brain diseases by preserving and improving brain function.

Good sources of omega-3 fatty acids include:

Cold-water fish, such as salmon, sardines, tuna, and salmonflaxseed, flaxseed oil, and chia seedswalnuts

Antioxidants

Vitamins A (beta carotene), C, and E contain substances called antioxidants.

Antioxidants help eliminate free radicals, which are.

If the body cant remove enough free radicals, oxidative stress may develop. Lots of health problems can result, which may include depression and stress.

The results of a 2012 research Suggested that swallowing the vitamins that provide antioxidants may reduce symptoms of anxiety in people with generalized anxiety disorder.

Fresh, plant based foods, like berries, are great sources of antioxidants. There is that A diet rich in fruits and vegetables, soy, along with other plant products might help reduce the stress-related symptoms of depression.

B vitamins

Vitamins B-12 and B-9 (folate, or folic acid) help protect And maintain the nervous system, including the brain. They may help reduce symptoms and the threat of mood disorders.

Sources of vitamin B-12 include:

Eggsmeatpoultryfishoystersmilkentire grainssome fortified cereals

Foods that contain folate include:

Dark leafy vegetablesfruit and fruit juicesnutslegumesentire grainsdairy productsmeat and poultryseafoodeggs

Zinc assists the body perceive flavor, but additionally, it boosts the immune system and might affect melancholy.

Some research have indicated that zinc levels might be lower in people with depression and that zinc supplementation might assist antidepressants operate more effectively.

Zinc is current in:

Whole grainsoysterssteak, chicken, and porkbeansnuts and pumpkin seeds

Protein

It might also help people, although protein allows the body repair and to raise.

The body uses a protein called tryptophan to create serotonin, thefeel good hormone.

Tryptophan is present in:

Tunaturkeychickpeas

Serotonin Seems to play a role In depression, but the mechanism is complicated, and how it works remains unclear. But may be beneficial.

Probiotics

Foods such as kefir and yogurt can boost the levels of bacteria.

Healthy gut microbiota may reduce the signs and risk of depression, based on some 2016 meta-analysis. The researchers indicated that Lactobacillus and Bifidobacterium might help.

Weight control

This increased danger could possibly be due to the hormonal and immunological changes which happen in people with obesity.

Someone who is overweight or has obesity may desire to seek advice from with a dietitian or their health care provider about ways to manage their own weight.

The Dietary Approaches to Stop Hypertension (DASH) diet, which health authorities recommend, can help reduce blood pressure and improve overall health.

Theres also evidence it may help with weight loss and may reduce the risk of melancholy.

Foods to avoid

The symptoms of depression can aggravate.

Convenience foods, such as fast food and junk foods, can be full of calories and low in nutrients.

Research Have suggested that those who consume a lot of food are more likely to have depression than those who eat mainly fresh produce.

Processed foods, particularly those high in sugars and refined carbs, May contribute to a greater risk of depression. When a person eats carbs that are refined, the bodys energy levels grow rapidly but crash. A rapid low can follow, although an immediate increase may be given by A bar of chocolate.

Its ideal to opt.

Processed oils

Processed and polyunsaturated fats can activate inflammation, and they might also impair brain function and aggravate the symptoms of depression.

Fats to avoid include:

Trans fats, that are present in many processed foodsfats in red and processed meatssafflower and corn oil, which can be saturated in omega-6 fatty acids

At least one study has found that a moderate consumption of caffeinein the form of java , may assist people with depression. The benefits of caffeine could be due to properties that are antioxidants and its stimulant effect.

Coffeeteachocolatesodasenergy beverages

There is some evidence That small amounts of caffeine can reduce improve and stress mood. Some research has found that it might increase feelings of stress, stress, and depression in kids of high school age.

While caffeine may benefit some individuals, Its Best to:

Consume it in moderationavoid products with a high caffeine content, such as energy drinksavoid caffeine after midday

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What Foods Are Good For Helping Depression? - The Health Eaducation

FDA panel recommends withdrawing approval of drug used to prevent preterm births – FOX 59 Indianapolis

A committee for the US Food and Drug Administration now recommends that the approval of Makena, a drug used to reduce the risk of preterm births, should be withdrawn and some women who have used the medication are sounding the alarm.

The 9-7 vote, which took place at a meeting of the Bone, Reproductive and Urologic Drugs Advisory Committee on Tuesday, came in response to evidence suggesting that the drug was not effective.

The committee serves as an advisory group to the FDA and the voting results are not binding, said Dr. Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, who was not involved in the committee meeting.

Most of the time the FDA will make a decision that aligns with the committee, but not always, Gellad said.

One study showed FDA will go against the committee about 20% of the time. But the committee did vote that removal of the drug from the market was warranted, which is relevant for supporting any FDA decision about withdrawal, he said.

An FDA spokesperson confirmed in an email on Thursday that the committee voted 13-3 that there is not substantial evidence of effectiveness of Makena in reducing the risk of recurrent preterm birth, based on findings from two trials that were part of a study called PROLONG, published last week in the American Journal of Perinatology.

