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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.

Original post:
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.

The Good Brigade via Getty Images

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.

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How to reverse insulin resistance through diet and exercise – Insider

Insulin resistance, also known as impaired insulin sensitivity, is when someone has built a tolerance to insulin, the hormone responsible for regulating blood sugar levels.

Although insulin resistance precludes the development of type 2 diabetes, not everyone who has the condition will develop type 2 diabetes or its precursor, prediabetes. In fact, insulin resistance can be reversed with proper diet and exercise.

Here is what causes insulin resistance, how to recognize it, and the best treatment options.

Insulin resistance occurs when the cells in your muscles, fat, and liver are less responsive to insulin and therefore struggle to absorb glucose aka sugar in the blood.

Typically, you get a boost of sugar in your blood after you eat something containing carbohydrates. This boost signals to your pancreas to release insulin, which then helps your cells absorb the sugar and convert it to energy so you can function normally. Insulin resistance disrupts that process.

"When cells in the body become insulin resistant, more insulin is required to do the same job [aka lower blood sugar levels]," says Daniel Vatner, MD, an endocrinologist at Yale School of Medicine. "A person with insulin resistance needs to make much more insulin after a meal, or they will not be able to store and use sugar properly."

However, your body can only produce so much insulin on its own. So, there's a critical tipping point where your cells become so insulin resistant that they lose control over your blood sugar, and you end up with dangerous, chronically high blood sugar levels.

When there's too much sugar in your blood for too long, your body eventually stores it as fat. That's why insulin resistance increases the risk of being overweight and obesity-related conditions like:

Insulin resistance rarely comes with any noticeable symptoms. And most tests designed to detect insulin resistance are complicated and expensive.

Therefore, a healthcare provider will usually rely on tests that assess your blood sugar levels. These tests include:

All of these tests can also be used to diagnose prediabetes.

In rare cases, some people with insulin resistance may also develop a skin condition called acanthosis nigricans. This condition causes the skin to develop thick, dark, purplish patches, typically in the underarms, groin, or on the back of the neck.

Being overweight or obese can significantly increase your risk of insulin resistance, says Vatner.

"As an individual gains weight, fat can accumulate where it doesn't belong, as in the liver or the muscle," he says.

As fat gets into the cells, it can interfere with the cells' ability to respond to insulin, forcing the pancreas to make more insulin to compensate.

However, people of any size can also become insulin resistant.

You should regularly monitor blood sugar if you have risk factors for insulin resistance, such as obesity, a sedentary lifestyle, or a family history of type 2 diabetes . Even if you don't have these risk factors, you should start getting tested at the age of 45, says Mark Schutta, MD, medical director of the Penn Rodebaugh Diabetes Center.

Exercising and eating healthy are the most effective strategies for reversing insulin resistance. Even just a 5% to 10% loss in body weight can help to reverse insulin resistance, says Vatner.

Exercise not only plays an important role in weight management but can also help people with insulin resistance manage blood sugar. A 2016 review found that regular, moderately-intense physical activity like walking or biking for at least 30 minutes, three to five days a week was associated with improved insulin sensitivity as well as blood sugar control.

Schutta advises starting with a brisk 30- to 45-minute walk several days a week and then working your way up to 150 minutes of weekly moderate to vigorous aerobic exercise.

Important: Always consult with your physician before starting a new exercise program especially if you've been sedentary and/or have any pre-existing conditions to avoid injury.

Diet also plays a crucial role in managing and reversing insulin resistance. If you have insulin resistance, physicians may suggest you follow the Mediterranean diet, a plant-based diet, or a low-carb diet, like the Atkins diet.

In general, Schutta recommends limiting your intake of:

Schutta also recommends eating more:

Vatner says insulin-resistant patients with co-occurring conditions may be prescribed the following medications:

Insulin resistance is a serious, but treatable condition. If left untreated it could develop into prediabetes, metabolic syndrome, or type 2 diabetes, all of which increase your risk of heart disease and stroke.

While insulin resistance does not have any symptoms, it can be diagnosed through a blood sugar test.

