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Archive for the ‘Hormone Physician’ Category

Does Sleep Affect Weight Loss? How It Works

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It's true: Being short on sleep can really affect your weight. While you weren't sleeping, your body cooked up a perfect recipe for weight gain.

When youre short on sleep, its easy to lean on a large latte to get moving. You might be tempted to skip exercise (too tired), get takeout for dinner, and then turn in late because youre uncomfortably full.

If this cascade of events happens a few times each year, no problem. Trouble is, more than a third of Americans aren't getting enough sleep on a regular basis. Yet experts agree that getting enough shut-eye is as important to health, well-being, and your weight as are diet and exercise.

Skimping on sleep sets your brain up to make bad decisions. It dulls activity in the brains frontal lobe, the locus of decision-making and impulse control.

So its a little like being drunk. You dont have the mental clarity to make good decisions.

Plus, when youre overtired, your brain's reward centers rev up, looking for something that feels good. So while you might be able to squash comfort food cravings when youre well-rested, your sleep-deprived brain may have trouble saying no to a second slice of cake.

Research tells the story. A study in the American Journal of Clinical Nutritionfound that when people were starved of sleep, late-night snacking increased, and they were more likely to choose high-carb snacks. In another study done at the University of Chicago, sleep-deprived participants chose snacks with twice as much fat as those who slept at least 8 hours.

A second study found that sleeping too little prompts people to eat bigger portions of all foods, increasing weight gain. And in a review of 18 studies, researchers found that a lack of sleep led to increased cravings for energy-dense, high-carbohydrate foods.

Add it all together, and a sleepy brain appears to crave junk food while also lacking the impulse control to say no.

Sleep is like nutrition for the brain. Most people need between 7 and 9 hours each night. Get less than that, and your body will react in ways that lead even the most determined dieter straight to Ben & Jerrys.

Too little sleep triggers a cortisol spike.This stress hormone signals your body to conserve energy to fuel your waking hours.

Translation: Youre more apt to hang on to fat.

Researchers found that when dieters cut back on sleep over a 14-day period, the amount of weight they lost from fat dropped by 55%, even though their calories stayed equal. They felt hungrier and less satisfied after meals, and their energy was zapped.

Sleep deprivation makes you metabolically groggy," University of Chicago researchers say. Within just 4 days of insufficient ZZZs, your bodys ability to process insulin -- a hormone needed to change sugar, starches, and other food into energy -- goes awry. Insulin sensitivity, the researchers found, dropped by more than 30%.

Heres why thats bad: When your body doesn't respond properly to insulin, your body has trouble processing fats from your bloodstream, so it ends up storing them as fat.

So its not so much that if you sleep, youll lose weight, but that too little sleep hampers your metabolism and contributes to weight gain.

In todays world, snoozing can be difficult, particularly when all your screens (computers, TVs, cell phones, tablets) lure you into staying up just a little longer.

The basics are pretty simple:


Alfredo Astua, MD, director of sleep medicine, Beth Israel Mount Sinai, New York.

National Sleep Foundation.


Hanlon, E. Sleep, February 2016.

Nedeltcheva, A. American Journal of Clinical Nutrition, January 2009.

Hogenkamp, P. Psychoneuroendocrinology, September 2013.

Shlisky, J. Journal of the Academy of Nutrition and Dietetics, November 2012.


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Does Sleep Affect Weight Loss? How It Works

Anti-Aging & Regenerative Associates | In The Know | – Hometown News

Question: You are known for your expertise in hormone replacement therapy. What otherareas of medicine do you specialize in?

Answer: I am board certified in primary care, metabolic cardiology, and chiropractic medicine.I am also board certified in physician weightmanagement, anti-aging medicine, aesthetic medicine and physiotherapy. I specialize in anti-aging and regenerative medicine, and I also treat patients who are in need of hormone replacement, cardiac management, mens and womens sexual health, and primary andurgent care. I offer my clients a holistic and personalized approach to healthcare.

Question: People assume that because you dont participate with insurance, yourservices are expensive. Is this true?

Answer: No. Its a misconception as far as pricing. We are able to utilize an individualsinsurance for diagnostic testing and certain medications. The patient pays us directlyfor our services, therefore our time is notlimited with each patient. This allows us to create a dialog and grow a relationship.My goal is to provide health care to everyone regardless of insurance, and our pricesare affordable for everyone.

851 Dunlawton Ave.

STE 104

Port Orange, FL 32127

(386) 366-7418

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Anti-Aging & Regenerative Associates | In The Know | - Hometown News

Effects of early estradiol valerate administration on bone turnover markers in surgically induced menopausal women – BMC Women’s Health – BMC Blogs…

The present investigation showed a significant elevation of bone turnover markers in surgically menopausal women who did not receive estrogen treatment. Despite a short period, an asymptomatic but significantly high bone resorption process occurred within 3 months after surgery.

Bone remodeling consists of two opposing activities: resorption of old bone by osteoclasts and formation of new bone by osteoblasts. The functions of bone remodeling are replacing old bone, regulating calcium homeostasis, acidbase balance, and releasing growth factors embedded in bone. The bone remodeling process is tightly coupled in time and area at the bone basic multicellular unit (BMU) level [25]. Bone turnover markers release into the bloodstream during the bone remodeling process and provide dynamic information regarding skeletal status.

During bone resorption, collagen is degraded by osteoclasts. CTX, a non-helical fragment of type I collagen-containing cross-linking regions, is released by cathepsin K, an osteoclast-specific protease. The native form of CTX undergoes spontaneous isomerization, which is attributed to protein aging [26]. They circulate in the blood and are partly excreted in the urine. Bone resorption displays circadian variation. CTX shows the highest diurnal amplitude among the BTMs with a peak at 05.00h and a nadir at 14.00h. Consumption of breakfast reduces serum CTX by 40% [25]. The secretion of the glucagon-like peptide probably mediates this effect of feeding [27]. Therefore, blood for its measurement must be collected in the fasting status in the morning (between 7 and 10 am). It is inadvisable for some patients (such as those with diabetes) in clinical practice and restricts clinic attendance to morning appointments.

Surgical removal of both ovaries in women before menopause leads to an abrupt declination of circulating estrogen levels [6]. From a previous study, serum CTX was elevated as soon as a month after surgery. Serum CTX levels were continuously elevated until 6 months after surgery. Furthermore, they found a significant negative correlation between bone turnover markers levels and lumbar spine bone mineral density (BMD) at preoperative and 6 months after surgery [14]. In another study, bone resorption and formation markers were raised 3 months after the surgical menopause procedure. However, bone markers levels declined to the baseline levels after menopausal hormone prescription for 3 months [23].

In terms of bone formation marker, we selected serum P1NP as the outcome measurement according to the IOF recommendation. Osteoid, composed of type I collagen, is formed in the early phase of bone formation. Procollagen is a trimer of two 1 and one 2 chain. The PINP is cleaved from procollagen molecule before an assembly of type I collagen molecules into fibers [28]. Although type I collagen is not specific to the bone, most circulating PINP originates from it. P1NP is released into circulation and offers several clinical advantages, including low circadian variation and stability at room temperature. Moreover, P1NP levels are not significantly influenced by dietary intake, and, consequently, patients do not need to be fasting [27]. In a previous study, serum P1NP levels were inversely associated with BMD for the lumbar spine, total hip, and femoral neck even after controlling for age, BMI, and years since menopause. P1NP level was significantly higher in postmenopausal women with osteoporosis compared to those with average bone mass. However, in clinical practice, its low specificity does not warrant utility in osteoporosis diagnosis [29].

Estrogen is essential for the maintenance of sufficient bone mass in reproductive age. Bone resorption and formation were modulated and balanced by circulating estrogen levels. Estrogen activates the synthesis of osteoprotegerin (OPG), the decoy antibodies which neutralize the receptor activator of NF-B ligand (RANKL) and inhibits RANK expression (receptor of RANKL). Responses to estrogen result in inhibition of differentiation and activation of the osteoclasts. Furthermore, estrogen modulates proinflammatory cytokines such as IL-1, IL-6, TNF-, and PGE2, reducing the pool of osteoclast precursors. The minor estrogenic mechanism on bone is regulated TGF- expression results in apoptosis of osteoclasts [30]. According to all mechanisms mentioned above, estrogen deprivation is a major detrimental factor on bone physiology. Besides, many studies demonstrated the positive effects of menopausal hormone treatment on bone turnover markers, BMD, and fracture prevention in postmenopausal women [31,32,33,34].

As the primary outcome in the present study, there were no notable changes in serum CTX and P1NP levels at 12weeks in the hormone treatment group compared to baseline. In contrast, serum CTX and P1NP levels were significantly elevated among women who did not receive hormone treatment. In other words, early administration with moderate-dose estrogen could inhibit abnormal bone resorption from acute estrogen deprivation. In secondary outcomes, serum CTX and P1NP levels at 12weeks after surgical menopause procedure were statistically different between the two groups. The 55% lower median serum CTX level than in the no-treatment group is statistically and clinically significant. The timing of hormone initiation might be an essential issue. In our study, hormone therapy was initiated proximately 2 weeks after surgery. In contrast, Peris et al. study [23] started hormone therapy 3 months post-surgery. The differences between our outcomes and Peris et al.'s finding are partly due to the timing of menopausal hormone initiation.

It should be noted that sixteen out of the total 48 women in our study had moderate to severe hot flushes as early as 2 weeks after oophorectomy. Hence, MHT could be considered as soon as possible in women who has MHT indication. The benefit of MHT in this condition is for improving the quality of life and protecting against accelerated bone loss. However, some clinicians may concern about the risk of venous thrombosis with MHT in the early postoperative period, especially in cases of obesity, metabolic syndrome, and advanced age patients. Transdermal estrogen administration with optimum dose is preferred to minimize the thrombosis risk in these patients.

In terms of treatment effects, we showed that early administration of 2mg of oral estradiol valerate significantly suppressed the bone remodeling process. However, a conclusion cannot be made for all oral MHT products in the market. Many available products around the world are 1mg of estradiol plus a variety of progestins. The lower dose of other estradiol products and estrogenic counter-action of various progestins may dramatically affect bone outcomes.

Each participant was evaluated and allocated to the hormone treatment group by FDA-approved MHT indication in the present study. Estradiol valerate 2mg/day was prescribed for 16 women who had moderate to severe hot flushes and five women diagnosed with early menopause at the time of surgery (age<45years). Although early menopause was associated with bone loss in general perception, there was no significant difference in bone turnover markers concentration across quartiles of patient age [29]. To the best of our knowledge, no study confirms a direct association between hot flush symptoms and bone turnover marker concentration. We attenuate selection bias risk by strictly allocating each participant to the hormone treatment group, depending on MHT indication. All participants and a physician assigned treatment did not know baseline bone turnover marker levels at the day of allocation.

Although elevation of bone turnover markers was associated with low BMD and increased risk of fractures, there are many limitations in interpreting bone turnover markers in clinical practices. The biologically interobserver variation, intra-individual variability, analytic reliability, and poorly defined abnormal cut point levels are issues of concern in clinical utility. Vitamin D levels, sunlight exposure, history of fractures over the preceding 12months, vigorous physical activity, and year should be considered and carefully considered for the interpretation of results. Moreover, the changes in the bone turnover markers are the only representative of bone metabolism; they cannot be used for diagnosing osteoporosis. Dual-energy X-ray absorptiometry for bone density measurement is the standard method used in clinical practice and osteoporosis research. Nowadays, bone turnover markers are primarily used for patients with poor responders, nonadherence to therapy patient identification [35], and can be used as indicators to restart treatment after the bisphosphonate drug holiday period [36].

There are incongruences in data interpretation and recommendations of estrogen therapy and bone, especially for postmenopausal osteoporosis. In the age group 5060years or within 10 years after menopause (the window of opportunity concept), the benefits of MHT are most likely to outweigh any risk. Based on the International Menopause Society (IMS) recommendations on women's midlife health and menopause hormone therapy, MHT can be considered first-line therapy in postmenopausal osteoporosis [37]. On the contrary, the North American papers, the American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines (AACE/ ACE) for Diagnosis and Treatment of Postmenopausal Osteoporosis 2020 stated that estrogen was never approved explicitly for postmenopausal osteoporosis. Estrogen is only approved by the US FDA to prevent postmenopausal osteoporosis and should only be used for women at significant risk of osteoporosis and for whom non-estrogen medications are not considered appropriate [38].

Traditionally routine salpingo-oophorectomy at the time of hysterectomy should be revisited, especially in pre and perimenopausal women, because the lifetime risk of developing ovarian cancer in the general population is only 1 in 70 or 1.4% [39], physicians should make sure that their counseling about risks and benefits is based on current evidence. The reduction of ovarian cancer risk, avoid possible morbidities and future surgery of ovarian disease are the significant potential benefits of salpingo-oophorectomy at the time of hysterectomy. However, these potential benefits must be balanced with the consequences of premature loss of circulating estrogen including, bone loss, hot flushes, cognitive impairment, sexual desire loss, and long-term survival rate [39]. This research emphasized this concept. Forty-nine percent (20/41) of women in our cohort did not receive MHT for bothersome vasomotor symptoms and early menopause indication. These women lost their bone significantly as early as 3 months after surgery. Careful clinical evaluation, lifestyle modification for bone health, and long-term follow-up for bone density and/or quality measurement should be considered. In the present study, we gave patients as much information as possible about the risks and benefits of salpingo-oophorectomy at the time of hysterectomy. Based primarily on patient autonomy, the decisions to do salpingo-oophorectomy were made by participants with adequate information from physicians. In our experiences as a medical school center in Thailand, we found that 3040% of advanced age premenopausal and perimenopausal women accepted and decided to remove their ovaries at the time of hysterectomy for benign gynecological conditions. However, bone measurement was offered only in a minority of these patients.

Finally, due to the possible effects of participant age on baseline bone turnover marker levels, we made an additional analysis of the correlation between age and bone turnover markers. However, there was no significant correlation between the serum CTX and age at surgical menopause in both hormone treatment and no treatment group, r=0.28 p-value=0.22, and r=0.14 and p-value=0.56, respectively. In the same way, there were no significant correlations between serum P1NP and age at surgical menopause in both hormone treatment and no treatment group, r=0.01 p-value=0.97 and r=0.08 p-value=0.72, respectively.