Nine members of the committee voted to pursue withdrawal of approval for Makena, and seven members voted to leave Makena on the market under accelerated approval and require a new confirmatory trial.

None voted to leave the drug on the market without requiring a new confirmatory trial.

Makena, sold by AMAG Pharmaceuticals, is a progestin hormone that gets delivered to a patient as an injection. In 2011, the FDA approved the medicine to reduce the risk of preterm birth in women who have a history of spontaneous preterm birth under the provisions of accelerated approval regulations.

Accelerated approval is a mechanism for drugs to be approved by FDA before they have proven benefit. They need to address a high need clinical condition for which there are no or few other therapies, like premature birth, and they have to show some effect on a surrogate outcome an outcome that is reasonably expected to be related to clinical benefit, Gellad said.

As a requirement for a drug that is approved through accelerated approval, the company must perform a confirmatory trial to show clinical benefit. In this case, it took eight years, and the confirmatory trial showed no benefit, he said, adding that many of the patients in the trial were not from the United States.

So one argument from the company is that the trial does not represent effectiveness in the US, and because there are no other drugs available, and a prior study showed effectiveness, and its recommended by various OB/GYN groups, that it should stay on the market and be evaluated in another trial, he said. The caveat is that this treatment existed even before accelerated approval because pharmacies could compound or make the therapy themselves so if the drug leaves the market, there is still an option to use the drug.

Current guidelines in the United States recommend the use of progesterone supplementation, such as Makena, in women with prior spontaneous preterm births.

Last week, when the results of the PROLONG study were published, the Society for Maternal-Fetal Medicine released updated clinical guidance for providers to discuss important factors with patients, including uncertainty regarding the benefit of the drug.

Meanwhile, the American College of Obstetricians and Gynecologists released a statement from its Vice President for Practice Activities, Dr. Christopher Zahn, indicating that ACOGs clinical guidance on the use of the medication will remain in effect.

ACOGs guidance is based on a review of the best available literature. As such, we will continue to monitor this topic, evaluate additional literature and any further analyses as published, and address findings as needed in relevant clinical guidance, Zahn said in the statement.

Danielle Boyce, a mother of four and research consultant based in Philadelphia, had significant preterm labor issues with her first two children, including her eldest son, Charlie. He was born preterm at 34 weeks, developed a seizure disorder as a baby and now has Lennox-Gastaut syndrome, severe intellectual disability and autism, Boyce said.

When Boyce became pregnant for a third time at age 42, she was very concerned about having another preterm birth and made the shared decision with her physician to start using Makena. Her third and fourth children came home from the hospital and did not require a NICU stay. They are both healthy and developing normally, Boyce said.

I am glad that I had the opportunity to use Makena while it was still available because it worked for me, Boyce said in an email on Thursday.

Boyce added that she respects the decision the members of the FDA panel made since it was based on evidence presented to them but noted that studies can be flawed.

As someone trained in epidemiology and statistics, as well as someone who has served on FDA panels myself, I can appreciate the difficult decision that the panel had to make given the evidence presented, Boyce said.

I agree that the study design could have been better and the statistical endpoints were not achieved, she said about the evidence. However, this is a rare case where the stakes are so high and the side effect profile is so low that an additional layer of scrutiny is warranted beyond the statistical evidence presented before a decision is made to pull this effective medication from the market.

Boyce said that she would ask the FDA panel to consider ACOGs judgment.

Meanwhile, there also have been calls for the FDA to ban Makena.

Earlier this month, the consumer advocacy nonprofit Public Citizen submitted a petition to request that the FDA immediately withdraw the approval of all medications containing hydroxyprogesterone caproate (Makena).

Meena Aladdin, a health researcher at Public Citizens Health Research Group, testified during the FDA committee on Tuesday, arguing that maintaining approval of Makena in the absence of any clinical benefits being demonstrated by Trial 002 or Trial 003 would make a mockery of the more than 50-year FDA legal standard requiring substantial evidence of a drugs effectiveness.

In response to the FDA vote, AMAG Pharmaceuticals Chief Medical Officer Dr. Julie Krop said in a statement that the company was disappointed.

We are committed to working with the FDA to identify feasible ways to generate additional efficacy data on Makena while retaining current access to the therapy for at-risk pregnant women, Krop said in the statement.

For more than a decade, health care providers have relied on hydroxyprogesterone caproate (Makena) to reduce preterm delivery in high-risk patients, which aligns with recently updated treatment recommendations of the American College of Obstetricians and Gynecologists, as well as the Society for Maternal-Fetal Medicine, she said.

The medication now remains in limbo until the FDA makes a final decision based on its committees new recommendations.

I predict FDA will remove the drug from the market, since the confirmatory trial showed no benefit, and removing the drug does not necessarily completely eliminate the opportunity for some women to receive the therapy, Gellad said. There is an 80% chance I will be right.

Excerpt from:
FDA panel recommends withdrawing approval of drug used to prevent preterm births - FOX 59 Indianapolis

This Mom Has Terminal Breast Cancer, But Shes Still Fighting for Her Kids – Glamour

My first diagnosis was stage IIIC breast cancer, which is as close as you can get to stage IV without actually being stage IV, which is terminal. At that point, IIIC, youre still considered curable.