To treat and reverse insulin resistance, eat a healthy diet full of fruits, vegetables, lean proteins, and whole grains while exercising for at least 150 minutes a week.

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How to reverse insulin resistance through diet and exercise - Insider

A Yogi’s Take on Stress and Burnout – CEOWORLD magazine

With the normal pressures of work compounded by the pandemic, stress and burnout are proliferating in the business world. Even before Covid-19, stress and burnout were ravaging the health of Americans. The number of hours worked is said by the non-profit American Institute of Stress to be the main source of job stress and this makes work especially problematic in the United States where Americans have a work ethic that is second to none.

A report a few years ago by the International Labor Organization showed that US workers averaged nearly 2,000 hours of work every year (40 hours per week x 52 weeks = 2,080 hours), or nearly 350 more hours per year (nine more weeks) than Europeans.

This is important because reducing stress is still the most important thing we can do for our health. Among other things, stress increases the risk of heart disease by 40 percent and the risk of stroke by 50 percent, and the American Institute of Stress tells us that three out of four doctors visits are for stress related ailments, and that stress is the basic cause of 60 percent of all disease and illness.

Whats the solution?

Many advocate shortening the work week. In Iceland, a trial from 2015 to 2019 of almost 3,000 people found that shortening the work week from 40 hours to 35 or 36 hours with no reduction in pay resulted in productivity either remaining the same or increasing over the working period, while perceived stress and burnout went down.

Microsoft Japan tried a four-day work week without a pay reduction over five weeks and reported happier workers and a 40% increase in productivity. And in 2018 Perpetual Guardian in New Zealand tried a four-day work week over 8 weeks for 240 of its staff. Employees there reported enjoying a better work-life balance and reported their stress levels decreased by 7%. The studies show that the workers reported less stress, but, of course, workers are motivated to praise shorter work weeks without pay reductions, and they may even be inspired to greater productivity during their working hours.

But there are doubters about this as a permanent solution, and, of course, some people find happiness in their work and dont want or need a shorter week. In all events, shortening the work week isnt a complete solution to stress and stress-induced disorders because of the myriad potential sources of stress that we encounter at work, at home, and in all our interactions. Is there then something we can add to better equip people to deal with the stresses and strains of life?

First, we should define stress to understand how we can best overcome it. Conversationally, we speak of the stress of the job or the stress of a divorce, ascribing the stress that people experience to an external event. However, more scientifically, stress refers to the internal bodily reactions to those events that are so disruptive to health.

The external events that are potentially stress-producing in the body are known as stressors or just stressful situations, to which individuals react very differently. One person in a given situation may suffer a stressful reaction such as a fight-or-flight response or a hormonal imbalance that can precipitate disease, whereas at least some people handle the situation with ease. Unfortunately, the latter appear to be in the minority.

A recent article in the Washington Post (What burnout really means, and what bosses and employees can do about it) tells us that the pandemic has caused prolonged stress to many, leading to burnout. Technically burnout is a combination of emotional exhaustion, and a reduced sense of personal accomplishment, and often a take this job and a shove it attitude. The author of the Post article says that experts say companies need to allow staff to set their own schedules, have meeting free days, proactively address rude workplace behavior, and avoid praising or normalizing working around the clock.

But these strategies, and even a shorter work week, seek to eliminate the stressors, but dont directly address the internal disorder that is stress, and they dont enhance our resilience to stressful stimuli. While eliminating stressors (if we can) may help in reducing future disruptions of the employees physical state, it does nothing to address the current internal disorder that leads to the headaches, stomach problems, high blood pressure, insomnia, and other stress-related disorders. And, of course, changing the work environment wont succeed for those companies unwilling or unable to change their environment. So, how do we overcome workplace stress?

Much stress is eliminated through night-time sleep. Although our bodies incur a heavy stress load on a regular basis, stress is a physical abnormality, which the body normalizes or heals whenever it is given the opportunity. When we become ill, we may relieve the symptoms with medicines, but Sir Hans Krebs, a Nobel Laureate in physiology, says The physician and the patient can do no more than assist nature, by providing the very best conditions for your body to defend and heal itself.