There were limitations of this study. As a nonrandomized design, we could not match the baseline prognostic factors between the two groups. This study type cannot eliminate selection bias. The randomized controlled trial to prove this hypothesis should be considered in further study. Because bone turnover markers can be involved by various factors, such as vitamin D status, sunlight exposure, vigorous physical activity, patient's medical data, and history of recent fractures should be recorded and carefully considered.

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Effects of early estradiol valerate administration on bone turnover markers in surgically induced menopausal women - BMC Women's Health - BMC Blogs...

Is the ‘diet’ in diet drinks a ‘false promise?’ Here’s what one study suggests. – The Daily Briefing

The artificial sweeteners used in diet drinks may stimulate the appetite and cause increased cravingsespecially for women and people with obesity, according to a study published in JAMA Network Open.

Want to help your patients lose weight? 3 reasons why commercial diet programs alone won't cut it.

For the study, researchers conducted a randomized crossover trial involving 74 participants over the course of three visits to determine if higher BMI and female sex are associated with increased brain reward activity or hunger response.

All participants were right-handed, nonsmokers, non-dieters, not taking medication, had a stable body weight for at least three months, and had no history of eating disorders, illicit drug use, or medical diagnoses. In addition, 58% of study participants were women. The average age of participants was 23.40 years old, and the BMI range was 19.18-40.27.

Notably, according to the study, most previous research on diet soda has focused mainly on males and people of normal weight.

As part of the randomized crossover design, participants consumed drinks containing sucrose, sucralose, or water. Then, the researchers measured the participants' responses to diet soda three ways, including:

According toKatie Page, a physician specializing in obesity at the University of Southern California and co-author of the study, the results showed that "females and people with obesity had greater brain reward activity" after they consumed the artificial sweetener.

Both females and people with obesity also experienced a reduction in the hormone that inhibits appetiteand they consumed more food after they had drinks with artificial sweeteners, compared with after they had drinks with sugar.

In comparison, male participants and people of healthy weight didn't experience an increase in brain reward activity or hunger response, which the researchers said suggests they aren't affected in the same way.

"I think what was most surprising was the impact of body weight and biological sex," Page said. "They were very important factors in the way that the brain responded to the artificial sweetener."

While some previous studies have shown benefits of artificially sweetened beverages, long-term research suggests that diet soda consumption islinked to increased weight gainand experts said the latest study should shed some light on this "false promise," NPR's "Shots" reports.

"This study offers some clues as to why," Laura Schmidt, a professor of health policy at the University of California, San Francisco, said. "Artificial sweeteners could be priming the brains of people with obesity to crave high-calorie foods," thereby disadvantaging people who may benefit most from a lower-calorie diet.

According to NPR's "Shots," one hypothesis as to why this disconnect occurs posits that the body may be confused by artificial sweeteners, making it believe sugar is coming.

As Susan Swithers, a behavioral scientist at Purdue University who was not involved in the study, put it, we're "supposed to get sugar after something tastes sweet. [Our bodies have] been conditioned to that." As a result, when we consume artificial sweeteners and the sugar never comes, our body's anticipatory responses are confusedwhich could throw off our ability to efficiently metabolize sugar that we consume later.

If this consistently happens to individuals who drink diet soda, it could increase the risk of Type 2 diabetes because when blood sugar rises, so does the body's insulin levels, Swithers added. "So what you're doing is you are kind of pushing the system harder," she said.

Given the results from this new research, Schmidt suggested, "People with obesity might want to completely avoid diet sodas for a couple of weeks to see if this helps to reduce cravings for high-calorie foods." (Aubrey, "Shots," NPR, 10/7; Yunker et al., JAMA Network Open, 9/28)

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Is the 'diet' in diet drinks a 'false promise?' Here's what one study suggests. - The Daily Briefing

Cracking the Egg Donation Market – The Regulatory Review

The booming U.S. egg donation industry requires more regulation to safeguard donor welfare.

Earn up to $50,000 dollars! Help a family! Donate your eggs!

Such slogans appear regularly on college bulletin boards and the social media feeds of many young women across the United States, advertising the altruisticand financialbenefits of donating their eggs to would-be parents.

But behind these advertisements lies a poorly regulated industry that buys and sells human eggs, with potential negative health effects for donors.

Unlike countries such as the United Kingdom and Canada, the United States has no federal regulations that specifically address advertising to potential egg donors. No U.S. agency tracks the long-term health effects of egg donation. And there is little oversight of the donation processwhich involves injecting someone with hormones for at least ten days, and then piercing the vaginal wall with a thick needle to extract eggs from the ovary.

Initially, it may seem that egg donation businesses are at least somewhat regulated. The U.S. Food and Drug Administration (FDA), after all, oversees any establishment that recovers, processes, or distributes human reproductive tissue, including eggs. These clinics must register with FDA and list their tissue-based products in accordance with federal standards, which also require that egg donors be tested for infectious diseases.

But although FDA has published guidance documents on egg donor eligibility, it has taken few steps to ensure that donors are treated fairly by egg donation businesses. In short, FDA regulates who can be an egg donorbut does not regulate how the for-profit egg donation industry treats donors.

And although payments for organ donation have been outlawed in the United States since 1948, paying egg donors is entirely legal. Economic inducements are potentially limitless, despite egg donation businesses insistence that the industry is driven by altruism and women helping women.

Certainly, the thousands of donors who pay off student loans and other expenses through egg donation payments understand the industrys economic value. Compensation for a single donation can range from about $5,000 to $50,000depending on factors such as a donors physical profile, SAT scores, and athleticism.

The advertisements that recruit these donors are also underregulated. Although federal agencies enforce general truth in advertising laws, rarely if ever have these general requirements been applied to advertising for egg donors. Only one state has moved to clarify what truth in advertising means in the egg donation context. Passed in 2009, a California law requires that egg donor advertisements with compensation information must also feature warnings about health risks.

Unfortunately, such health risks may be haphazardly disclosed and are not well-studied. A survey of egg donors concluded that most donors were not informed fully of health risks prior to their donation. Short-term side effects from donationsuch as bleeding and infectionsare often not reported, as clinics rarely follow up with donors. Although some donors later report health problems such as ovarian cysts and infertility issues, the potential long-term risks of egg donation are not well-known. Some studies have also linked an increased risk of cancer with hormone stimulation of egg production.

These uncertainties persist as the egg donation market continues to grow. The number of women donating their eggs soared from 10,801 in 2000 to 18,306 in 2010a 70 percent rise, motivated in part by the growing practice of delaying pregnancies and an increasing demand for assisted reproductive technology. By 2018, industry analysts valued the U.S. market for egg donations at $487 million. Prominent egg donation businessesbearing names such as Extraordinary Conceptions and Premier Egg Donorshave engaged in a series of investor-driven mergers and acquisitions in recent years.

Yet government regulation has failed to keep pace with this industry growth. Two professional organizations have tried to create self-regulatory guidelines for egg donation businessesbut only with mixed success.

The Society for Assisted Reproductive Technologys minimum training standards for clinic employees have been largely uncontroversial. But another organization, the American Society for Reproductive Medicine (ASRM), faced litigation after it attempted to restrict egg donor compensation. ASRM advised that payments above $5,000 require justification and that sums above $10,000 are not appropriate. In response, four egg donors sued the organization, arguing that the price caps undercompensate women for a painful and risky procedure. After four years of litigation, in 2016 the organization agreed to strip the financial caps from its guidelines.

ASRM also insists that egg donors are owed the same duties present in the ordinary physician-patient relationship. But the egg donation model complicates this duty of care, as doctors employed by egg donation businesses are financially motivated to ensure that women donate their eggs. One researcher posing as a potential egg donor observed that physicians were focused primarily on the infertile recipients of the eggsand less on the donor undergoing invasive surgery.

These ethical issues in the egg donation industry may be addressed by a variety of regulatory solutions. The U.S. Department of Health and Human Services could establish a National Egg Donor registry and initiate more government-funded studies on the long-term effects of donation. Such efforts may provide potential donors with unbiased information, rather than forcing them to rely on egg donation businesses for advice. In addition, the Department could use rulemaking to elevate private health organizations physician-patient care and compensation cap guidelines into federal law.

On a more structural level, the fragmentation of the U.S. healthcare system may impede better tracking of the health effects of egg donation. The uninsured, financially driven donation process used by U.S. egg donation businesses disconnects donors from their general healthcare provider. In contrast, by prioritizing the health of donors and providing insurance coverage for egg donation, Scandinavian countries with nationalized health care systems have produced robust data on the health effects of reproductive technology procedures.

Although the future of egg donation regulation may be uncertain, for now it is clear that the allure of up to five-figure payments provides fertile ground for ongoing ethical and medical concerns that merit better regulation to protect donors.

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Cracking the Egg Donation Market - The Regulatory Review

See the Presentation Menopause Startup Alloy Used to Raise $3.3 Million – Business Insider

In 2019, Anne Fulenwider, a former Marie Claire editor-in-chief, was surprised while speaking with her friend Monica Molenaar, who'd had her ovaries removed as a preventive measure against breast cancer. The procedure essentially kick-starts menopause Fulenwider explainedto Insider, but Molenaar hadn't been able to find suitable options for treating her new symptoms, like hot flashes, for nearly five years.

"I couldn't believe that it took her five years to figure it out," Fulenwider told Insider. "I just thought we have to fix this."

In 2020, Fulenwider, 49, and Molenaar, 47, cofounded Alloy, a direct-to-consumer digital-health company that treats menopause symptoms. On Wednesday, the company raised $3.3 million in seed funding from PACE Healthcare Capital and Kairos HQ, where the two women had incubated the company.

"This group of millennial men said, 'Yes, we've been looking at this space,' and I just about fell off my chair," Fulenwider said of starting the company with Ankur Jain, Kairos HQ's cofounder and CEO.

Alloy is still a rarity. While women's-health companies have broken fundraising records this year, Rock Health's third-quarter report said, menopause startups remain overlooked, Fulenwider said.

Alloy says it's working with a select group of customers in a small trial phase and plans to fully launch its website and mail-order hormone treatment in November. Fulenwider said Alloy planned to start by using low-dose estrogen to treat hot flashes, the most-complained-about menopause symptom among the women she knew. Over time, she hopes to add treatments for the full range of menopause symptoms, which can include weight gain and mood changes.

Alloy provided Insider the presentation it used to raise the seed funding from Kairos HQ and PACE Healthcare Capital. The presentation has been edited to remove sensitive financial data and outdated information.

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See the Presentation Menopause Startup Alloy Used to Raise $3.3 Million - Business Insider

Letters To The Editor: Oct. 12, 2021 – The Rhino Times of Greensboro – The Rhino TImes

Questions About Vaccines

Dear Editor,

I am not anti-vaccine. However, I believe the COVID-19 vaccine being so new (heck, COVID has only been around for less than three years) should be something an individual decides along with their physician if it is right for them.

We dont know the long term effects of COVID, much less the long term effects of the COVID vaccine.

When the chicken pox vaccine first came out my pediatrician advised against giving it to my children. Their reason, it was unknown at that time how long the vaccine would last and chickenpox in children is less severe than getting it as an adult. Now it is a vaccine routinely given and was given to my grandchild.

There are several things that were deemed safe when they first came out but proved problematic in the long term. Thalidomide, DES (diethylstilbestrol), hormone replacement therapy for all women and heroin as the safe way to get off opium are just a few examples.

There are so many aspects of the policies and mandates that dont make sense. Why was hydroxychloroquine not allowed to be given when COVID first appeared? It was a drug that had been around for years, the side effects were well known and physicians could have prescribed off label use. It became forbidden to prescribe or dispense for COVID. Why? Same thing happened with ivermectin. What other disease have we forbidden doctors to use treatments they feel are in the best interest of their patients? Why are we not studying how long immunity may last if someone recovers from a COVID infection?

Covid has been around for almost two-and-a-half years and we are still proclaiming emergency orders. Why? The greater good? I know a lot of people look with derision upon those espousing individual freedoms over the greater good, but our country was founded on upholding individual freedoms. Young people have been shown to be very unlikely to get sick with COVID. The vaccine can produce severe long lasting effects on this cohort yet we are pushing mandates on this age group. Why?

The unvaccinated are being blamed for the spread of COVID and its variants. How do we know for sure vaccinated people cant spread COVID? What about the possibility that universal vaccine may cause a more virulent mutation of the virus since the current vaccine only causes an immune response to the spike protein? What happens if the virus mutates to evade that? What does over vaccination cause? Viruses have been mutating for years and if this is a man engineered virus how do we know more rapid mutations arent part of the process?

There are many things we could force people to do for the greater good. Giving blood comes to mind. It would save millions of lives. What about forced organ donation? Is it really such a leap from the mandates now in effect?

If COVID scares you beyond living then you can isolate yourself but please dont force me. I recommend washing hands, disinfecting surfaces, getting vaccinated if you want (it has been proven to be an excellent idea for specific groups) and spending a lot of time outdoors if you are able.

We can choose to live in fear or we can choose to live. Let us not give up our right to choose.

Susan Smoot

Universal Vaccine Mandate Needed

Dear Editor,

To prevent further spread of the coronavirus, we should require everyone to get fully vaccinated, (including a possible third dose) unless exempted by a sincerely held religious belief or medical condition. We should write to our legislators and executives at all levels of government.

Alvin Blake

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Letters To The Editor: Oct. 12, 2021 - The Rhino Times of Greensboro - The Rhino TImes

Why The Fertility Cliff Concept Needs To Go, According To Doctors – Women’s Health

Tick, tick, tick. If you, like me, are a woman in her childbearing years, you may recognize that sound as your biological clock.

The noise isnt so bad in your mid-to-late 20s, a faint hum, maybe. But once you turn 30, the volume gradually turns up, and if youre anywhere around the age of 35, the ticking has likely turned into a booming echo that drowns out a lot of other stuff.