My oncologist told me that I had triple-negative breast cancer, which can be more aggressive and more difficult to treat than other forms of breast cancer. (Triple-negative breast cancer doesnt respond to some common breast-cancer treatments, such as hormone therapy.)

I went through chemotherapy and then had a double mastectomy in May of 2018. The lump was in one breast, but I felt like I would always worry that wed missed something if I hadnt had both removed. I have three sonsnow 12, 13, and 16and every step of the way, Ive wanted to do whatever I could to heal myself and be here for them.

I made the most of my (bald) 44th birthday.

The mastectomy was followed by a second round of chemotherapy, which was followed by radiation. And then my oncologist said, Youve done all the treatment thats reasonable at this point. Now you need to go back to your normal life and watch for any symptoms. Well check you out every three to six months.

After recovering from the radiation, I went back to work the first week in December. I worked for a month and then was diagnosed with stage IV cancer the first week of January.

The cancer had metastasized to my liver and lungs. I did even more chemotherapy, but a follow-up scan showed that the tumor in my liver had doubled in size in the three months since my last scan. Following treatment, some tumors will shrink or disappear. The 14-centimeter tumor in my liver didnt react that way; its there, not getting smaller. There really isnt much room left in my liver. For now, my best-case scenario is that the cancer doesnt spread further.

It was really hard to tell my kids. Ive always wanted to be really honest with them. I was honest about what I had and that it was serious. Theyre old enough that they can do their own research. There was no point in trying to mislead them from the beginning. Also, I tried to be lighthearted.

I want my sons to know and remember how much I love them. Im glad that theyre at a point where theyll remember me. And my husband can remind them.

My eldest son has thanked me a couple of times for handling things so well. He feels like the fact that Im not complaining a lot or acting down or sad or depressed has been really helpful. I really try to stay positive and make the most out of all the moments that I still do have with them.

It was hard for them to see me go bald again. Having my hair grow back was a big milestone for my kids. My youngest, especially, was so excited when my hair started to grow back. He would measure it and rub my headhe really celebrated me starting to look more normal again.

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This Mom Has Terminal Breast Cancer, But Shes Still Fighting for Her Kids - Glamour

Microbiota and the social brain – Science Magazine

Animal sociability through microbes

Accumulating evidence suggests that the microbiota living in and on animals has important functions in the social architecture of those animals. Sherwin et al. review how the microbiota might facilitate neurodevelopment, help program social behaviors, and facilitate communication in various animal species, including humans. Understanding the complex relationship between microbiota and animal sociability may also identify avenues for treating social disorders in humans.

Science, this issue p. eaar2016

Increasingly, it is recognized that the microbes resident in the gastrointestinal tract can influence brain physiology and behavior. Research has shown that the gastrointestinal microbiota can signal to the brain via a diverse set of pathways, including immune activation, production of microbial metabolites and peptides, activation of the vagus nerve, and production of various neurotransmitters and neuromodulators in the gut itself. Collectively, this bidirectional pathway is known as the microbiota-gut-brain axis. In the absence of a microbiota, germ-free and antibiotic-treated mice exhibit alterations to several central physiological processes such as neurotransmitter turnover, neuroinflammation, neurogenesis, and neuronal morphology. Perhaps as a result of these neurological alterations, the behavior of rodents lacking a microbiotaespecially social behavioris remarkably different from that of rodents colonized with bacteria. Conversely, supplementation of animals with certain beneficial live bacteria (e.g., Bifidobacterium and Lactobacillus) can lead to notable improvements in social behavior both in early life and in adulthood. Collectively, these results suggest that microbial signals are important for healthy neurodevelopment and programming of social behaviors in the brain. Although research on the functional and ecological implications of the gut microbiota in natural populations is growing, from an evolutionary perspective it remains unclear why and when relationships between microbes and the social brain arose. We propose that a trans-species analysis may aid in our understanding of human sociability.

Sociability comprises a complex range of interactive behaviors that can be cooperative, neutral, or antagonistic. Across the animal kingdom, the level of sociability an animal displays is variable; some are highly social (e.g., primates, termites, and honey bees), living within cooperative communities, whereas others have a mostly solitary existence (e.g., bears). Consequently, although studies on germ-free and antibiotic-treated animals have yielded insights into how the microbiota may influence social behaviors, they are perhaps too reductionist to fully appreciate the complex relationship between symbiotic bacteria in the gastrointestinal tract and host sociability when considering a broader zoological perspective. Some social interactions have evolved to facilitate horizontal transmission of microbiota. Observations across both invertebrate and vertebrate species suggest that factors such as diet and immunity generate selection pressures that drive the relationship between microbiota and social behavior. Although microbiota may influence behaviors endogenously through regulation of the gut-brain axis, some animal species may have evolved to use symbiotic bacteria exogenously to mediate communication between members of the same species. Hyenas, for example, produce an odorous paste from their scent glands that contains fermentative bacteria that is suggested to facilitate social cohesion among conspecifics. This complex relationship between animals and microbiota raises the hypothesis that microbes may have influenced the evolution of the social brain and behavior as a means to propagate their own genetic material.