The rest we gain during sleep is a crucial requirement for assisting nature and allowing the body to heal itself. In fact, sleep is so important, it is part of every physicians prescription for virtually every disorder. However, while we naturally eliminate a lot of stress through sleep, the statistics tell us that most people are not winning their fight against stress and have come to accept being stressed as normal. We manage our stress with an increasing number of pharmaceuticals as we get older and think nothing of a full medicine cabinet to deal with our many disorders. If assisting nature is the key, what more can we do to help our bodies eliminate stress? How do we supplement our sleep if rest is so beneficial to health? This is where the yogis approach comes into play.

Research by co-author Dr. Wallace first published in Science and Scientific American in the 1970s showed that the meditation technique he analyzed, the Transcendental Meditation (TM) technique, produced a unique state of rest and orderliness in the mind and body, correcting physical disorders beyond what sleep had accomplished. His research showed that during the TM meditation session, the body gained a profound and unique state of rest. During the TM practice, even though the meditator was alert, the research showed remarkable decreases in oxygen consumption and respiration, reduced concentrations of blood lactate levels (high blood lactate is associated with anxiety), and a marked increase in skin resistance (associated with relaxation).

Later studies by Wallace and his colleagues showed reductions in cortisol (the stress hormone), as well as increases in serotonin (the happiness hormone), increases in blood flow to the brain, and perhaps most importantly, a marked coherence in the functioning of the brain. Sleep heals by creating order where there is disorder, but, interestingly, the rest during the Transcendental Meditation practice has been found to create more coherence, so in some respects it is more profound than what occurs during sleep.

The charts above show EEG brain wave measurements during sleep and the Transcendental Meditation technique. The mountains or spindles show periods when there is especially high coherence in the brain wave activity. High brain wave coherence is associated with memory, concept learning, creativity, high self-esteem, and reduced anxiety, depression, and other disorders, whereas abnormally low brain wave coherence is associated with autism, schizophrenia, Alzheimers, and other mental disorders. This is why researchers are so interested in studying brain waves.

And as can be seen from the charts, the individual who has been practicing TM for four months has significantly more brain wave coherence during the TM session than during sleep. And the five-year meditator has extremely high levels of brain wave coherence both during the meditation session and before and after meditating when just sitting with the eyes closed (see the EC or eyes closed period in the meditators charts). This is a level of coherence not found in other meditation practices.

Being resilient in the face of stress is also important since we cant possibly eliminate all the stressors in our lives. An article by Dr. Wallace recently published in Medicina describes a series of studies on TM that investigated the meditators response pattern to stressful stimuli as compared to a relaxation control group.

The meditators heart rates and other physiological measurements increased appropriately in response to stressful stimuli, but the meditators recovered much more quickly than the non-meditators, basically brushing off a situation that would tend to have a lasting effect on the non-meditators and disrupt their nervous systems. Dr. Wallace coined the phrase neuroadaptability to refer to the more resilient physiology that can better withstand stressful events.

Another interesting analysis by Dr. David Orme-Johnson, a former professor at Maharishi International University in Iowa (where all the students learn TM), determined that the number of medical visits of about 2,000 TM meditators were just a fraction of the number of visits of non-meditators of comparable age, gender, and profession, who had similar health insurance policies. Over the five-year study period, the TM meditators had significantly fewer incidents of illness in 17 medical treatment categories, including 87 percent less hospitalization for heart disease, 87 percent less for nervous system disorders, 73 percent less for nose, throat and lung diseases (including virus caused diseases), 65 percent less for metabolic disease, including diabetes, and 55 percent less for cancer.