Its a still-common belief for many women that they need to have their reproductive life figured out before the big 3-5, out of fear that their ability to get pregnant and stay pregnant will take a massive hit and only get grimmer from there. And that age has been referred to as the fertility cliff, by medical experts, articles, you name it. Anyone who is 35-plus is considered to be of advanced maternal age and experiences a geriatric pregnancy in (quite harsh) medical terms. Women structure their lives around that dreaded numberwhich is not old at all in the grand scheme of things!

The pandemic only made matters worse for anyone with a shred of anxiety who was considering kids. For many, 2020 felt like a year when they couldnt move the dial forward or make any personal progress, says Taraneh Nazem, MD, a reproductive endocrinology and fertility specialist in New York. The worries led to increased interest in fertility preservation services, like egg and embryo freezing, in the past year. One clinic example: At Shady Grove Fertility (which has several dozen locations in the U.S.) there was a 50 percent jump in the number of egg freezing cycles started between June and November 2020, compared to the same time period the year before.

But the truth is, what we *think* we know about a womans age and fertilityand the root cause of much of this time-clock stressis, uh, pretty inaccurate. More and more experts are coming forward to say the research that the fertility cliff is originally based on is actually outdated, and point to newer studies that show much more promising results. Take this one out of the University of North Carolina School of Medicine that found that 81 percent of 38- and 39-year-old women (who had been pregnant before) got pregnant naturally within a year of trying at those ages. Eighty-one percent! That development is just one of many reasons you should detangle yourself from the cliff conceptand the heavy anxiety that comes with it. Instead, let doctors explain the latest perspectives; their take should leave you feeling assured and empowered about your future outlook.

Sure, its true that fertility (a.k.a. the quantity and quality of your eggs) declines as you age. But theres a big misconception that that happens significantly and universally at 35, says W. Spencer McClelland, MD, assistant professor of obstetrics and gynecology at Denver Health/University of Colorado. In fact, in one of the largest studies on fertility and age in Fertility and Sterility, researchers studied the length of time to conception, and found that while 84 percent of women ages 20 to 34 will get pregnant within a year of trying, that number is 78 percent for women who are 35 to 40on average, not a big differenceand still good chances!

Fertility is much more individual than people realize, says Dr. McClelland. For some, 30 could be the age at which things become more difficult; for others, it could be 45. Whats more, a variety of factors play a role in fertility, a few being lifestyle-driven, says Jaclyn Tolentino, DO, a physician at Parsley Health who specializes in hormone optimization. Its hard to know if someones struggles are age-related or whether they would have had them if they started trying to conceive when they were younger too, Dr. McClelland adds.

So why is 35 seared into our brains as the time when chances plummet? First, the emphasis placed on 35 as advanced maternal age comes from outdated research related to pregnancy complicationswhich is not the same thing as fertility, or the likelihood of getting pregnant, says Dr. McClelland.

Lets take a trip down memory lane, shall we? In the 70s, genetic testing became more widely available for women to find out about chromosomal abnormalities in the fetus (mainly, ones that indicate Down syndrome), and doctors had to determine when it was worth recommending that women have these tests. The risk of genetic abnormalities goes up with a pregnant persons age, but the test is invasive and can lead to miscarriage, so it only made sense to recommend it when the odds of Down syndrome were higher than the risk of miscarriage from the testing procedure. That tipping point, as you can guess, ended up around age 35. But what we know about the test has changed since then, says Dr. McClelland, and alsoit doesnt have much to do with fertility or pregnancy complications.

Yet the idea of 35 being advanced maternal age stuck, and several population studies on fertility furthered the notion, but again, not in the way you might assume. They tended to show that the risk of infertility as well as miscarriage, conditions like preeclampsia and gestational diabetes, and fetal chromosomal abnormalities climbs more significantly at 35. But the numbers dont skyrocket. The perceived change in fertility is much more extreme than the reality of it, says Dr. Nazem.

Also alarming: The studies reported on in the past are based on (disturbingly) antiquated research. Its commonly stated that one in three women ages 35 to 39 will not be pregnant after a year of trying, but those stats are based on a study from 2004 that uses French birth records from 1670 to 1830 (!). Seems borderline impossible to believe, but we still rely on historical data in the fertility discussion because its difficult to perform large and accurate studies on the topic.

This isnt to say that fertility and complications shouldnt be a concern at all for women as they agesimply that the level of concern may be overblown, says Dr. Nazem, particularly when it comes to the ease of getting pregnant. Its important to be aware of risks you may be facing, yet also understand that stressing about how your age might impact your pregnancy isnt helpful either.

So, despite what weve been taught, doctors and researchers do know that a woman doesnt go from perfectly fertile at 34 to suddenly doomed to struggle at 35. But, for the sake of simplicity, many docs treat 35 as a time when pregnant women become high-risk based on age, not individual health and history, and offer increased testing throughout those pregnancies.

This would seem harmless and maybe even like a good idea, but again, testing comes with its own risks. For instance, women who are 35 or older are often told to have extra ultrasounds to check their babys progress, says Dr. McClelland. Essentially, early testing may detect an abnormality that, for some women, will clear up before routine testing, and that can unnecessarily prompt another test that can increase risk of miscarriage, as well as anxiety. Theres something to be said for the pressure women feel about trying to conceive or becoming pregnant at 35 and beyondthat anxiety might be more detrimental to fertility and pregnancy than age itself. Stress certainly doesnt help overall health, fertility, and pregnancy, says Dr. McClelland. And people arent even worrying for a valid reason.

This perception may be so prevalent because fertility specialists, in particular, are constantly surrounded by people who are having fertility troubles, so theyre more likely to be aggressive in how they counsel anyone coming in with concerns about their future. Theres also the fact that no one wants to have a patient who regrets not taking action. Its always easier to do something than do nothing when it comes to testing and treatment, says Dr. McClelland. If you try, and something goes wrong, that feels more defendable than trying nothing, and something still going wrong, even though often, doing nothing is the smarter move. Its also undeniable that fertility is a $25 billion dollar industry globally that, while life-changing for some, leaves others feeling disappointed.

Information Overload Knowing that fertility is incredibly individual, the idea of testing it probably sounds pretty great. Several at-home kits and fertility clinics promise to help you see where you stand. Unfortunately, they cant actually tell you much.

One common test in question is the anti-mllerian hormone (AMH) blood test, which is meant to determine ovarian egg reserve (how many eggs you have left). Studies show these tests are notoriously unreliable, says Dr. McClelland.

They can only tell you if your reserve is above or below whats normal for the decade of life youre in, and theres no way to know how it might change. And your reserve says nothing about egg quality. Evaluating fertility is a bit of a misnomer, says Dr. Nazem. It can really only be proven by trying to conceive. One way to get data on how that might go? Track your cycle, says Dr. Tolentino. Irregular periods, heavy bleeding, painful cycles, and PMS can indicate issues (diagnosed or not) like PCOS, endometriosis, or fibroids, which can make getting and staying pregnant harder.

Look, everybody wants to put the ticking to rest. But worrying about your age, testing your fertility, and planning your life around those things isnt the way to do that. What it really comes down to is accepting that the ease with which youll be able to conceive and have a healthy pregnancy is a bit of a mysterybut its actually more likely that youll have success at any childbearing age. And hopefully that provides some relief.

If were going to let population data guide us, we should feel optimistic, because chances of getting pregnant on your own are still very high from 35 to 40, says Dr. McClelland. Think back to that positive stat from earlier: If you ask me, an 81 percent chance of getting pregnant is really good odds, says Dr. McClelland. Most people dont believe theyre in that group, and as medical professionals, we need to rewire that automatic pessimism. A lot of those assumptions come from the fact that youre more likely to hear about fertility struggles than someone who got pregnant quickly when they were older because thats just not talked about, he adds. For every patient I have who is 37 or 38 and trying for the first time and having trouble that may or may not be age-related, I have 10 to 20, if not more, stressing out about issues they think theyre going to have, but dont, says Dr. McClelland. I cant tell you how many patients have gone through unsuccessful IVF then gotten pregnant naturally; theyd pulled the trigger for IVF after only six months or a year of trying, which probably wasnt quite long enough, but everyone is afraid to keep trying because they think their chances will only get worse.

Ultimately, the decision of when to have kids and preserve your fertility, if at all, is an extremely personal one, and no one wants to have any regrets about not trying every single option they could have put into place when they were younger. But one thing is for sure: Fertility is much more complex than weve been made to believe, and the constant obsession and ongoing discussion about how age will impact it doesnt actually seem to be helping anyone. So once and for all, lets put the idea of falling off the fertility cliff to bed. Taking a walk down a gradual hill seems like a more accurate metaphorand sounds much better to me.

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Menopause Symptoms Predict Risk of Heart, Memory Trouble – Everyday Health

New research presented at the 2021 North American Menopause Society (NAMS) Annual Meeting in Washington, DC, held September 2225, 2021, highlighted how many of the conditions and symptoms experienced in menopause are linked, and how they may impact our health as we age.

New data identified a link between the density of the fat around the heart and cognitive function in midlife women, and how it might affect Black women differently.

The findings provide further clues on how the declining cardiovascular health that happens after menopause may contribute to the increased prevalence of dementia in women. Nearly two-thirds of Americans with Alzheimer's are women, according to the Alzheimers Association.

What's new We know that fat around the midsection, including the heart, isnt good, says Stephanie S. Faubion, MD, the director of the Center for Womens Health at the Mayo Clinic in Rochester, Minnesota. Waist circumference alone is an important marker for cardiovascular disease; even normal-weight women who have a thicker waistline are at higher risk, she says.

RELATED: 12 Ways to Beat Menopausal Belly Fat

Research details In this new study, investigators used data fromSWAN (Study of Women's Health Across the Nation) to assess the associations of heart fat volume and radiodensity (the density of fat measured with a special machine) with future cognitive performance among midlife women.

Of the nearly 500 participants, 30.6 percent were post-menopausal and 35.9 percent were Black. Racial differences in the associations were specifically analyzed to further investigate a seeming contradiction; on average, Black Americans have lower cardiovascular fat volume but have a higher risk of heart disease and a higher prevalence of Alzheimer's disease compared with white Americans, according to the researchers.

Study results showed that a higher perivascular adipose tissue (PVAT) radiodensity (higher density) was significantly associated with a worse performance in working memory. Researchers also found a significant interaction between fat around the heart and race. A higher baseline PVAT radiodensity at midlife was associated with lower future performance in verbal episodic memory among Black women, but not white women. Those associations remained even after researchers controlled for the volume of heart fat, as well as waist circumference and other known confounders.

RELATED: Sexual Violence Can Have Long-Term Physical Effects

Why it matters This study is furthering our understanding about fat around the heart, says Dr. Faubion, who is also the medical director of theNorth American Menopause Society (NAMS). Its not just how much fat, but also the quality of fat around the heart that could determine health risk, and not just for heart disease; now were seeing it connected to dementia risk, too. Its all tied together, she says.

A higher vascular risk is bad for the brain because a lot of dementia risk really has to do with blood vessel health, adds Faubion.

RELATED: Help for Midlife Hair Thinning, Hair Loss

The results suggest that the density of fat around the heart could serve as a novel biomarker of cognitive function status in women later in life, says Samar El Khoudary, PhD, MPH, a researcher at the University of Pittsburgh School of Public Health and a lead author of the study. Dr. El Khoudary has published other studies that look at heart fat accumulation in women and how it impacts the arteries.

We still need more research to better understand what we have reported. At this stage, we can only stress the importance of thinking about risk factors of heart diseases, including visceral fat around vasculature, as shared risk factors that could also be related to brain health, she says. Interventions that address these shared risk factors may benefit both the heart and the brain, adds El Khoudary.

Right now, we dont know why higher density fat is worse, says Faubion. It may be because its more active, she says.

Is fat density modifiable or is it more like breast tissue density and cant be changed? Thats a good question. I dont know if you can change the density of the fat, says Faubion. Given what we currently know, the goal should be to have a healthy amount of fat, she says.

RELATED: Predicting How Long the Menopausal Transition Will Last, and When Youll Reach Menopause

Even if you spend eight or nine hours in bed, you may still accrue poor-sleep-related outcomes unless you fix your WASO, saidHadine Joffe, MD, the executive director of the Connors Center for Womens Health and Gender Biology, who presented on the topic during a symposium at NAMS.

What's new WASO, short for "wake time after sleep onset," is associated with adverse consequences for mental health, daytime well-being, and metabolic health for women during midlife, said Dr. Joffe, who is also the director of the Womens Hormone and Aging Research Program at Brigham and Womens Hospital and Harvard Medical School, during her presentation.

Research details Data suggests that menopause-pattern sleep fragmentation may impact metabolism and contribute to an increase in body fat, which happens in about half of all women during and after menopause, she said.

The focus has always been on getting enough sleep; we always ask, Have you been getting at least seven hours of sleep? says Kristi Tough DeSapri, MD, an assistant professor of medicine at Northwestern University and a physician at the Northwestern Medicine Center for Sexual Medicine and Menopause in Chicago.

Thats often the public service message that is out there get enough sleep but during the menopause transition it may be more beneficial to focus on sleep quality, she says. Finding ways to improve sleep efficiency, less waking during the night, whether thats from menopause symptoms or other reasons, are important to consider, rather than simply the number of hours we sleep, says Dr. DeSapri.

RELATED: To Boost Your Sex Life, Try Getting Better Sleep

Why it matters There is a connection between menopausal symptoms, such as hot flashes and night sweats, and WASO, and it might be appropriate to try hormone therapy or management of hot flashes to address those, says Faubion. There are also a number of reasons that have nothing to do with your health that could interrupt your sleep as well, everything from your partner snoring to your old dog getting up to pee every hour, she says. Alcohol, bladder issues, and mood may also be behind interrupted sleep, says Faubion.

WASO is absolutely worth working on either on your own or with the help of your provider, she adds.

A new study from Mayo Clinic confirms a link between a history of migraine and hot flashes and highlights the association of both phenomena with an increased risk of heart disease.

A prior study from SWAN showed a connection, and we wanted to see if our data would corroborate that finding, says Faubion, the lead author of the study.