Understanding the factors that affect the development and programming of social behaviors across the animal kingdom is important not only in terms of rethinking the evolution of brain physiology and behavior, but also in terms of providing greater insight into disorders of the social brain in humans [including autism spectrum disorders (ASDs), social phobia, and schizophrenia]. Evidence for a link between the microbiota and these conditions is growing, and preclinical and emerging clinical data raise the hypothesis that targeting the microbiota through dietary or live biotherapeutic interventions can improve the associated behavioral symptoms in such neurodevelopmental disorders. Larger clinical trials are required to confirm the efficacy of such interventions before they are recognized as a first-line treatment for neurodevelopmental disorders. Although such connections between gut bacteria and neurodevelopmental disorders are currently an intriguing area of research, any role for the microbiota in the evolution of social behaviors in animals does not supersede other contributing factors. Rather, it adds an additional perspective on how these complex behaviors arose.

The bidirectional pathway between the gut microbiota and the central nervous system, the microbiota-gut-brain axis, influences various complex aspects of social behavior across the animal kingdom. Some animals have evolved their own unique relationship with their gut microbiota that may assist them in interacting with conspecifics. The relationship between the gut microbiota and social behavior may help to explain social deficits observed in conditions such as autism spectrum disorders (ASDs) and could potentially lead to the development of new therapies for such conditions.

Sociability can facilitate mutually beneficial outcomes such as division of labor, cooperative care, and increased immunity, but sociability can also promote negative outcomes, including aggression and coercion. Accumulating evidence suggests that symbiotic microorganisms, specifically the microbiota that reside within the gastrointestinal system, may influence neurodevelopment and programming of social behaviors across diverse animal species. This relationship between host and microbes hints that host-microbiota interactions may have influenced the evolution of social behaviors. Indeed, the gastrointestinal microbiota is used by certain species as a means to facilitate communication among conspecifics. Further understanding of how microbiota influence the brain in nature may be helpful for elucidating the causal mechanisms underlying sociability and for generating new therapeutic strategies for social disorders in humans, such as autism spectrum disorders (ASDs).

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Microbiota and the social brain - Science Magazine

How the End of Daylight Saving Time Can Affect Your Health – Yahoo Lifestyle

If you tend to wake up feeling like all you need is "just one more hour" of sleep, youre probably pretty stoked about "falling back" an hour this Halloweekend, marking the end of Daylight Saving Time. After all, when you change your clocks (or, let your iPhone do it for you) to switch back to standard time, you're gifted with an extra hour of sleep basically the best thing since the advent of the snooze button, right?

Well, according to experts, while you may gain that extra hour this weekend, the end of DST can actually have some pretty negative effects on your sleep and overall health.

In fact, although around 70 countries currently participate in DST, several are now pushing to scrap the practice altogether, citing general unpopularity and public health concerns. (One scary example? Scientists found that the pedestrian risk for being struck and killed by a car at 6 p.m. in November, when DST ends, is 11 times higher than the risk at 6 p.m. in April, when DST begins.)

Because at least for now DST isnt going anywhere in the U.S., its important to know what lies ahead. Here, experts weigh in on how Daylight Saving Time affects your health and mood and how you can squash symptoms related to the transition.

RELATED: We Tried 4 Products Designed to Help You Sleep Better

Youve probably already guessed this one, but the reason your sleep suffers as a result of the time change comes down to light (or lack thereof), says Clifford Segil, DO, a neurologist at Providence Saint John's Health Center.

"We get used to going to sleep a few hours after it gets dark, which is disrupted when all of sudden it's dark earlier than we are used to, Dr. Segil says. "Its hard for many people to continue to fall asleep at the same time or to maintain good sleep for the same amount of time as they did before a time change."

Someone whos regularly logging plenty of sleep will be able to adapt more easily to the shift. However, it can feel like the last straw if you are already dealing with not-so-great sleep habits, says Caroline Rasmussen, a meditation teacher, herbalist, and founder of brain health company, Antara.

The fix: Light cues can help your body's internal clock adjust more quickly to the time change, Dr. Segil says. If you wake up and its still dark, try to mimic morning light by turning on a nearby light or salt lamp, Dr. Segil says. He adds that the type of light isn't as important as the duration of time spent in the light and the volume of light the more the better. The same goes for when nighttime darkness begins to creep in; turn on a lamp at your desk if you can so your system knows it's not time for bed.

Maintaining a consistent sleep schedule aiming to hit the hay and wake up at the same time each day can also shorten the time it takes to feel back to normal after a time change, Dr. Segil adds.

As a result of poor sleep, your mood, productivity level, and concentration may all suffer, Dr. Segil says. Beyond feeling irritable and sluggish, theres a more serious mental health risk at play, too.