Our new book, The Coherence Effect (Armin Lear Press, 2020), has many personal accounts of business people overcoming stressful work situations. Josh Griffith is one good example. He went from being burned out on the job to having the enthusiasm of a new hire. Josh has been the head writer for the popular daytime TV shows Days of Our Lives and The Young and the Restless. In 2013, he was having serious stress issues at work, and he started looking into meditation practices. Co-author Marcus interviewed Josh a few years ago after he had tried other techniques and had been practicing TM for a year. Josh said:

I saw a celebrated doctor on television and decided to try a meditation he said would help. So, I tried his meditation for about a year . . . . It was kind of helping, but then the work issues got worse and I was still feeling the same way that I had before.

Then Josh saw an interview about TM on television, and he decided to try it. He said:

In the world of daytime TV, youre having to create five shows a week. As head writer [The Young and the Restless] I was responsible for all the stories that aired. I walked away from it a few years ago because I felt burned out. It was too much of an output, and I didnt feel the quality of the output was something I could be proud of. It was taking such a toll on me that I walked away.

Then I started doing TM. I thought I was a meditator before starting TM. Boy, was I wrong. I was offered the head job on Days of Our Lives, and I agreed to take it because with TM I already felt sort of a creative energy bubbling back inside of me. So, I stepped back in, and it was sort of the case where I felt like Im back at the beginning of the career.

I felt like I had the energy that I had when I first started doing daytime. I was able to come in and the ideas flowed nonstop, whereas before I didnt know if I would be able to finish this. I was thinking I dont know what Im going to do Ive hit a wall. TM allowed me to generate so many story ideas that it was, in a way, sort of like a rebirth. You know Ive had a 30-year career. And the changes happened within a month of practicing TM. I feel like Im starting [my career] now. I feel like a 25-year-old again.

In years past, businesses have been slow to adopt meditation as a tool. That is changing and will change even more once businesses use brain-wave coherence as a means of evaluating different meditation programs. We have referred to some of the findings on Transcendental Meditation, a technique that we have each practiced for about 50 years. If you are interested in trying a meditation program, there are many to choose from, but we suggest letting science be the guide in selecting one, and we say the principal criterion needs to be the degree to which the program creates coherence in the mind and body, especially in the brain. Because the brain is the control center of the body, when the EEG activity is coherent, it has a maximum effect in creating the orderly and neurologically adaptive state that counteracts stress and makes us more resilient.

Written by Jay B. Marcus.

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A Yogi's Take on Stress and Burnout - CEOWORLD magazine

Fall River’s Females in Action Hopes to Expand [TOWNSQUARE SUNDAY] –

Females in Action South Coast is a Fall River-based organization for women that formed11 months ago during the COVID-19 pandemic.

Its member work out together at North Park in Fall River twice a week, Wednesdays at 6:15 p.m. and Saturdays at 8 a.m. There is no registration fee; just show up and get involved.

In addition to the workouts, members are also building friendships and helping their community along the way.

Organizer Caitlin Botelho and member Andrea Silvasaid this week on Townsquare Sunday that Females in Action is all about fitness, friendships, and philanthropy. The group has been involved in various charitable efforts during its first year.

Now the organization is looking to increase its numbers and expand to New Bedford.

Females in Action is actually a national programwith active groups in 20 states. It first began in North Carolina in 2013.

Caitlin Botelho, a Fall River native, was living in Tennessee at the time and became involved. She returned home in 2019 and started what's believed to be the first FiA chapter in the Northeast.

Both Caitlin and Andrea spoke about their experiences with FiA, and their hopes of getting more women involved. Their interview can be heard here:

Townsquare Sunday is a weekly public affairs program which airs Sunday at 6 a.m. and 11 am. on 1420 WBSM. The program highlights individuals and organizations working to make the SouthCoast a better place to live and work.

If you would like your organization featured on Townsquare Sunday, please e-mail the host at

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Fall River's Females in Action Hopes to Expand [TOWNSQUARE SUNDAY] -

TestoPrime Reviews – Testo Prime Testosterone Booster – The Ritz Herald

TestoPrime is a dietary supplement that can help struggling with low testosterone levels. Testosterone is very important for overall male health as it can contribute to ones energy levels, stress response, muscle growth, sexual health and much more. It is common for men above the age of 40 to experience some sort of decline in their natural testosterone level. Issues such as erectile dysfunction, a lack of libido, weight gain, and low energy become common over time and even some younger people can suffer from the same problems. Taking a natural supplement that can boost the bodys natural testosterone levels can have a significant impact on ones overall health. TestoPrime is another addition to a long list of supplements that claim to boost natural testosterone levels in the body. Is the supplement worth purchasing? Does it work? Here is everything you need to know about TestoPrime.