RELATED: New Therapies for Hot Flashes Are on the Horizon

What's new We found that the correlation between hot flashes and migraine was significant, and the correlation with the severity of hot flashes was significant: The more severe your hot flashes were, the more likely you were going to report severe migraines, says Faubion.

Research details The cross-sectional analysis used theData Registry on the Experiences of Aging, Menopause, and Sexuality (DREAMS), which was completed by women ages 45 to 60 who visited one of the Mayo Clinic locations in Minnesota, Arizona, and Florida. A total of 3,308 women were included; the population was 94.5 percent white, 93 percent had at least some college, and 27 percent reported a history of migraine.

The nature of the relationship is still unknown, Faubion says. Its also unclear [whether] migraine and hot flashes are separate things that are both tied to heart disease risk or if they share a common pathophysiology, says Faubion.

RELATED: Coping With Hot Flashes and Menopausal Symptoms: What 10 Celebrities Said

Why it matters These findings could help us be more proactive in offering treatment and lifestyle interventions for menopause symptoms in women with a history of migraine, she says.

More research is needed to determine whether having both a history of migraine and hot flashes in midlife predict greater heart disease risk than either factor on its own, and whether these female-specific factors could be used to enhance the accuracy of CVD risk calculations for women, says Faubion.

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Superfoods to Help You Sleep – AARP

Superfood No 4: Tart cherry juice

Tart cherries have a high dietary melatonin concentration and have also been shown to exhibit anti-inflammatory characteristics that may be beneficial in improving sleep quality, explains Kristine Dilley, a registered dietitian at TheOhioState University Wexner Medical Center. One small Louisiana State University study found that drinking 8 ounces of tart cherry juice twice a day for two weeks increased both sleep time and sleep efficiency in adults with insomnia. Another study had 20 volunteers drink tart cherry juice or a placebo for seven days. Those who drank the cherry juice had significantly higher melatonin levels than those who didnt.

As tart cherry juice contains natural sugars, Dilley warns that individuals with diabetes or conditions that make them sensitive to sugar intake should consult their physician before adding this to their daily routine. And when purchasing, opt for brands without added sugars.

Chamomile tea has been used for decades as a sleep aid for its calming and antioxidant properties. It comes from a flower and is full of calming scents, says Dana Ellis Hunnes, adjunct assistant professor in the Department of Community Health Sciences at UCLA Fielding School of Public Health. Chamomile also contains apigenin, a flavonoid (plant nutrient) that promotes sleepiness, she adds.A recent study that examined the effect of chamomile extract on the sleep habits of adults age 60 and older found that when compared to the placebo group, those who drank chamomile had significantly improved sleep quality.

But this classic isnt the only type of herbal tea to try. Low-caffeine green tea contains theanine, an amino acid that research has found can help lower stress and significantly improve sleep quality. And teamade from the herb lemon balm contains naturally occurring oils with terpenes, organic compounds that can promote relaxation and better sleep, Hunnes says.

One study of Japanese men and women found that a high dietary glycemic index and high rice consumption was significantly associated with good sleep. The study also looked at bread, which was not associated with sleep quality and found that noodles were linked to poor sleep.

Dilley recommends brown rice, which is higher in fiber. In a study published in theJournal of Clinical Sleep Medicine,eating a higher fiber diet was associated with less nighttime awakenings and more restorative slow-wave sleep, she explains. This effect, she says, could be due to the fact that fiber helps prevent blood sugar spikes that may lower melatonin. Sylvia Melendez-Klinger,a registered dietitian and founder of Hispanic Food Communications, recommends trying a rice-dairy combo of rice pudding with no added sugar or rice crackers or rice cakes with a glass of warm milk, as another optimal bedtime snack.

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Trastuzumab Deruxtecan Granted Breakthrough Therapy Designation by FDA for Pretreated Unresectable/Metastatic HER2-Positive Breast Cancer – Cancer…

The FDA has granted fam-trastuzumab deruxtecan-nxki (T-DXd; Enhertu) breakthrough therapy designation for adult patients with unresectable or metastatic HER2-positive breast cancer who have received one or more HER2-targeting agents in prior lines of therapy, according to a press release from AstraZeneca.1

T-DXd demonstrated promising efficacy in this patient population in the phase 3 DESTINY-Breast03 trial (NCT03529110).2 The HER2-directed antibody drug conjugate yielded a 12-month progression-free survival (PFS) rate of 75.8% (95% CI, 69.8%-80.7%) compared with 34.1% (95% CI, 27.7%-40.5%) with ado-trastuzumab emtansine (T-DM1; Kadcyla). The median PFS was not reached in the T-DXd arm and was 6.8 months (95% CI, 5.6-8.2) in the T-DM1 arm.

The trial enrolled patients who had been diagnosed with unresectable or metastatic HER2-positive breast cancer and had been previously treated with trastuzumab (Herceptin) and a taxane in the advanced or metastatic setting. Additionally, patients were allowed to have clinically stable, treated brain metastases.

Patients were randomized 1:1 and were stratified based on hormone receptor status, prior treatment with pertuzumab (Perjeta), and history of visceral disease. The 2 treatment arms included a 5.4 mg/kg dose of T-DXd every 3 weeks (n = 261) or 3.6 mg of T-DM1 every 3 weeks (n = 263).

The primary end point of the study was PFS by blinded independent central review (BICR), with key secondary end points including overall response rate (ORR) by BICR, duration of response by BICR, investigator-assessed PFS, and safety.

Of the patients who were treated with T-DXd (n = 257), 132 are receiving ongoing treatment and 125 have discontinued due to death (n = 3), adverse effect (AE; n = 35), progressive disease (n = 66), clinical progression (n = 4), patient withdrawal (n = 13), or physician decision. Additionally, of the patients who were treated with T-DM1 (n = 261), 47 are receiving ongoing treatment and 214 have discontinued due to death (n = 3), AEs (n = 17), progressive disease (n = 158), clinical progression (n = 12), patient withdrawal (n = 11), or physician decision (n = 8). The median follow ups were 16.2 months and 15.3 months for the T-DXd and T-DM1 arms, respectively.

Additional findings from the trial indicated that patients in the T-DXd arm had an investigator-assessed median PFS of 76.3 months (95% CI, 22.1not evaluable [NE]) vs 7.2 months (95% CI, 6.8-8.3) reported in the T-DM1 arm (HR, 0.27; 95% CI, 0.20-0.35; P = 6.5 10-24). Additionally, the 12-month investigator-assessed PFS rates were76.3% (95% CI, 70.4%-81.2%) and 34.9% (95% CI, 28.8%-41.2%) in the T-DXd and T-DM1 arms, respectively.

Moreover, the median OS was NE for both treatment arms, and the 12-month OS rates were 94.1% (95% CI, 90.3%-96.4%) and 85.9% (95% CI, 80.9%-89.7%) in the T-DXd and T-DM1 arms, respectively (HR, 0.56; 95% CI, 0.36-0.86; P = .007172). Those who were treated with T-DXd had a confirmed ORR of 79.7%, including a complete response (CR) rate of 16.1% and partial response rate (PR) of 63.6%, compared with 34.2% in the T-DM1 cohort, including a CR rate of 8.7% and a PR rate of 25.5%.

The most common any-grade blood and lymphatic AEs were neutropenia (42.8%), anemia (30.4%), and leukopenia (30.0%) and common gastrointestinal toxicities included nausea (72.8%) and vomiting (44.0%). Moreover, the most common grade 3 or higher blood and lymphatic AEs included neutropenia (19.1%), thrombocytopenia (7.0%), and leukopenia (6.6%). Grade 3/4 gastrointestinal AEs included nausea (6.6%), vomiting (1.6%), and diarrhea (0.4%).

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Hormone replacement therapy not linked to an increased risk of developing dementia, study finds – CNN

However, the study -- which published in the BMJ medical journal Wednesday -- did show a slightly increased risk of developing Alzheimer's disease, a specific form of dementia, among women who used estrogen-progestogen therapies for between five and nine years and for 10 years or longer. That translated into five and seven extra dementia cases, respectively, per 10,000 women.

"While the observational nature of the study means we can't be sure of knowing what causes what, I think the results here can still reassure us that these hormone therapies mostly aren't associated with increased risk of dementias," Kevin McConway, emeritus professor of applied statistics at The Open University in the UK, told the Science Media Centre in London. He wasn't involved in the research.

"And where there is some evidence of an increased risk, the increase isn't very big at all," he said.

Previous research into dementia and HRT has been inconsistent, the study noted. Lab studies and small trials have suggested a beneficial link between estrogen and age-related brain decline. However, a large trial of HRT, the Women's Health Initiative Memory Study, found an increased risk of developing dementia among users of estrogen-progestogen treatments, but these women were all elderly. And a Finnish study that published in 2019 flagged an increased risk of developing Alzheimer's disease among users of both estrogen-only and estrogen-progestogen treatments.

Using UK medical records, the researchers involved in the new study identified 118,501 women age 55 and over who were diagnosed with dementia between 1998 and 2020. A control group consisted of 497,416 women matched by age and by the same medical practice, who had no records for dementia.

Of the women with a dementia diagnosis, they found that 16,291 -- 14% -- had used HRT. The same percentage of women in the control group, or 68,726 of them, also used the treatment.

Not definitive

Also known as menopausal hormone therapy, HRT is used when women experience hot flashes, night sweats, insomnia and mood changes due to the disappearance of sex hormones called estrogen and progesterone. That happens as women approach menopause, typically in their late 40s or early 50s.

According to the study, overall there were no increased risks of developing dementia associated with menopausal hormone therapy "regardless of hormone type, application, dose, or duration of treatment."

Other risk factors, such as family history, smoking, alcohol consumption, pre-existing medical conditions and other prescribed drugs, were taken into account as part of the analysis. As an observational study, it can only show an association and is not definitive.

There are different types of HRT, and the type used depends on whether a woman has a uterus. Women who don't have one must use estrogen-only HRT. Those who haven't had a hysterectomy must use a combination of estrogen and progesterone to avoid thickening of the lining of the womb. Recently, replacements for progesterone have broadened choices for women.

Study author Yana Vinogradova, a senior research fellow at the department of primary care at the University of Nottingham, said the new research found only a small risk association between using combined HRT for long periods and development of Alzheimer's.

"Alzheimer's disease is a type of dementia which develops slowly, and some signs of it such as insomnia or memory loss are similar to menopausal symptoms," she said via email.

"The increased risk is very small and we also do not (and could not) claim that it was caused by MHT/HRT. It should not alarm users of MHT/HRT."

The study put the risk of dementia in context for doctors and their patients, wrote Pauline Maki, a professor in the University of Illinois at Chicago's department of psychiatry, psychology, and obstetrics & gynecology, and JoAnn Manson, a professor of medicine at Harvard Medical School and a physician at Brigham and Women's Hospital, in an editorial that accompanied the study.

"The primary indication for hormone therapy continues to be the treatment of vasomotor symptoms, and the current study should provide reassurance for women and their providers when treatment is prescribed for that reason," they wrote. Vasomotor symptoms include hot flashes and night sweats.

Dr Haitham Hamoda, spokesperson for the Royal College of Obstetricians and Gynaecologists, and chair of the British Menopause Society, told the UK's Science Media Centre that the findings "should be considered in the context of overall benefits and risk associated with HRT including symptom management and improvement in quality of life as well the bone and cardiovascular benefits associated with HRT intake.

"Every woman experiences the menopause differently. Symptoms can vary and be extremely debilitating, significantly impacting on their physical and psychological health, career, social life and relationships. Sadly, many women are still suffering in silence and are reluctant to seek advice and support due to concerns around HRT," Hamoda said to the Science Media Centre.

Not the last word

While McConway said the study was "very reassuring," he said it was unlikely to be the last word on a medical therapy that has been enveloped in mixed messages since doctors began being prescribing it widely in the late 1980s.

The use of HRT plummeted. A decade later, other data suggested that the news wasn't all bad, and that the risk of HRT might vary depending on a woman's age. The original Women's Health Initiative analysis looked at older women, who were already at risk for heart attacks, blood clots and stroke, meaning the findings might not apply to younger women.

Today, it's believed that HRT could be helpful in controlling menopausal symptoms at the time when most women begin to go through it -- in their late 40s and early 50s -- when their risk for chronic disease is lower.

Women who wish to take hormones later in life, when the risk for blood clots, stroke and cancer are higher, should discuss the options thoroughly with their doctor.

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Doctors on Closing the Breast Cancer Mortality Gap for Black Women – WTTW News

For women in the U.S., breast cancer is devastatingly common. One in eight women in America can expect to develop breast cancer over the course of their lifetimes. And for Black women in the U.S., what comes after the diagnosis is especially worrying. The mortality rate for Black women diagnosed with breast cancer is 42% higher than their white counterparts.

One big reason is access limited to lower-quality resources inside and outside the hospital system, said Dr. Arlene Richardson, chair of the department of radiology at Jackson Park Hospital. It contributes significantly to all of these disparities we see in our community. There are many different social determinants of health from economic instability, including unemployment, lower quality environment, including housing and transportation in our community, lower quality and lower level of education, lower access to high quality foods and also lower quality health care assistance in our community.

In addition to higher mortality rates, a particularly aggressive subtype called triple negative breast cancer is more likely to present itself in Black women.

Dr. Surbhi Warrior, a physician at Rush University Medical Center, says that the science on TNBC is still young. Dr. Warrior took part in aresearch studythat looked at data for over 20 years of breast cancer patients more than 8000 Chicago women.

One of the things that we found was that Black women were 1.5 times more likely to present with metastatic disease, meaning that the cancer had already spread to different parts of their body, meaning it was much less curable. But we also found that Black women were 2.1 times more likely to have triple negative breast cancer. And both of these are big areas that lead to higher occurrence and mortality rates and especially for triple negative breast cancer. What that means is that these breast tumors dont express the hormone receptors of estrogen or progesterone or HER2 protein. And this is what usually breast cancer directed therapies target.

Dr. Warrior notes that for breast cancer treatment, follow-up care is as critical as the initial diagnosis but it also presents barriers for many Black women.