A 2016 study published in Epidemiology showed that depression diagnoses have a tendency to spike as people make the transition out of DST and into standard time. The studys authors noted that they believe the shift is related to the "psychological distress associated with the sudden advancement of sunsetwhich marks the coming of winter and a long period of short days."

This could be related to a larger condition that affects people during the winter months Seasonal Affective Disorder (aka SAD). People who experience SAD notice an increase in depressive symptoms in early fall or winter that experts say is linked to decreased exposure to light.

"The change in light information created by the time change directly influences the level of stress hormones in the body," Rasmussen says. If you already have chronically elevated cortisol levels, the time change can have an even more noticeable, negative impact on mood, she adds.

RELATED: 8 Signs You Might Have Seasonal Affective Disorder

The fix: If you think you have SAD, seek help from a mental health expert, who may recommend medication or light therapy; a 2009 study showed using a light box daily for 20 to 40 minutes resulted in significant and immediate mood improvement in people with SAD.

If its an overall feeling of irritability or stress you're experiencing, you may also want to consider adding in relaxing habits, like sipping tea. Not only is the act soothing, but Rasmussen says tea also contains L-theanine, an amino acid that can help keep stress at bay. On the supplement home front, consider popping an adaptogen, like tulsi or ashwagandha, which can help ease anxiety.

"Adaptogens help balance the stress response system for example by restoring the normal sensitivity of our cortisol receptors so that the adrenals aren't forced to pump out overly high levels of the hormone to achieve the same physiological effect," Rasmussen says.

Surprisingly, the time change and subsequent disruption of our circadian patterns can also have downstream effects on everything from our levels of inflammation to our eating habits, Rasmussen says.

"The brain is programmed for a 24-hour day, and when our internal clocks are disrupted, it leads to a domino effect, disrupting many bodily functions, including your appetite, body temperature, bowel function, and even heart and lung function," explains David Cutler, M.D., a California-based family medicine physician. Because these functions are all controlled by the brains internal clock, the end of DST can take your body on a bit of a roller coaster, he adds.

Translation: If you notice you're way hungrier than usual or that your digestion is out of wack DST may actually be partially to blame.

The fix: While there are some health factors out of your control, it never hurts to help your body along by taking care of it with diet and exercise. Aim to stick to your regular workout schedule at least 150 minutes per week of moderate-intensity aerobic activity per week or 75 minutes of vigorous aerobic activity and save protein-heavy meals (which involve more digestion and may disrupt your sleep) for earlier in the day, Rasmussen says.

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How the End of Daylight Saving Time Can Affect Your Health - Yahoo Lifestyle

If Diabetes Leads to Heart Disease, Should Cardiologists Care For Diabetes? – American Council on Science and Health

I used to think that the brain was the most wonderful organ in my body. Then I realized who was telling me this.

Emo Philips, American Comedian

A research letter in JAMA Cardiology captures the same idea, substituting cardiologist for brain and physician for organ in my body.

Researchers begin by noting that new medications for diabetes also modify the course of heart disease; and that there are increasing numbers of patients with new-onset Type 2 diabetes. They then look at new-onset cases of Type 2 diabetes by state comparing them to the available supply of cardiologists, endocrinologists (physicians caring specifically for diabetes among other hormone-related conditions), and nephrologists (physicians who care for kidney disease). Low and behold, with three times more cardiologists than either endocrinologists or nephrologists, who is well-positioned to participate in diabetes care given their numbers and distribution relative to diabetes cases? Yes, cardiologists.

In addition to their sheer numbers, cardiologists bring other values to the table. Cardiologists see more patients with diabetes than endocrinologists; cardiologists are more frequently consulted in the hospital for issues involving patients with diabetes increasing the teachable moments. And finally, diabetes is becoming less glucocentric and more about global risk reduction. Frankly, who knows more about reducing risk, cardiologists just ask them.

All right, I must confess, I have a conflict of interest here. As a vascular surgeon, I have watched cardiologists claim that they can care for vascular disease, the area I trained in for six years because they are good with wires and balloons and they fix coronary arteries that are very small and important, so the big arteries that I care for are easy. Arteries are arteries after all unless, of course, you are a vascular surgeon that, for some bizarre reason, feels that you should fix a coronary artery with a balloon and stent; then, those arteries are different.

There is an invited commentary from a primary care physician; more specifically, an individual specializes in general internal medicine. He points out that patients often require coordinated, collaborative care, and there is a push to create a medical home, business-speak for having one consistent primary care physician. To extend that medical home metaphor, he points out that other specialists, part of the medical neighborhood, have much to offer, but that the decision to involve the neighbors, like cardiology, nephrology, or endocrinology involved should be made by the patient and their immediate real and medical family.

Collaboration and communication are not easy, even in this day of smartphones and text. It is challenging to coordinate a discussion about a patient using text messaging.; If you think that a physician has a time advantage when calling another physician, then you havent witnessed the dance of competing office staff trying to eliminate any waiting time for their doc - someone has to wait on the line. As a result, coordinating care often means prolonging decisions, increasing patient wait times, and in some instances, anxiety. Who is best qualified to coordinate the neighborhood? I agree with the commentator, the generalist has the best view, seeing more than the heart disease or glucose management.