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TestoPrime is a natural supplement that anyone over the age of 18 can use. The supplement is intended for those men that are suffering from low testosterone levels as it can help bring them back to the level they need to be.

If youre experiencing some form of erectile dysfunction, low sex drive, low energy levels, fat gain, symptoms of depression, loss of body hair, chronic fatigue, and are extremely unmotivated, then you may be suffering from low testosterone levels. Testosterone is a very important hormone for male health, and it should not be overlooked.

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Overall, TestoPrime looks like the answer to the common problems faced by most men. If you are facing any of the problems mentioned above, then consider TestoPrime as its a safe and affordable option.

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TestoPrime works by using a natural formula full of different powerful ingredients that support the bodys natural testosterone production mechanisms. However, thats not the only thing the supplement does, otherwise it would just be another testosterone booster. The ingredients inside the supplement also target the different things inside the body that could be contributing to low testosterone levels.

For example, stress is a big contributor to low T-levels and the supplement works inhibit the stress hormone cortisol to reduce the impact it has on the bodys testosterone levels. Similarly, there are different mechanisms inside the body that are responsible for converting testosterone into DHT (an androgen derived from testosterone), and estrogen. The ingredients inside the supplement work to reduce such mechanisms and prevent the conversion of testosterone. By reducing the rate at which testosterone is converted, and by promoting natural production of testosterone, TestoPrime can help support healthy T-levels in the body for fantastic health benefits.

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Therefore, if youre in the market for a supplement that can help improve your health naturally, then TestoPrime might be the right choice for you. However, its recommended that one does their own research as well in order to make an informed decision.

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Pricing and Refund Policy

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Please note that any guidelines and advice given here are not a substitute for medical advice. Please consult your physician if you are under medication or have doubts following the advice/instructions given. Individual results may vary.

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TestoPrime Reviews - Testo Prime Testosterone Booster - The Ritz Herald

Post-Pandemic Joy: Why It Feels So Good to Do Simple Things Again – Healthline

For Keith Wexelblatt of Massachusetts, it was walking into a full-capacity playoff ice hockey game for his beloved Boston Bruins.

For Eileen Fetterolf of New Jersey, it was smiling at strangers and seeing their whole face smile back.

For Katie Black of California, it was seeing her medical specialists in person.

For many of us, feelings of euphoria are coming quickly as we move back into the things we could do before the COVID-19 pandemic began.

That feeling of joy is chemically based, experts say.

Is it good for us? Like many scientific questions, the answer reads like this: yes, no, or maybe.

There was a layer placed between us and pleasure, Dr. Gail Saltz, a clinical associate professor of psychiatry at the NewYork-Presbyterian Hospital/Weill-Cornell Medical College, told Healthline.

The absence of pain is pleasure, she said. And so many people have been constrained (the basis for much of the pain). The removal of that limitation the unpleasant stimulus is pleasure.

Which means, she said, as we all re-enter normal life, you dont have to summit Mount Everest on your first venture out in the world to feel that joy. With the way weve been locked down and layered away from the world, she said, just about anything triggers joy right now.

For some people, food shopping is pleasure, she said. Looking at the fruits and vegetables set out for us, touching them without worry, when you can do it unrestricted, it is a pleasure for many.

What happens chemically?

Saltz said that the body releases dopamine, which she calls the reward hormone, when it senses a new and pleasurable experience.

This often requires something relatively exciting.

Often in couples counseling, Saltz advises couples to share a new activity or experience for just that reason. Dopamine can trigger that euphoric vibe, something that can help them enjoy one anothers company again.

Dopamine can also pump through the body when a long-time pleasurable experience, simple or grand, is withheld from a person for some time.