When we did our analysis of why there were a lot of areas where patients werent following up, we found out it was due to difficulty with child care and transportation as well as even difficulty getting time off work to go to their doctors appointments. And a lot of these competing social and economic demands that patients go through make it difficult for patients who are already presenting with advanced disease to adhere to months and months of chemotherapy and radiation and overall breast cancer care, and this long term impacts their overall mortality and their cancer outcomes directly.

Its everyday needs like those that health care organizations must consider in order to improve health outcomes for Black women, says the American Cancer Societys Michelle Hicks-Turner.

We know that these disparities are rooted in policies that contributes to the barriers to care. Not everyone can take the time off during the week to go to doctors appointments, so offering weekend and evening mammogram appointments are crucial. Also, to ensure uninsured women receive the care they need, hospitals can strengthen their partnerships with faith-based organizations, referring providers and promote the utilization of the Illinois, breast and cervical cancer program. And this would allow low-income women across the state to get care.

Hicks-Turner adds that services for health care navigation and even child care or transportation can help boost patients ability to access health care.

Jackson Park Hospital is collaborating with nonprofits Black Womens Health Imperative, the National Alliance for Hispanic Health, and medical device company Hologic to bring state of the art 3D mammography equipment to patients for breast screening plus wraparound care services. Dr. Richardson says the initiative, calledProject Health Equality, is one way Jackson Park Hospital is trying to address disparities in prevention and treatment for breast cancer.

3D mammography has proved to be superior when compared with 2D mammography alone is for detecting breast cancer, particularly in dense breast which is more common in the Black and African American community. So in addition to this technology, theres other support of innovative care including public education and nursing navigation that will be added to our side to improve our screening and treatment for women in our community that might otherwise go without.

Ultimately, Hicks-Turners bottom-line advice to Black women hoping to protect their health is straightforward.

Go get your mammogram. Its very important. It saves lives.

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Missing campers, falsified documents and other issues revealed in CT weight-loss camp investigation – Danbury News Times

Problems that arose at a Connecticut weight-loss camp before it closed in July included missing campers and falsified documents, newly released investigative records indicate.

After weeks of investigations, a witness list 34 people deep, and pages upon pages of interviews and inspection notes, a fuller picture of the goings-on at Camp Shane informed by state documents obtained by Hearst Connecticut through a Freedom of Information Act request is taking shape.

The state document release included an investigation narrative, interview summaries, a case summary, a license surrender affidavit, and the Notice of Proposed Licensure Action and Statement of Charges sent to camp owner David Ettenberg.

The weight-loss camp located at the South Kent School abruptly shuttered on July 13, and surrendered its 11-day-old license on Aug. 23, at which point the Office of Early Childhood and Department of Children and Families terminated their joint investigation. The investigation was announced in July after the camp closed its doors, but the OEC officially launched its investigation on July 8.

Since Ettenberg legally surrendered the license prior to the completion of the state investigation, violations that would be substantiated were not formally presented to the owner, the investigation summary explained.

In the affidavit surrendering his license, Ettenberg denies all charges set forth, but agreed that if he tried to reinstate or obtain a new license from the agency in the future, it would mean that the allegations would be deemed true.

Ettenberg has not responded to multiple requests for comment since mid-July when he said he shut camp down due to staffing issues.

The allegations in the records also include:

A camper sleeping on a common area couch.

Campers walking around unsupervised at night and in lightning storms, and who were encouraged to work out until they vomited.

Counselors leaving campers unsupervised to hang out and party in the lounge.

A counselor who yelled at and threatened to fight a camper.

Falsified medication administration training documents presented to the state.

Inappropriate comments of a sexual nature by a male camper toward a female camper.

Multiple reports of campers being bullied.

And the day before camp officially shut down, an 8-year-old girl suffered a serious head injury at camp. Her parents were leaving to pick her up when they got the phone call.

The OEC investigation summary states that multiple families, many from out of state, reported trying to contact the camp about concerns with their child and not receiving any response via email, text or phone for extended periods of time.

The most continuously reported investigation concerns, which were repeated throughout interviews with parents, campers, and a counselor, were lack of proper medical oversight and mishandling of medication.

In the final summary, the camp licensing specialist summed up her medical concerns: Serious medical needs of the campers were not met when the operator failed to provide anyone trained to provide the necessary medications, failed to prepare the staff for emergency situations, and failed to seek medical assistance from trained professionals in a timely manner. Lack of supervision and untrained/uninformed staff led to campers being injured and not properly cared for.

Earlier in the report, the investigation revealed that multiple campers had reported experiencing injuries, including sprains, knee injuries, smashed toes, and serious sunburn.

Campers were not allowed to seek medical attention for up to a week in some instances. Other campers were told if they left camp to seek medical assistance, they could not return due to COVID-19 restrictions, the documents read.

Despite multiple requests from the state, the operator of the camp never located a medically trained individual to administer medications, according to the documents. Additionally, the camp presented the state with falsified medication administration training documents, allegedly signed by a doctor who ran a training in 2019. The physician whose name was presented on the training certificate said that the signature on the certificate is not his, the report states.

The doctor, whose name is redacted, provided the OEC with samples of his signature.

The certificate submitted by Camp Shane indicates a full training for oral, topical, inhaled and injectable medications as well as auto-inject medication. The signature is found to NOT be the signature of the physician, the documents said.

Former camp director and girls head counselor Jennifer DAmbrosio, who goes by Bella, quit her job on June 29 because she was concerned about camp administration and the safety and well-being of campers, she said in an interview with Hearst Connecticut Media.

DAmbrosio was also interviewed at least two times by the OEC. Her name has been redacted in the report, labeled as first director, but her identification was independently confirmed by Hearst Connecticut Media.

DAmbrosio said she was hired two days before arriving at the camp, claiming the camp was in disorder when she arrived and that there was no paperwork ready for opening.

The summary of the conversation between the investigator and DAmbrosio included concerns about not having appropriate staff, no guidance counselor, no paperwork about medical problems, no paperwork to the nutritionist regarding allergies and food restrictions, no certified medical staff on site, and no trained person for the behavior therapy program.

The fact that there was no medical person on campus, no information for counselors about the serious medical conditions of some of the campers and that there was a lot of medication concerns contributed to [redacted] deciding to leave the camp, the summary states.

The OEC interview summary included a physician whose name was redacted from documents, along with parts of the summary of his interview.

The doctor told the OEC, according to the documents, that he had been asked to serve as camp doctor 10 days before the start of camp but declined due to the fact that he had a family vacation scheduled. He assumed the camp had found another physician. This was not the case.

The doctor agreed to help out until a replacement was found.

After an initial visit to the camp on June 30, the doctor reported having immediate concerns about the way medications were being administered.

The doctor also said that he recommended that the camp close on more than one occasion to due to lack of safety.

The new state investigation documents also show repeated instances of camper discomfort, at times the result of alleged comments of a sexual nature made by male campers towards female campers, and at others a result of bullying and a counselors alleged prior arrest that a camper found online.

One violation description reads: operator took pictures of campers during Zumba class without their consent causing them to feel uncomfortable and ill at ease.

When Ettenberg was asked about this, he explained that he took pictures of a lot of the activities on the camp for the purpose of posting on an advertising website, the interview summary reads.

In interviews with an OEC employee, a male counselor whose name has been redacted said that a female camper informed him that a male camper had made her feel uncomfortable when he made sexual remarks about her.

Another male counselor who was hired to do Cognitive Behavioral Therapy (CBT) despite not being trained in the technique prior to camp reported that he had a conversation with a female camper who told him that an older boy (who left the camp prior to [REDACTED] arriving at camp) tried to force her to have sex.

Further details were not revealed to the CBT counselor, but he told investigators that he felt he should report what he was told. The counselor estimated that the female camper was around 15 or 16 years old.

Issues persisted through the camps official shut-down on July 13. Parents were alerted of the camp's closure via email at 7:51 a.m. on July 11. The email, obtained by Hearst Connecticut Media, said the children had to leave by the following Tuesday.

In interviews, parents said they tried to figure out how to get their kids home safely with little notice booking expensive flights, calling relatives nearby or driving to the camp themselves.

On the day the camp closed, according to the investigation documents, one parent drove onto campus and picked up not only her own child, but another child as well without being asked for any identification. The records also indicate that another parent picked up her child earlier on June 30 and did not have to sign the child out or show any identification.

Camper Stellan Petto, 14, said in an interview that his general experience at camp, which included getting the wrong dosage of his essential hormone medication, definitely left me with some trauma.

Now at home with his mother in North Carolina, Stellan has entered his freshman year of high school. With some distance from his camp experience, he said hes feeling better.

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Missing campers, falsified documents and other issues revealed in CT weight-loss camp investigation - Danbury News Times

This Is How To Choose the Right Herbs for Your Body and Its Needs, According to an Herbalist – Well+Good

Consider this your 201-level guide to all the various leaves, seeds, powders, and potions that get so much buzz in the wellness scenethen discover how to actually incorporate them into your life. So whether you want to power up your smoothie with natural supplements, or you're just wondering how to use the cacao powder sitting in your pantry, you'll get the intel you need here. See All

With so many herbs, remedies, and supplements on the market, all with different and numerable benefits, it can sometimes be overwhelming to know where to start when it comes to creating the right routine for your body and its specific needs. So often patients ask herbalists to tell them "what they need" without asking themselves big questions first. On the latest episode of Plant-Based,herbalistRachelle Robinett discusses what questions to ask yourself in order to find the best herbal routine for your body and mind.

Some of the most common challenges that Robinett sees are digestion and gut health woes, sleep and energy problems, brain health struggles when it comes to mood regulation, stress, and anxiety, general wellness, and hormone imbalances. To start, it's important to understand that there's no one size fits all herbal solution for everyone. It's vital to look at your life and reflect on what support your body, brain, and lifestyle are craving. Do you need help with a specific ailment or a more preventative practice? Both are so important, explains Robinett.

Next, you have to think about what is realistic for you. What sorts of herbs will you actually stick to? How often? When? In what form? Everyone's daily routine is different, so check in with yourself to see what you can commit to, since these remedies work most efficaciously when taken regularly, and there are so many options to choose froma few big capsules, more smaller capsules, teas, additions to your morning diet, changes to your nighttime routine, etc.

Finally, what do you have around you? See what is available in your area and what role your climate, geography, and environment have in your ailments or concerns. Herbs don't only work if they are ingested. Sometimes it can be helpful to see more herbs or green around you in the form of a house plant, more time outside, lifestyle or diet changes, or more sensory in the form of essential oils. Watch the full episode to learn more about Robinett's opinions as a registered herbalist, but be sure to check in with your physician before starting any new supplements.

For more healthy recipes and cooking ideas from our community, join Well+Good's Cook With Us Facebook group.

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This Is How To Choose the Right Herbs for Your Body and Its Needs, According to an Herbalist - Well+Good

The #1 Best Juice to Drink, Says Nutritionist | Eat This Not That – Eat This, Not That

High in sugar. Zero fiber. Spikes your blood sugar. Can you think of other reasons to avoid becoming a regular juice drinker?

Vegetable and fruit juices sound super healthy (and they are actually excellent sources of vitamins and antioxidants), but as we've warned at many times before, it is possible to sip a lot of juice calories in a sitting without even knowing it and experience many of those aforementioned downsides.

"Juice lacks the fiber found in whole fruits and vegetables [because] the juicing process strips fruit and vegetables of their fiber,"Sarah Rueven, MS, RD, founder ofRooted Wellness tells us. That's why she always recommends grabbing a piece of fruit over a glass of fruit juice. Or, if you'd still prefer to drink your produce, consider blending whole fruits and vegetables into smoothies, which will retain the fiber that's missing from the juicing process. (Related: Dangerous Signs You're Not Getting Enough Fiber.)

While experts may recommend whole fruit over juice whenever possible, that doesn't mean you need to avoid the fruit beverage entirelyespecially since juice can provide your diet with extra antioxidant vitamins and minerals hidden in plants. To get the most out of this juice, we wondered, what is the best juice to drink?

"If you are going to drink juice, be sure it's cold-pressed juice from fresh fruits and vegetables," says nutritionist Heather Hanks, who specializes in holistic nutrition for USA Rx. "Cold-pressed juices are not heated to high temperatures, meaning that they still contain most of the antioxidants and vitamins that are killed off during pasteurization."

Cold-pressed juices are just thatthey are made with a hydraulic press that squeezes the juice from fruits and vegetables cold, unlike juices that go through the pasteurization process, which involves high heat. While the heat and oxygen used in pasteurization kill off harmful bacteria in the liquid, it also destroys many of the nutrients in the process. The upside of pasteurized juice is its long shelf-life, whereas cold-pressed juice needs to be consumed quickly, within a day or two.

Unless you make the cold-pressed juice yourself, "make sure your juice contains no added sugars, colors, or food dyes," says Hanks. "The ingredients should be fruits and vegetables only with no fillers or preservatives."

As for types of fruits and vegetables that make the healthiest juice, nutrition research points to these. Read on, and for more on how to eat healthy, don't miss 7 Healthiest Foods to Eat Right Now.

Tart cherries contain anthocyanins, red and purple plant pigments that offer strong antioxidant activity that reduces inflammation. In animal studies published in the Journal of Medicinal Food, rats were fed a high fat diet and either freeze-dried tart cherry powder or a control diet of equal calories but without the tart cherry addition. Only those fed the tart cherries experienced a 9% reduction in abdominal fat and other markers of metabolic disease. Tart cherry juice is also a sleep enhancer, the anthocyanins and tryptophan compounds in the juice boost production of the sleep-inducing hormone melatonin.

RELATED:Popular Drinks That Fight Inflammation, Say Dietitians

Another juice that's rich in anthocyanins (you can tell by the red color) is cranberry. Registered nutritionist Jay Cowin, director of formulations for ASYSTEM calls it one of the healthiest juices you can drink. Loaded with cell-protecting antioxidants, including vitamins C and E,"cranberry juice has also be found to be anti-inflammatory and may help to ease symptoms ofrheumatoid arthritis (RA) and offer protection against heart disease," he says.

When buying cranberry juice, it's important to check the label and make sure that it says, "Contains 100 percent juice" and does not contain added sugar, preservatives, or additives.

RELATED: Sign up for our newsletter to get daily recipes and food news in your inbox!