Why are cardiologists so interested in expanding their lane? Why are they not content, supporting the hard work of primary-care physicians? As we move deeper into team medicine, not everyone can be the quarterback coordinating the play; even that gifted receiver, the one in this instance caring for your heart.

Source: Implications of Specialist Density for Diabetes Care in the United States JAMA Cardiology DOI: 10.1001/jamacardio.2019.3796

Optimizing the Physician Workforce for Care of Patients with Type 2 Diabetes JAMA Cardiology DOI: 10.1001/jamacardio.2019.3827

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If Diabetes Leads to Heart Disease, Should Cardiologists Care For Diabetes? - American Council on Science and Health

Why this program can help you lose weight and keep it off for life – ABC 4

Posted: Oct 28, 2019 / 05:26 PM GMT-0600 / Updated: Oct 29, 2019 / 11:47 AM GMT-0600

Everyone wants to lose weight and keep it off, but even with exercise and diet, that can be hard. Dr. Kristen Kells, DC, BSc, Chiropractic Physician.

Dr. Kells started her successful weight loss center in Colorado. She explained how her patients saw results, hit their target weight and were able to keep the weight off! Kells herself struggled with weight resistance.

Dr. Kells and her team specialize in weight loss resistance treatment. Triggers that can keep you from losing the weight are symptoms such as brain fog, hormone disregulation, fatigue, belly fat and craving carbs. There are many factors that can contribute to this and everyones body is different so the approaches are client specific.

Kristin DeHerrera, a client of Dr. Kells weight loss program over the last 3 months has already lost an astonishing 45lbs. She says it works because you dont need to do anything too special outside your daily life to make things work. I like the real life aspect of it That I just have to take whats out there and make it work.

If you are struggling to keep the weight off and feel that you have tried every trick in the book, call (385) 217-6368 for a free consultation or visit drkellsweightloss.com.

This story includes sponsored content.

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Why this program can help you lose weight and keep it off for life - ABC 4

More women are getting breast cancer in their 20s, University of Iowa research shows – The Gazette

IOWA CITY A growing percentage of younger women are getting breast cancer with rates among 20-somethings increasing the fastest, according to new University of Iowa-led research.

Although the overall number of affected women in that age range remains well below other age groups, the rate of 20 to 29-year-olds diagnosed with stage 1 to stage 3 breast cancer increased about 2 percentage points a year during the 15-year study period, according to research published in the September issue of the Journal of the National Cancer Institute Cancer Spectrum.

Breast cancer rates for women in their 30s and 40s also increased from 2000 to 2015, although not as fast, inching up about .3 percentage points a year.

The study looked not only at incidence rates but survival rates and found that, in addition to seeing the largest annual percentage increase, the diagnosed 20-somethings had lower 10-year survival rates than their 30-to-40-year-old peers.

Reasons for the worse outcomes could be multifold and include that younger women often experience diagnosis and care delays in part because breast-cancer screening is less common among that age group.

Physicians might be less suspicious of malignancy in younger patients even when they show up in clinic with a breast lump, according to researchers.

Detecting cancerous growth in younger women also can be more challenging due to their dense breast tissue, according to the studys lead author, UI professor of epidemiology Paul Romitti.

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Romitti said the findings could have important clinical and self-care implications encouraging increased education and self-checks at a younger age.

Try to avoid care delays with these women, Romitti said. Be aware that because theyre traditionally not screened to make sure that when patients report a lump in their breast, its checked.

Brooke McKinnon of Coralville said shes glad her physician did, when last December she went in for her annual gynecology appointment. At age 27, the UI graduate and Hawkeye rowing athletic trainer hadnt yet had a mammogram.

But during her appointment, the doctor felt a lump and given that McKinnons mother not even two years before had been diagnosed with breast cancer the physician encouraged her to get a full work-up, while trying to calm her nerves.

Shes like, You know, young women get cysts in their breasts sometimes. She said, Dont get yourself worked up, but lets just get it checked out, McKinnon said.

That guarded reassurance did infiltrate McKinnons thinking as she waited four long weeks between that original appointment and when they could get her in for more imaging and tests.

I kind of convinced myself that Im too young to have breast cancer and this is not cancer and Ill be fine, she recalled.

But ultrasound and biopsy results revealed McKinnon despite her young age did have cancer grade 1B invasive ductal carcinoma. She got the call on a Monday morning and by that afternoon she had an appointment with the breast surgeon.

They mapped out a plan for a lumpectomy and more tests, and just after Christmas she learned her cancer hadnt spread and therefore was considered stage 1.

That was the best news you could get, she said.

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McKinnon still endured chemotherapy and continues to undergo hormone therapy in that her cancer cells grew in response to estrogen and progesterone.

Being premenopausal complicates treatment for younger patients, especially those such as McKinnon who havent had children but want to.

Having my own kid is very important to me, so I did IVF (in vitro fertilization) before even starting chemotherapy, she said.