The joy we feel is probably intense, too, from the setup we may have experienced over the pandemic year leading up to the experience.

We dont fully realize the toll the loss has taken on us. There is a residue that has built up over the last year, Karen Doll, PsyD, a licensed psychologist in Minnesota, told Healthline.

Lack of stimulation and lack of variety of inputs creates a fog in the brain, she said. As humans, we have a strong need to connect with people in person.

Thats why, beyond dopamine, we may also have more good hormones pumping, and we may feel excited to see just about anyone we know in real life.

The isolation and loneliness have been significant, Doll said. Reconnecting with individuals is having a powerful impact on people and relationships. The increase in oxytocin (love hormone) that occurs when we are connected with people is so important for well-being.

Its not all dopamine and hugs, though.

First, said Saltz, its important we all amp up our compassion mode in real time.

Why? Because, she said, not everyone is at a place of joy.

Its very individual, she said. How close is someone to loss? What psychology did they have heading into this?

She points out that loss has many incarnations. Theres the loss of lives, of jobs, of income, of financial security, and more. Top that off, she said, with the non-pandemic concerns such as racial inequality, and you can see that many may still be having a difficult time.

Realizing and owning that is not only crucial, she said, its humane.

The person you may see who isnt joyful like you, she said, can feel really bad, thinking something is wrong with them (when everyone else seems so happy).

Her advice? As much as you may want to dance through the market aisle hugging everyone you pass, Give yourself and others a lot of space. If youre not feeling it and everyone around you seems to be going woo hoo! it can seem pretty awful.

We could also, said Doll, take the joy vibe too far.

There are risks to letting loose after operating with such restrictions in our environment, Doll said.

She points out that over the pandemic year, our social skills were not put into practice as much and may be languishing a bit.

I heard someone describe it as letting a bunch of caged animals out can be dangerous, she said.

So, we may not be as accurately in tune with our senses and cues that will tell us when we are on the verge of poor choices. Its like our social judgments in public havent been exercised or utilized, so are likely out of tune, Doll said.

What to do? She suggests we remember to take a pause and check in with ourselves, to ensure that we dont overdo it or lose sight of the risks and impact of our behaviors.

It could also, Doll said, lead to letdown.

To avoid a post-joy crash, she said, It can also be helpful to increase our emotional awareness and literacy. Being aware of what we are feeling, how intensely, and what are the triggers can be useful for healthy emotional regulation.

The message? As we savor those hormone highs, we should also take time to adjust.

Coming out of this is going to take time, Saltz said. The idea that we are just flipping a switch is not correct. Set smaller goals.

And if you dont feel a shift toward joy over time? Take action.

The good news? We all, for the most part, should get to joy in time.

These are treatable conditions, she said.

For now, many are savoring the joy of even the most basic.

Its making me so happy to smile at strangers and friends, said Fetterolf.

She works with first graders and has realized a new joy there as well.

I did not realize how much I missed toothless grins and wiggly teeth, she said.

Wexelblatt marvels at how something as joyful all his life as a Bruins playoff game could feel even better. But, he said, it did and it does.

There was an unreal pent-up energy that exploded with fans, he said. A huge sense of almost normalcy. Immense joy.

And for Erin Duggan of Massachusetts, total joy joins with wearing makeup once more.

I can wear lipstick and not just leave it on my mask now, she said. Its the simple things.

Originally posted here:
Post-Pandemic Joy: Why It Feels So Good to Do Simple Things Again - Healthline

FDA approves obesity drug that helped people cut weight 15% – Minneapolis Star Tribune

Regulators on Friday said a new version of a popular diabetes medicine could be sold as a weight-loss drug in the U.S.

The Food and Drug Administration approved Wegovy, a higher-dose version of Novo Nordisk's diabetes drug semaglutide, for long-term weight management.

In company-funded studies, participants taking Wegovy had average weight loss of 15%, about 34 pounds (15.3 kilograms). Participants lost weight steadily for 14 months before plateauing. In a comparison group getting dummy shots, the average weight loss was about 2.5%, or just under 6 pounds.