If you have high blood pressure, ask your doctor about drinking beetroot juice, which contains nitrates that have been proven to improve blood pressure by relaxing blood vessels. "Beetroot juice is low in sugar content in comparison to other juices and is also an amazing source of vitamin B-6, calcium, and iron," says Elliot Reimers, a sports nutritionist certified by the International Society of Sports Nutrition and the National Academy of Sports Medicine. The deep red of beets is due to pigments called betalains, phytonutrients that "inhibit signaling pathways that are connected to many inflammatory diseases," Reimers says.

Turning a couple of stalks of celery into pulpy juice may help with weight loss because it has only about 30 calories in 16 ounces and delivers 3 grams of filling fiber. Plus, celery has been shown to have powerful antioxidant properties to remove free radicals, according to a study in The Journal of Evidence-Based Complementary & Alternative Medicine.

Watermelon juice is touted as an excellent low-sugar beverage for sports rehydration by physician Mark Hyman, MD, the New York Times best-selling author of Food: What The Heck Should I Eat? The amino acid L-citrulline found in watermelon helps move lactic acid out of muscles, reducing soreness and fatigue, another reason to drink it after a tough workout. Researchers in the Journal of Agricultural and Food Chemistry found that athletes who drank watermelon juice as an exercise beverage reported less soreness and slower heart rate 24 hours after working out.

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The #1 Best Juice to Drink, Says Nutritionist | Eat This Not That - Eat This, Not That

Need motivation to exercise? Here are some reasons to get moving Press Telegram – California News Times

Q. Im a 63 year old man and I hate exercise. My physician and wife urge me to do so. Okay, Im a little overweight, but Im doing well all of these years. What encouragement and justification for exercising? PA

Getting Started: We cant let people do what they dont want. There is always a reason to disagree with the facts, find exceptions, and ignore advice. At the same time, it is important to recognize that it is difficult to change lifelong behavior and attitudes.

So when will health behavior change? When written on the prescription, they often change with the next verbal message from the doctor: Living past the age of 75 or attending a daughters wedding, grandsons blessing, or grandsons Bar Mitzvah. If you want to, we strongly recommend the following:

During the pandemic, the sofa became a close friend of many.according to Pew Research CenterPeople over the age of 60 spend about half of their leisure time in front of the screen. In most cases, TV is about 4 hours a day.

Its time to get up from the couch and start a simple exercise, walking. You dont need equipment, you just need good walking shoes. No special clothing or training required, its free. We know that taking certain steps each day can reduce the risk of coronary heart disease, stroke, colon cancer, and type 2 diabetes. It can lower blood pressure, increase muscle strength, prevent falls and injuries, reduce depression and burn calories.

This is a bonus benefit. People who are physically active tend to live longer than those who are not. One way to define physical activity is the number of steps you take each day. Ive heard about the magical daily goal of 10,000 steps that you can easily record on your smartwatch, iPhone, or Fitbits. There is some controversy over the exact number of daily steps to improve health and longevity.

Researchers at the University of Massachusetts Amherst, the CDC, and other institutions have found a strong link between steps and mortality. They found that men and women who accumulated 7,000 steps a day were about 50% less likely to die than those who walked less than that number. At 9,000 steps, the chances of premature death were 70% lower than those with less than 9,000 steps. With 10,000 steps, the benefits were leveled. People who take more than 10,000 steps a day rarely live longer than those who take at least 7,000 steps. For each story of the New York Times on September 21st..

There is still more to confuse the problem. The JAMA Internal Medicine online publication contains a study of over 16,000 women with an average age of 72 years. Women with an average of about 4400 steps per day had significantly lower mortality than the least active women with an average of about 2700 steps per day. ..

And there is one more from National Institute on Aging.. They recommend that adults require 150 minutes or 2.5 hours of moderate-intensity aerobic exercise per week to stay healthy. Active walking is a good example. The 30 minutes can be divided into three 10 minute walks.

This is the benefit of the Super Bonus. Walking is good for your brain health. Dr. Dean Sherzai, a clinical neurologist and co-director of the Loma Linda University Brain Health and Alzheimers Disease Prevention Program, identified three links between exercise and improved brain health. He said exercise increases blood flow to the brain, providing more oxygen and nutrients. At the same time, it flushes inflammatory and oxidative elements from the brain, increasing chemicals like neuronal growth hormone, but especially for connections between neurons. PBS Next Avenue, A digital platform for information for baby boomers. Both aerobic and anaerobic exercise are effective, he added.

The bottom line is that walking is a good exercise to add brain health benefits and improve overall health, function, fitness and longevity. These remedies and interventions are not purchased at local CVS or Walgreens.

AP Thank you for your important question. I would appreciate your encouragement. Now, after stretching, put on your shoes and get out of the door. Take a walk with your friends and dogs, greet your neighbors, smell the roses and enjoy the beautiful weather. Stay safe and get well. Of course, be kind to yourself and others.

Note: Check with your healthcare provider before starting an exercise program.

Helen Dennis is a nationally recognized leader in new retirement issues with aging, employment, and academic, corporate, and non-profit experience. Contact Helen with any questions or comments at Visit Helen on and follow her on / Successfulaging Community.

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Need motivation to exercise? Here are some reasons to get moving Press Telegram - California News Times

October Health and Safety | Richland Health – Richland Public Health


Richland Public Health flu vaccines will be available by appointment starting in October through our Public Health Clinic. Call 419-774-4700 to schedule a flu shot for you and your family.

Everyone from age six months and up should get an annual flu shot. The Centers for Disease Control and Prevention (CDC) recommends getting your flu shot in October, but if you miss that month, get one as soon as possible.

Influenza is a contagious disease that spreads around the United States every year, usually between October and May. Flu is caused by influenza viruses, and is spread mainly by coughing, sneezing, and close contact. Anyone can get the flu. Flu strikes suddenly and can last several days. Symptoms vary by age, but can include: fever/chills, sore throat, muscle aches, fatigue, cough, headache, and runny or stuffy nose.

Flu is more dangerous for some people. Infants and young children, people 65 years of age and older, pregnant women, and people with certain health conditions or a weakened immune system are at greatest risk.

No one likes to be sick. Getting the flu will cause you to miss work or school, along with your favorite activities, Amy Schmidt, Director of Nursing at Richland Public Health, said. You might also pass the flu on to your family, friends, or co-workers. Protect yourself and others. Get your flu shot.

According to the CDC, cold and flu season runs from approximately October to May, with a peak somewhere between December and February. Flu can be widespread, with up to 49 million cases each year in the United States.

Last year, the flu season was very mild due to restrictions in place for COVID-19 such as masking, social distancing, closing of mass events, and remote learning for schools. With most of those restrictions not in place, health experts are predicting a rise in flu cases. Thats worrisome, considering the strain hospitals are already experiencing with COVID cases. Its another reason to make sure to get your flu shot in October.

For additional information about influenza, visit the CDC at talk with your pediatrician or family physician. For special home-bound services, call 419-774-4540.


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October Health and Safety | Richland Health - Richland Public Health

Blood Cancer Patients and Covid-19: Higher Risks but Vaccine Ready – Physician’s Weekly

Special patient population needs special attention, especially those who undergo HCT

Patients with cancer have been particularly hard hit by the Covid-19 pandemic, both clinically with a higher infection risk and logistically with delays in care delivery. Several recent studies have taken a closer look at how SARS-CoV-2, and the vaccines against the virus, have impacted patients with cancer, particularly those with hematologic malignancies who underwent transplant therapy.

As more transplant physicians are now resuming normal functioning of their transplant units, possibilities of absolute increase in the number of transplant patients getting infected with Covid-19 is expected to rise, cautioned Kamal Kant Sahu, MD, and Ahmad Daniyal Siddiqui, MBBS, both of Saint Vincent Hospital in Worcester, Massachusetts, in a 2021 review. While our understanding about Covid-19 has improved dramatically, a special population such as [hematopoietic stem cell transplant] patients remains at high risk and needs special attention.

HCT and Covid-19

Patients who had hematogenic/hematopoietic stem cell transplant (HCT) or cellular therapy were at significant risk of increased mortality and morbidity due to Covid-19, according to Sibgha Gull Chaudhary, MD, of University of Kansas Medical Center in Kansas City, and co-authors in a publication-only study at the 2021 American Society of Clinical Oncology (ASCO) virtual meeting.

They conducted a systematic review and meta-analysis evaluating the outcomes of Covid-19 in HCT patients, settling on six studies with 1,619 patients (median age 63; 59% men), 646 of whom underwent HCT.

The authors reported that the median days for autologous HCT (autoHCT) was 690 days while it was 450 days for allogeneic HCT (alloHCT). The average follow-up duration after Covid-19 was 24 days.

Gull Chaudharys group found that Covid-19 mortality in HCT patients was 20% (95% CI 0.17-0.23) in a pooled analysis, with a 19% (95% CI 0.15-0.24) mortality rate among those who received autoHCT and 21% (95% CI 0.17-0.25) in those who got alloHCT.

There is a need to prioritize HCT patients for Covid-19 vaccination, close surveillance, and aggressive management, they concluded.

In another ASCO study, the same authors reported that patients who received HCT and CAR-T cell therapy were at an increased risk of moderate-to-severe Covid-19-related pneumonia, and a higher mortality rate with Covid-19.

Muhammad Umair Mushtaq, MD, from the Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, and co-authors conducted a prospective study of 40 patients (median age 58; 67.5% male) at their institution who were diagnosed with Covid-19 from April 2020 to January 2021. Of those, 25 underwent alloHCT with a median time since treatment of 12.4 months.

While the authors found that >42% of the patients in the study had mild-to-moderate Covid-19, nearly 63% had pneumonia, and that the mortality rate was 12.5% in all patients and 20% in alloHCT patients. They also reported that significant predictors of Covid-19 severity included alloHCT, concurrent immune suppression (65% of those with severe disease received this), and elevated inflammatory markers, such as a mean neutrophil-lymphocyte ratio of 19.7 in those with moderate-to-severe Covid-19.

Mushtaq and co-authors concluded that the findings confirm the need for continuing vigilance with social distancing and masks, and the results join data from other groups that offer similar conclusions: patients with hematologic malignancies undergoing HCT need special handling.

Researchers from the University of Michigan Rogel Cancer Center in Ann Arbor conducted a retrospective study of adult patients who received alloHCT or autoHCT and were subsequently diagnosed with moderate-to-severe Covid-19 infection between March and December 2020.

They found that the majority were either on immunosuppression or had significant comorbiditiesmost commonly diabetes and hypertension, according to a separate study from Braziland that all patients with chronic graft-versus-host disease (GVHD) required hospitalization. They advised that the potential relationship between Covid-19 infection and GVHD development or exacerbation needed more clarity.

A group from the Dana Farber Cancer Center in Boston reported that they had no cases of nosocomial Covid-19 infections in HCT or CAR-T patients at their single center, indicating that these therapies can be safely administered during this [pandemic] period. They also found that in alloHCT patients, cryopreservation of unrelated donor products does not appear to negatively affect early clinical outcomes.

However, they did have one patient with myelodysplastic syndrome (MDS) whose transplant was deferred and whose disease transformed to acute myeloid leukemia, highlight[ing] the risk associated with delaying treatment of hematologic malignancies and the benefit of proceeding with definitive therapy during the pandemic, as long as appropriate safeguards are implemented.

Akshay Sharma, MBBS, of St. Jude Childrens Research Hospital in Memphis, Tennessee, and co-authors conducted an observational study of cases reported to the Center for International Blood and Marrow Transplant Research, and found that recipients of autoHCT and alloHCT with Covid-19 had poor overall survival. We found that in [alloHCT] recipients, age >50 years, male gender, and having received their transplantation within the last 12 months were all associated with worse survival, Sharma explained to VJHemOnc at the 2021 Transplantation & Cellular Therapy (TCT) meeting.

Vaccine Safety

The two-dose mRNA-based Covid-19 vaccine BNT162b2 was deemed to be safe and achieve satisfactory serologic status in patients with cancer, although the study authors noted that there was a pronounced lag in antibody production compared with the rate in noncancer controls; however, the second dose did lead to seroconversion.

The prospective-study cohort consisted of 232 patients (median age 68; 57% male) with solid tumors (27% gastrointestinal; 21% genitourinary; 18% breast) who got IV treatment administered at the infusional ambulatory unit of the oncology center, or inpatient service, at the Rambam Health Care Campus (RHCC) in Haifa, Israel. Nearly three-fourths of the patients had metastatic disease and >70% received immunotherapy or a biological agent. Hematologic malignant neoplasms are treated in a different institution so these patients were not included in the study, explained Irit Ben-Aharon, MD, PhD, of RHCC, and co-authors in JAMA Oncology.Study enrollment and follow-up took place from January to March 2021. All patients were on active treatment and received both doses of the vaccine. They were age-matched with healthy healthcare workers (n=261) who formed the control group.

Serum samples were collected after each vaccine dose and in cases of seronegativity, and electronic health records were reviewed for documentation of Covid-19 infection and results of blood cell counts, liver enzyme levels, and imaging studies, according to Ben-Aharons group.

They reported that after the first dose of 29% of the patients were seropositive versus 84% of the controls (P<0.001), while after the second dose, the seropositive rate reached 86% in the patients.

Testing rate ratios/1,000 person-days after the first dose were 12.5 (95% CI 3.4-45.7) for the patients and 48.5 (95% CI 37.2-63.2) for the controls. The authors also found that patients getting chemotherapy showed reduced immunogenicity (odds ratio 0.41, 95% CI 0.17-0.98). Additionally, the rate of documented absolute leukopenia in seronegative patients reached 39%.

No Covid-19 cases were documented throughout the study period, but there were two cases in the patients immediately after the first dose. In the general U.S. population, a little over 10,000 post-vaccine breakthrough infections were reported by April 2021, according to the CDC.

For adverse events (AEs), 69% of the patients reported injection-site pain, followed by fatigue (24%). Also, elevation of liver enzyme levels >1.5 times from baseline levels was documented in 24 patients up to 6 weeks after the first vaccine dose, the authors reported, but the AE spontaneously resolved in 37% of those patients.