When McKinnon was diagnosed, she was engaged with a wedding date planned for the coming summer. They managed one embryo from the IVF, and she took a drug to protect her ovaries during her cancer treatment in hopes shell be able to conceive without IVF in the future.

After her follow-up radiation, McKinnon today is cancer free and has a good prognosis not to mention a wedding still on the books for June.

Learning that her age group is getting breast cancer at a faster clip than others, she said, was shocking.

Its unsettling, she said.

The UI research in addition to assessing incidence and survival rates by age range looked at different types of breast cancers and variations by race and ethnicity.

Survival rates were lower among those who identified as non-Hispanic blacks and Hispanics, compared with non-Hispanic whites and Asian/Pacific Islanders.

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Some of those differences could be tied to variations in access to health care, according to Romitti, who is continuing his research by focusing on Iowa women in hopes of identifying life factors that might contribute to incidence and survival rates.

But based on what this initial research has found, his colleague and co-author at Wake Forest School of Medicine, Alexandra Thomas, stressed physicians should reject assumptions that younger women with lumps in their breasts dont have cancer.

We want physicians to be alerted to the rising cancer incidence among this population, Thomas said.

Comments: (319) 339-3158; vanessa.miller@thegazette.com

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More women are getting breast cancer in their 20s, University of Iowa research shows - The Gazette

Medically Necessary Or ‘Cruel’? Inside The Battle Over Surgery On Intersex Babies – wgbh.org

When Kimberly Zieselman was 41, she got hold of her medical records from Massachusetts General Hospital. What she found was shocking.

The words "male pseudo hermaphrodite" were written on her chart.

Zieselman discovered she was born with XY chromosomes. Until that moment, she had no idea she was born intersex, an umbrella term used to describe people born with male and female anatomical characteristics.

As a teenager, Zieselman came to discover, doctors had performed surgery on her reproductive organs in an effort to conform her anatomy to fit one mold a move that had serious psychological ramifications for her later on in life, she said, and that was done without her complete, informed consent.

Like, Zieselman, many intersex adults who underwent procedures as babies have dealt with painful consequences later in life. Now 53, Zieselman has become a part of a growing movement within the intersex community speaking out against surgeries performed on intersex babies. Unless surgery is medically necessary, activists say, doctors should not interfere. Some activists are lobbying their state governments to pass legislation to ban surgeries that are medically unnecessary such legislation has already been proposed in California and Connecticut.

In the medical community, though, many say the issue should not be legislated, and that medical decision-making for children should remain parents responsibility after consulting with medical professionals.

A 2000 study in the American Journal of Human Biology found that 1.7 percent of babies are born intersex. There are many variations of intersex that manifest as differences in external genitals, internal reproductive organs and sex chromosomes. Another term used is DSD, which stands for Differences of Sex Development.

In Zieselmans case, she has Complete Androgen Insensitivity Syndrome, or CAIS. She was born with external female anatomy and internal testes. This means her body doesnt respond to testosterone and instead converts it to estrogen. In 1982, when Zieselman was 15, doctors removed her testes and told her and her parents that it was a partial hysterectomy, when, in fact, she never had a uterus or ovaries. All she knew was that she would never menstruate or be able to get pregnant.

My parents were told I was born with partially formed reproductive organs, Zieselman said.

She felt betrayed.

I realized I had been lied to by the medical community, by doctors who had been involved in this surgery and diagnosis. The truth was hidden even from my parents, she said.

Zieselman believes her doctors thought they were doing what was in her best interest at the time. But she disagrees.

The procedure, she said, meant having to take hormone replacements for the rest of her life. She maintains that had doctors not removed her gonads, she wouldnt have to take estrogen supplements. The psychological toll of learning the truth about her surgery was also devastating.

Its that feeling of being told youre not good enough. That there is something wrong with your body, that it is something to be shameful of and something to hide. And the fact that youre lied to. It was so shameful that the doctors didnt even tell your parents the whole story, she said.

Learning she is intersex was a turning point for Zieselman. The married mother of two who lives outside of Boston is now the executive director of InterACT, an advocacy group for intersex youth. Shes also publishing a memoir next spring, titled "XOXY."

Activists and medical professionals alike acknowledge that in rare, severe cases involving the reproductive organs like when there is no passage for urine, or when the bladder is on the outside of the body surgery is imperative.

Activists say that the types of surgeries that they condemn are not medical emergencies. Its common for infants with atypical genitalia to undergo procedures within the first year of their lives to make their anatomy look more traditionally male or female. Some baby girls undergo clitoral reduction, a cosmetic surgery, solely for appearance reasons. In 2013, the U.N. Human Rights Council deemed these procedures cruel.

But Jack Elder, chief of pediatric urology at Massachusetts General Hospital, said the term "medically necessary" can be interpreted differently, and he thinks legislation gets in between the physician and patient.

How can somebody else, an outside group, a legislative body, decide what is medically necessary or unnecessary when we're dealing with genital ambiguity? Elder said.

Elder says he and his colleagues dont dictate what parents should do. Instead, he encourages parents of his patients to educate themselves on the pros and cons of having their infant undergo surgery.

We're just trying to help parents and provide some guidance. They might say, What do you think I should do?" he said. "You've got to make a decision at some point, because when they hit puberty, its going to create issues, and the surgery is a lot more involved.

As the debate around these surgeries grows fiercer, pediatric urologists have found themselves being increasingly questioned about their practices surrounding surgeries on intersex babies. WGBH News reached out to three other hospitals in and around Boston and pediatric urologists declined, two of which cited the sensitive nature of the topic.

In March 2018, the Societies for Pediatric Urology and the American Urological Association issued a joint statement on pediatric decision-making. They said they believe medical decision-making for children should remain parents' responsibility after consulting with medical professionals and should not be legislated. The statement also said that children should be involved in these decisions.

In Nov. 2018, the Massachusetts Medical Societys Committee on LGBTQ Matters submitted a report to MMS, recommending hospitals create teams designed to assess the needs of intersex babies and proposing that MMS advocate for a delay of surgery.

Parents who have just welcomed a newborn can find themselves overwhelmed with a multidisciplinary team made up of pediatric urologists, endocrinologists and pediatric gynecologists and social workers.

A Boston-area mother, who asked not to be named to protect the identity of her child, has a daughter with an intersex condition who was treated at a different Boston hospital three years ago. Within a couple days of their daughters birth, she and her husband met with a team of 15 people.

[It] is very overwhelming, and everyone is telling you different things: She doesnt have a uterus, there are testes," she remembered. "They started talking about her vagina hole size and talking about intercourse for her one day. It was hard to talk about my daughters sexual health when she was just born.

She and her husband felt some pressure to have their daughters gonads removed. They connected with an intersex support group in search of advice.

We heard adults telling us that they felt violated, that they had to have multiple surgeries. We were shocked at the horror stories we heard, she said.

When she called their daughters pediatric urologist with their decision not to have their daughters testes removed, she said he was visibly unhappy with their decision. He abruptly ended the meeting.

In the beginning when we made the decision, we were still skeptical. Like, is this real? We were nervous that we only talked with people who were unhappy and rightfully so. But the more we talk about it, the more we feel really strongly against surgeries, she said.

Their daughter could develop secondary male characteristics once she hits puberty, but this is a possibility her parents have accepted. They believe their daughter should decide what she wants to do with her body when shes older.

Dina Matos, executive director of the CARES Foundation, an organization based in New Jersey that offers support for people with Congenital Adrenal Hyperplasia the most common DSD said the organization is not for or against genital reconstructive surgery and that their role is to educate parents and patients.

We always encourage people to get more than one opinion. The one thing we highlight most importantly, is if they decide that surgery is indicated with their child, that they seek out an expert," Matos said. "It really takes the surgeon with significant experience, and we really only refer to three or four surgeons in the country right now.

Meredith Nierman/WGBH News

For some, surgery is never an option. Tatenda Ngwaru, an intersex activist from Zimbabwe, recently moved to the suburbs of Boston.

Some people tried to burn down my father's house and kill all of us. And this was done just because of me, because I have a big mouth, Ngwaru said.

When Ngwaru was born, doctors mistook her enlarged clitoris for a penis. She was raised as a boy for the first 10 years of her life, until doctors discovered she had ovaries. It was what she calls an aha moment she never felt like a boy. But in her small town, going from son to daughter was out of the question.

It had always been treated as an abomination, as bad. Back then they used to say we're the ones who will give bad luck to the community, Ngwaru said.

Her parents, stunned by this news, didnt want her to be bullied, so they urged her to continue wearing a boys uniform throughout high school. It was agonizing.

I remember sleeping at night sometimes and thinking, Couldn't morning just come so that we can get it over with? Or maybe morning shouldn't come at all, because I didn't want to deal with daylight and having to be out and pretending and hiding something. There's nothing as painful as an untold story that you have to hide inside, she said.

Ngwaru waited until she was at college in a different part of Zimbabwe to live as a woman and started Zimbabwes first intersex advocacy organization. But trouble soon followed. She was attacked, her office was raided and her family was threatened.

So she fled for the U.S., seeking asylum from gender persecution. And she thought things would be different here.

I thought, they are promoting transgender lives on their TV shows. Clearly, they must know about intersex. I had a rude awakening. Nobody seemed to know what intersex is. And in America what was most shocking for me are the surgeries that had been done on infants, she said.

Zieselman said she wants attitudes to shift in the way they recently have for transgender people.

With transgender children, what the standard of practice has become is to do reversible procedures first and provide a lot of psycho-social support to the child and family, so no irreversible decisions are made too quickly until the child is really sure about what they want," she said. "Why arent we using the same standard of practice for intersex children?

Massachusetts voters may someday see a push for legislation banning medically unnecessary surgeries on infants. Zieselman said she is in discussion with state lawmakers about proposing a bill "to protect intersex children."

All humans have bodily differences, and if theres nothing making them sick or interfering with their health, then theres no reason to modify them," she said. "Intersex people can grow up without surgery and be happy and healthy.

Correction: A previous version of this story misspelled Kimberly Zieselman's name.

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