As to whether the specific type of cancer treatment had any role in seroconversion, Ben-Aharons group explained that patients with breast cancer comprised 29% of the seronegative group, and 74% of these patients were treated with chemotherapy, and the treatments were diverse. Hence, we cannot assume that a specific class of drugs may hamper immunogenicity but rather that lymphosuppressive agents may induce a lack of effective seroconversion.

Study limitations included the older population and the fact that cancer patients are generally more adherent to public health and safety measures. Finally, the study lacked a control group of unvaccinated patients.

During a January 2021 European Society of Medical Oncology (ESMO) roundtable, Ravindran Kanesvaran, MRCP, MD, of the National Cancer Centre Singapore, noted that both the mRNA and adenoviral vaccines induce both humoral and cellular immunity, which might be a good thing thinking about this population of patients that is often older or has comorbidities. The immunogenicity data that weve seen on older trial participants is promising and it might also work on the slightly immunocompromised population. We dont know the correlate of protection yet, so its hard for us to predict what type of immunosuppressive therapy would impact the vaccine efficacy.

Ben-Aharon and co-authors pointed out that [a]lthough the immunogenicity pattern was gradual and slower than in the noncancer population, after the second dose most patients were seropositive Our study lends credence to the widely adopted recommendation to prioritize patients with cancer for SARS-CoV-2 vaccination.

But many cancer patients have expressed vaccine hesitancy. For instance, a June 2021 survey-based study in Mexican breast cancer patients reported that over a third were uncertain about vaccination, while more than a fourth said they wanted to see the vaccines AEs in others, and 4% said they would only take the jab if it became mandatory. The study authors called for the active participation of oncologiststo educate cancer patients on the benefits of Covid-19 immunization and to endorse vaccination.

Its a message that cancer care specialists have been driving home. Health experts and federal agencies like the CDC all agree Covid vaccination is especially important for people with cancer. Even if the vaccine might be a little bit less effective in someone who is undergoing cancer treatment its actually even more important to take that vaccine, noted Welela Tereffe, MD, chief medical executive, of the MD Anderson Cancer Center in Houston.

In the same YouTube video, David Tweardy, MD, also of MD Anderson, emphasized that itll be important for cancer patients to work with your doctors to decide when to receive the vaccine in relation to when youre receiving chemotherapy or other treatments for your cancer.

ESMO President Solange Peters, MD, PhD, of the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland, suggested that all patients under chemo, under immuno-oncology, under hormone therapy, under antibody therapy should be vaccinated. Some of my colleagues would say, If you can avoid giving the vaccine on the day of high-dose cancer therapy, it might be preferable but even if you have to do thatdo that. That is my main message, for the time being we shouldnt compromise this [Covid-19] protection.

Shalmali Pal, Contributing Writer, BreakingMED

Gull Chaudhary and Mushtaq reported no relationships relevant to the contents of this paper to disclose. Co-authors reported relationships with, and/or support from, TherapeuticsMD, Incyte, Seattle Genetics, AbbVie, Acetylon Pharmaceuticals, Astellas Pharma, Celgene, Millennium, Therakos, AlloVir, Juno Therapeutics, Kite/Gilead, Magenta Therapeutics, EcoR1 Capital, Fresenius Biotech, Gamida Cell, Novartis, and Pluristem Therapeutics.

The study by Ben-Aharons group was supported by the Israel Cancer Research Fund.

Ben-Aharon reported no relationships relevant to the contents of this paper to disclose. A co-author reported a relationship with Pfizer.

Cat ID: 118

Topic ID: 78,118,570,633,730,933,118,125,190,926,192,927,151,928,925,934,172

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Blood Cancer Patients and Covid-19: Higher Risks but Vaccine Ready - Physician's Weekly

Why Gail Devers Is on a Mission to Educate About Graves’ Disease and Thyroid Eye Disease – Everyday Health

Gail Devers is best known as an American track-and-field star who won a gold medal in the 1992 Summer Olympics and two more in 1996. Competing in the 100 meters, 100 meter hurdles, and 100 meter relay, Devers wowed the crowds with her speed, strength, and agility, not to mention her signature long, colorful fingernails.

But her first Olympics, in Seoul, South Korea, in 1988, didnt go so well. In fact, it almost didnt happen, even though just months earlier, Devers had broken the American record in the 100 meter hurdles with a time of 12.61.

Soon after setting that record, Devers began feeling tired and had trouble training. Every time I stepped on the track, she says, every race that I ran, every practice, every time I warmed up was just taking more and more out of me.

Devers managed to qualify for the U.S. Olympic track-and-field team in the hurdles, but not for the 100 meter race, as she had hoped, and she was eliminated in the semifinals.

Things just got worse from there: Her hair starting falling out, her fingernails became brittle, she lost weight, she developed sores on her skin, she started having trouble sleeping, she had headaches and tremors, and she started having memory problems. On top of that, her eyes were bulging and irritated.

To say these symptoms were upsetting would be an understatement. I actually covered my mirrors, because I couldn't stand looking at that person. That image was not me, says Devers.

But even while she and those around her could clearly see that something was very wrong, the doctors she consulted had no answers.

It wasnt until Devers visited her old team physician at the University of California in Los Angeles, where she attended college, that anyone mentioned the word thyroid or suggested she get a thyroid-stimulating hormone (TSH) test.

Two days later she had a doctors appointment, but given how many doctors had already told her nothing was wrong, Devers was nervous.

This time was different: The doctor looked at me and he said, I can tell you're a walking thyroid disorder.

And not surprisingly, The tears just started flowing. I was like, Oh, my gosh. After two and a half years, somebody finally, finally, finally, finally saw what was going on!

Devers was diagnosed with Graves disease, an autoimmune disease thats the most common cause of hyperthyroidism.

In Graves disease, the immune system produces an antibody that stimulates the thyroid gland to produce more thyroid hormone than the body needs.

When this happens, the thyroid gland enlarges an enlarged thyroid gland is called a goiter and makes excessive amounts of thyroid hormone, leading to the symptoms of hyperthyroidism.

RELATED: Treatments for Hyperthyroidism: Medications, Surgery, and Other Therapies

Once Devers started treatment for Graves disease, she was able to start training and competing again, and in some respects, the rest is a gold-medal studded history of Olympic wins and World Championships.

But something still wasnt right.

Devers still had eye pain and cloudy vision, and she was constantly needing to use eye drops. The blurriness was so bad that when she was racing she couldnt even see the hurdles.

How did she make it through an event? I know its eight steps from the blocks to the first hurdle, three steps in between, five steps off the last hurdle to the finish line, Devers recounts.

It took Devers 30 years to find out she had a second condition in addition to Graves disease: Graves ophthalmology, also known as thyroid eye disease.

Thyroid eye disease is caused by inflammation in the tissues surrounding the eyes.

The disease typically occurs along with Graves disease, although it can occur on its own.

Symptoms of thyroid eye disease can include redness, a feeling of grittiness in the eyes or constant eye watering, sensitivity to light, swelling or puffiness, bulging eyes, difficulty closing the eyes fully, double vision, and vision loss.

Several forms of treatment can help to relieve symptoms and treat the inflammation in the eyes.

Generally, treatment of thyroid eye disease includes:

On a Mission to Educate

Now that Devers knows whats going on with her health, she wants to make sure it doesnt take other people with Graves disease as long as it took her to find out about thyroid eye disease.

I feel like I've suffered for everyone in the world, she says. No one should have to go through what I went through. And the way to alleviate that suffering is education.

As the onetime relay runner says, You pass the baton from one person to the other. So what we can do as a community is to pass that baton of knowledge and education.

Devers is a strong believer in writing things down symptoms, questions, concerns and bringing those notes to doctor appointments so you can have a conversation and help your doctor help you. If you don't tell them everything, how can they make a proper diagnosis? she asks.

Deverss running goals helped her push through the challenges that Graves disease and thyroid eye disease put in her path. As she says, I'm a very goal oriented person.

Now that she's 53, Deverss goals have changed, but shes still up for a challenge. Right before the COVID-19 pandemic, somebody suggested she train for a half-marathon to coincide with the Olympic marathon trials in Atlanta, where she lives.

Her first response was, You do know I'm a sprinter. Distance for me is anything over 105 meters. But she trained for it and ran 13.1 miles in 1 hour and 53 minutes.

When shes not running, Devers can be found bicycling, dancing, skating, walking, or volunteering at her kids school. I love to stay fit, she says, and I think my life is about service.

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Why Gail Devers Is on a Mission to Educate About Graves' Disease and Thyroid Eye Disease - Everyday Health

Tips to Manage when You’re in Menopause with ADHD –

Living with ADHD while going through menopause can be challenging, but there are ways to manage both.

What do ADHD and menopause have in common other than mood changes and inattention?

Though some symptoms are observable on the outside, folks around you may not understand even half of what youre handling internally, let alone that youre managing both at the same time.

Living with attention deficit hyperactivity disorder (ADHD) comes with its own challenges. And if youre going through perimenopause or menopause, you may face more difficulties.

ADHD is a neurocognitive disorder that has three presentations:

People can receive a diagnosis early in childhood as well as late in life.

Dr. Ellen Littman, a clinical psychologist in New York state, explains that estrogen has powerful effects on brain chemistry throughout your lifetime.

Menopause is among the top biggest events to change estrogen in your body, among starting your period and becoming pregnant.

Estrogen is considered neuroprotective, in that high levels increase the availability of neurotransmitters (brain messengers) like dopamine and serotonin, which enhance cognition, mood, sleep, verbal memory, and even ADHD symptoms, Littman says, who is publishing an upcoming review article about the female hormonal effects on ADHD.

However, your levels of estrogen decline beginning in perimenopause and are spent during menopause.

While people face some symptoms off and on during menopause, Littman says those who also have ADHD experience intensified symptoms.

By understanding the relationship between menopause and increased ADHD symptoms, they are less likely to be ambushed by the amplified difficulties they experience, she says.

Both ADHD and menopause are known for patternless shifts in brain activity and hormone changes.

So, you might begin to see how overlapping symptoms happening concurrently or one after the other can worsen the experience of both conditions and make them difficult to manage.

A 2016 study even looks at the effectiveness of using ADHD medication to treat people experiencing executive function issues during menopause.

While going through menopause when you have ADHD can feel overwhelming, there are ways you can manage both conditions.

Finding a psychiatrist whos well versed and experienced in treating ADHD in people going through menopause can help you get the care you deserve.

While it might not be easy to find a psychiatrist with experience in this area, start by asking your current mental health professional or gynecologist for recommendations.

If you cant find a psychiatrist whos familiar with research demonstrating hormone involvement in ADHD symptoms, Littman suggests sharing information or articles (like this one) with them.

If you feel that your credibility is being questioned, its important to feel entitled to finding the clinician who best fits your needs, she says.

Littman suggests finding a gynecologist whos experienced in treating people going through menopause, and who will also work with the doctor who treats your ADHD.

Since women now spend about a third of their lives in menopause, it is critical to find a treatment regimen tailored to your specific needs, she says.

According to a 2019 survey of postgraduate resident trainees in family medicine, internal medicine, and obstetrics and gynecology in U.S. residency programs, only 6.8% of them reported feeling just adequately prepared to manage women experiencing menopause.

No one clinician is knowledgeable about all aspects of each individual experience, but Littman says finding doctors who will collaborate and communicate with your gynecologist can help tailor treatment.

For instance, if your ADHD medications need adjusting, as well as your decreasing estrogen levels, having both your gynecologist and doctor who treats your ADHD collaborate could help.

While pharmacologists often adjust the dosage to meet the new challenges, increased estrogen could address both menopausal and ADHD symptoms. Bioidentical hormone replacement therapy (HRT) is one route to increased estrogen for many women, Littman says.

Although your doctors may be hesitant to communicate with each other, being assertive and informing them of your conditions, as well as bringing information from each doctor to your appointments, can help ensure theyre in tune with whats going on with your body.

While theres a wide range of menopausal symptoms that occur on a continuum, Littman points out that ADHD can worsen symptoms like impaired cognition and mood.

In fact, a 2019 research paper suggests that ADHD symptoms, and even concurrent symptoms from other conditions, are also vulnerable to the hormonal changes experienced during menopause, says Littman.

Both conditions can muddle with your executive functions, a clinical term for your:

If you find that these areas of your life are becoming more difficult to manage, coming up with a plan to help navigate them can make your days easier.

For instance, if keeping and organizing appointments and commitments is difficult, setting an email calendar reminder so you get notifications on your phone, tablet, and desktop can help you stay on track.

If self-monitoring is a blind spot as of late, you could try leaning on your inner circle to gently give you a signal if agitation or strong emotions are coming off more than intended.

You might also look into present moment awareness to reconnect with mindfulness and strengthen your self-awareness.

In addition to seeing a professional, Littman suggests pursuing your own psychoeducation. Consider bookmarking the following resources:

The more you can understand about the relationship between your [brains response to ADHD] and your body in menopause, the more you can be an active participant in your treatment. And the more your support network understands about your challenges, the more supportive and compassionate they can be, Littman says.

While managing your ADHD while going through menopause can be challenging at times, there are ways to make the process easier.

Littman says that on the clinical front, new research brings hope for better treatments ahead.

Were on the brink of an exciting new understanding of the experience of women with ADHD, she says. As new studies continue to implicate the powerful role of hormones in womens experience of ADHD, the potential for more comprehensive and successful treatments may be on the horizon.

You can stay tuned for Littman and teams upcoming study on ADHD and estrogen, titled: ADHD in Females Across the Lifespan and the Role of Estrogen. It publishes August 2021 in The ADHD Report.

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Tips to Manage when You're in Menopause with ADHD -

Primary care providers called on to respond to survey to improve trans health care in Hamilton – Global News

Local health-care providers are being asked to fill out a survey to help make it easier for people who are transgender to access care in Hamilton.

The Hamilton Trans Health Coalition is calling on primary care providers to explain what barriers they face in providing gender-affirming care for patients who are trans.

Gender-affirming care includes things that are related to transitioning, like HRT (hormone replacement therapy) or surgery, but also includes doctors recognizing their patients pronouns and chosen names, and not making assumptions about their sexual history or sexual orientation.

Cole Gately, chair of the coalition, said the goal of the survey is to determine what kind of barriers and motivators are impacting Hamiltons health-care providers when they have a patient who is trans.

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We just want to know what are the barriers, whats getting in the way? Why arent you doing it and how can we help? There are lots of resources out there. Maybe youre not aware of them.

Since introducing a project co-ordinator earlier this year, the coalition has heard from some doctors, but its also heard from many trans Hamiltonians who are travelling outside of the city to get basic health care that their own doctors are capable of providing.

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Gately said some people are being told by their doctors to seek out specific care on their own and then theyll write a referral, but he said that burden shouldnt be on the patient if providing that care is well within the doctors own abilities.

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What I said to somebody yesterday was, imagine if you broke your wrist and you went into the doctor and the doctor said, Well, you find an orthopedic surgeon and then Ill make the referral. That doesnt happen. The doctor finds the orthopedic surgeon for you and makes the referral because the doctor is the expert.

The survey is open until July 28 and the coalition is urging any and all primary care providers in Hamilton including family doctors, registered nurses, nurse practitioners and physician assistants to fill it out.

2021 Global News, a division of Corus Entertainment Inc.

Primary care providers called on to respond to survey to improve trans health care in Hamilton - Global News

Perimenopause: The Women’s Health Issue No One’s Talking About Enough – HuffPost

Arianna Sholes-Douglas remembers the moment her body was in the grips of perimenopause though she didnt recognize it for what it was at the time, despite being an OB-GYN and integrative health physician focusing on womens health. Sholes-Douglas was performing a C-section, a surgery she estimates she had done over a thousand times, and her brain just blanked.

I had a total brain freeze. I couldnt remember what to do, she recalled. It was very scary, and I didnt know who to talk to or what to do.

At first, she worried it was early-onset Alzheimers. But the big changes shed been experiencing in cognitive function were hormonal. She was going through perimenopause, the transitional period before menopause when a womans body starts making less estrogen until eventually her ovaries stop releasing eggs.

And shes not alone about being in the dark. Many Gen X women and cusp millennials who are at the age range when perimenopause has begun or could soon start have far too little support and information.

We havent been educated. Patients havent been educated. Doctors havent been educated. There really hasnt been a resource thats been reliable for women, so they are caught off-guard, said Sholes-Douglas, who went on to write the book The Menopause Myth: What Your Mother, Doctor, and Friends Havent Told You About Life After 35.

Because in their minds, theyre thinking menopause is an old lady issue, she added. They think its only relevant when they stop having a period.

But thats not true. So here are three important things Xennial women should know about perimenopause:

It can start in your 30s or 40s.

There arent lines around when perimenopause begins, in part because it varies by individual and also because the types of symptoms are so broad. The term perimenopause really just means around menopause.

Its also a stretch of time that can drag on for a while. Many women start to experience symptoms five or even 10 years before they stop having a period (though the average is about four years). And given that full menopause can happen when women are in their 40s or 50s, perimenopause can begin when theyre in their early 40s or even mid-30s.

Since 5% to 7% of women are fully menopausal by age 45 (theyve gone that magical full year without a period), they could be experiencing these symptoms at age 40, not thinking a thing about menopause because these symptoms can be very vague and dont come with a big sign You are entering perimenopause, said Mary Jane Minkin, an OB-GYN with Yale University and founder of the informational website Madame Ovary.

Youre still able to get pregnant during perimenopause.

If youre a woman in your 30s or 40s who is planning to have children (and many women are) and youre fretting that you might instead enter perimenopause, dont freak out. Its very much still possible for women to get pregnant during this phase, though its definitely worth bringing up with your doctor if you have concerns.

The symptoms go way beyond hot flashes.

When most people think menopause, they think of hot flashes. And many (if not most) women getting closer to menopause will experience hot flashes, or brief feelings of being overheated, at some point ranging from pretty mild to really severe.

But there are so many other symptoms that can come along with perimenopause, including missed periods or periods that are heavier or lighter than usual, mood swings, changes in cholesterol levels and bone density, urinary incontinence and cognitive fuzziness.

Many [women] get disrupted sleep usually falling asleep quickly as they are exhausted, but are then up at 1 a.m., sometimes with a hot flash, sometimes without. They may have headaches, they may be achy, they may have some vaginal dryness or urinary leakage (although that usually comes later), Minkin said.

Perimenopause can affect your sexual health and well-being, as well. The sexual aspect part of perimenopause is something I deal with a lot, Sholes-Douglas said. Women are very much caught off-guard when they experience a decline in libido, vaginal pain, vaginal dryness and they dont know why.

But while the possible symptoms associated with perimenopause are wide-ranging, they all really come back to the hormonal changes women go through in the run-up to menopause, as estrogen and progesterone levels fall or rise and fall in uneven spikes.

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Finding adequate care and support can still be difficult.

Though theres far more information available to women and health care providers now than had been the case a few decades ago, and many active support communities have flourished, perimenopause is still something women arent adequately educated about, according to experts.

Minkin said Gen X women are probably slightly better prepared, but not dramatically so. Sholes-Douglas was more emphatic: Most women are just not prepared.

There are a few reasons for this, one of which is that there simply isnt a test doctors can perform to see if women have entered perimenopause.

Hormone levels may not show much, Minkin said. For example, a doctor might do an estradiol test to check your estrogen levels, but since normal levels during a menstrual cycle range wildly (from 45 to 350 picograms per milliliter), its hard to know where your level should be.

Lets say we draw a blood level of 50. Well, is that normal? It may be. But if your level should be 300, thats low, Minkin explained.

Its a tough diagnosis to make at the time, she added. When the patient goes that year without the period, you can then say, Well, hey that was all perimenopausal!

On top of which there is a lack of consensus about how to treat symptoms of perimenopause even if it is clear thats the issue. Hormone therapy, which involves taking supplemental hormones, is one option, but some past studies have indicated it can come with other health risks. Some doctors might recommend lifestyle changes to help manage symptoms; in other cases, women might take medications to more directly address such symptoms as vaginal dryness or mental health changes.

Unfortunately, a lot of this ends up falling on women. They end up needing to connect the dots in their own symptoms and find health care providers who have experience dealing with perimenopause. Which is why it is so important for Xennial women to be aware of whats happening in their bodies now, or what lies just ahead.

Ive had countless patients tell me they went to the doctor and told them they suspected they were perimenopausal, and the doctor said: Oh, youre too young for that. Youre too young for that, Sholes-Douglas said.

You should not assume that your doctor is going to know more about this than you do, she added. On some level, obviously they will. But dont underestimate the power you have.

Perimenopause: The Women's Health Issue No One's Talking About Enough - HuffPost

To Your Good Health: What is treatment for a fatty liver? – Agri News

I am a 77-year-old woman. I am 5 feet, 2 inches tall and weigh 107 pounds. I take no medication. When I went to the doctor last week, he found that my alkaline phosphatase was 176, my ALT 10, and my AST 11. He told me I had fatty liver and to get a scan, but I had no way to get to the place to have it done. He did not say anything else about it. I have no symptoms. Does this sound like fatty liver to you? I did not really like my doctor, but with my insurance it is hard to change doctors. If I do have fatty liver, is there anything I can do for it?

Fatty liver is an increasingly common problem. Risk factors include being overweight and having diabetes, high blood pressure and abnormal blood cholesterol levels.

Alcohol use is also a cause of fatty liver, and all people with fatty liver are strongly recommended to abstain from alcohol entirely. The primary treatment is diet and weight loss.

It sounds like there was some missed communication between you and your doctor. Fatty liver is a possibility; however, it does not seem likely to me, as you have not identified any of the risk factors, and you are certainly not overweight if anything, you are a bit underweight.

Further, although the alkaline phosphatase can be elevated in fatty liver yours is just a bit high it is more common for AST and ALT to be elevated, which yours are not.

An ultrasound scan is a good, but not definitive, way of looking for fatty liver. A liver biopsy is still the definitive test, but its often not done in people whose history, physical exam and ultrasound are all suggestive.

A slightly abnormal alkaline phosphatase does not necessarily mean you have a liver problem. Bone issues fractures, Pagets disease of bone, high thyroid and parathyroid hormone levels can cause a high alkaline phosphatase, too.

Additional liver tests checking the GGT level or specifically what kind of alkaline phosphatase you have, by isoenzyme analysis can make the source of the elevated alkaline phosphatase clearer.

Getting an ultrasound scan and additional blood tests is a reasonable place to start. Unfortunately, lack of confidence in your physician is a different problem.

If you really cant get a new doctor, then you need to have a conversation about proceeding with evaluation in such a way that you can do so while being confident that you are getting good advice.

A few years ago, I read that the herbal supplement feverfew may help with some migraines. Having suffered with severe migraine for over 50 years, I decided to try it. I take one capsule four times a day, and it has completely rid me of my migraines. Would you please mention it again?

Feverfew is a common herbal remedy to prevent migraine, and although not all trials have shown benefit, the majority of studies I have read showed that it is more effective than a placebo and the side effect risk is very small.

Other nonprescription treatments that have been shown in most studies to be beneficial include magnesium, riboflavin and coenzyme Q10. They are generally safe and well-tolerated, and I hope others may get the same relief you have found.

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To Your Good Health: What is treatment for a fatty liver? - Agri News

Disruption in Breast Cancer Care During COVID-19 Pandemic May Slightly Increase Long-Term Mortality –

Delayed mammograms and breast cancer diagnoses during the COVID-19 pandemic may have a small long-term impact on breast cancer mortality rates up to 2030, according to results of a study with simulation modeling.

Findings from this study published in the Journal of the National Cancer Institute highlight the importance of continuing breast cancer screenings and evaluations in symptomatic women.

Some women simply skipped their mammogram if they were scheduled to undergo a mammogram during the pandemic, said Oguzhan Alagoz, who holds a PhD in industrial engineering and is a professor of industrial and systems engineering at University of Wisconsin-Madison, in an interview with CURE. What we are suggesting is rather than skipping the mammogram and waiting for your next mammogram whether it is in two years or next year this suggests you need to make up that missed mammography exam as soon as possible. Thats the primary means of undoing the impact of the pandemic.

When the COVID-19 pandemic first started, screening mammography and diagnostic mammography declined up to 80%, according to the studys introduction. There were also changes in breast cancer treatment protocols, which led to treatment delays and lower rates of chemotherapy administration.

In this short term, there was a huge reduction in the number of screenings (and) diagnoses, Alagoz said. The concern is if we have these short-term declines in breast cancer control activities, what will be the impact in the long term? Breast cancer is an interesting disease, where if you delay mammography, youre not going to see the full effect of it in six months or 12 months. Sometimes, some of these effects are seen in five years, 10 years.

To assess the potential long-term impact of breast cancer control disruptions during the COVID-19 pandemic, researchers used three established breast cancer models to simulate reductions in mammogram screenings, delays in the diagnosis of cancer in symptomatic patients and reductions in chemotherapy treatments for women with early-stage breast cancer. These scenarios were assessed within the first six months of the pandemic, when reduced screening rates were observed, following a return to patterns similar to before the pandemic.

Alagoz provided the reason as to why researchers only focused on the first six months of the pandemic rather than the entire pandemic.

By the end of the summer of 2020, many practices, clinics and health systems actually made up all of the missed mammography exams, Alagoz said. We have seen the screening volumes basically reach almost 100% capacity back in the summer. I (spoke) with our radiologist collaborators, (who) are telling me that they scheduled additional weekend and weeknight mammographic screenings.

Based on the model projections, researchers found that by 2030, there could be 950 cumulative excess breast cancer deaths related to reduced screenings during the COVID-19 pandemic. In addition, there could be 1,314 deaths from the delayed diagnosis of symptomatic patients and 151 deaths linked with reduced chemotherapy in women with hormone-positive, early-stage cancer. Collectively, there may be an estimated 2,487 excess breast cancer deaths, which represents a 0.52% increase in deaths by 2030 compared with models indicating breast cancer deaths without the effect of the COVID-19 pandemic.

Although any increase in mortality rates isnt ideal, Alagoz mentioned that these results were a pleasant surprise for his research team.

Before I started this study, I was really expecting a significant number of breast cancer mortality over the next 10 years due to the pandemic, Alagoz said. Fortunately, the impact is actually relatively small (in magnitude). I was expecting maybe 10,000 additional deaths, 15,000 additional (deaths), but our modeling suggests that we are going to see an additional 2,500 deaths over the next 10 years due to the pandemic.

He mentioned that these lower-than-expected increases in mortality rates are a somewhat positive finding of the study.

I think the silver lining in this unfortunate paper is that the impact is not as high as I was scared it would be, which is good news, Alagoz said. Primarily, that is because many practices after the initial shock of the pandemic and many patients were able to actually make up the exams and did resume the normal operations within a six-month period.

Alagoz added that delays during the COVID-19 pandemic did not greatly affect women who were already diagnosed with breast cancer.

Our findings show that disruptions didnt affect (these women) too much, Alagoz said. In other words, anybody who was supposed to get surgery, radiotherapy or chemotherapy, they already got the treatment. Oncologists aware of the really terrible potential effect of delaying the treatment or stopping the treatment didnt really change treatment practices very much. The patients who were already diagnosed with breast cancer prior to the pandemic, the effect of the pandemic on their care or mortality, we found, is limited.

Although there are some effects of the COVID-19 pandemic that can be undone, such as making up missed mammograms sooner rather than later, Alagoz said there are some consequences that cannot.

For example, many women during their self-exam (or) during their annual physician visit, they observe a palpable lump in their breast and then they go and visit the clinic, Alagoz said. And those cases dropped significantly during the pandemic. There is very little we can do to undo those effects. Those women already came for a delayed diagnosis, maybe like three months (or) six months later, and, unfortunately, there is not much we can do to undo that. But at least for the screening mammography exams that women (missed), we can certainly mitigate the impacts of the pandemic.

For more news on cancer updates, research and education, dont forget tosubscribe to CUREs newsletters here.

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Disruption in Breast Cancer Care During COVID-19 Pandemic May Slightly Increase Long-Term Mortality -