"With existing drugs, you're going to get maybe 5% to 10% weight reduction, sometimes not even that," said Dr. Harold Bays, medical director of the Louisville Metabolic and Atherosclerosis Research Center. Bays, who is also the Obesity Medicine Association's chief science officer, helped run studies of the drug.

In the U.S., more than 100 million adults about 1 in 3 are obese.

Dropping even 5% of one's weight can bring health benefits, such as improved energy, blood pressure, blood sugar and cholesterol levels, but that amount often doesn't satisfy patients who are focused on weight loss, Bays said.

Bays said Wegovy appears far safer than earlier obesity drugs that "have gone down in flames" over safety problems. Wegovy's most common side effects were gastrointestinal problems, including nausea, diarrhea and vomiting. Those usually subsided, but led about 5% of study participants to stop taking it.

The drug carries a potential risk for a type of thyroid tumor, so it shouldn't be taken by people with a personal or family history of certain thyroid and endocrine tumors. Wegovy also has a risk of depression and pancreas inflammation.

Wegovy (pronounced wee-GOH'-vee) is a synthesized version of a gut hormone that curbs appetite. Patients inject it weekly under their skin. Like other weight-loss drugs, it's to be used along with exercise, a healthy diet and other steps like keeping a food diary.

The Danish company hasn't disclosed Wegovy's price but said it will be similar to the price of its Saxenda, a weight loss drug injected daily that now typically costs more than $1,300 per month without insurance.

Dr. Archana Sadhu, head of the diabetes program at Houston Methodist Hospital, said Wegovy's usefulness "all depends on what the price will be." She noted patients' health insurance plans sometime don't cover weight-loss treatments, putting expensive drugs out of reach.

Sadhu, who has no connection to Novo Nordisk, plans to switch patients who are obese and have Type 2 diabetes to Wegovy. It makes patients feel full sooner and increases release of insulin from the pancreas to control blood sugar, she said. Patients would then be more likely to get motivated to exercise and eat healthier, she added.

Wegovy builds on a trend in which makers of relatively new diabetes drugs test them to treat other conditions common in diabetics. For example, popular diabetes drugs Jardiance and Novo Nordisk's Victoza now have approvals for reducing risk of heart attack, stroke and death in heart patients.

Phylander Pannell, 49, of Largo, Maryland, joined a patient study after cycles of losing and then regaining weight. She said she received Wegovy, worked out several times a week and lost 65 pounds over 16 months.

"It helped curb my appetite and it helped me feel full faster," said Pannell. "It got me on the right path."

Shortly after she finished the study and stopped receiving Wegovy, she regained about half the weight. She's since lost much of that, started exercise classes and bought home exercise equipment. She's considering going back on Wegovy after it's approved.

Novo Nordisk also is developing a pill version.


Follow Linda A. Johnson at


The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content.


This story has been corrected to show the length of time study participants lost weight before plateauing was 14 months, not 16 months, and the last name of the Houston physician to Sadhu, not Sudhu.

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FDA approves obesity drug that helped people cut weight 15% - Minneapolis Star Tribune

Laws banning trans athletes from competing in girls’ and women’s sports not grounded in science, say experts | TheHill – The Hill

On June 1, Florida Gov. Ron DeSantis signed a bill into law that would ban trans athletes from participating on female sports teams at the high school and college level. It states that individuals with a biological sex indicated as male on their birth certificates cannot participate on girls sports teams. Several other states have proposed or passed similar legislation, including Mississippi, Minnesota, Idaho, Ohio and Tennessee.

Politicians who support the bans say that this is an issue of fairness and of protecting girls sports. Experts say that this fear is not well supported.

This argument that trans people are somehow going to ruin sports as we know it is not based on anything connected to fact, said Vinnie Pompei, who conducted a survey of LGBTQ+ youth in California for the Human Rights Campaign Foundation, to The Mercury News.

Physician and geneticist Eric Vilain, who has studied sex differences in athletes and advised the International Olympic Committee and the NCAA, said to NPR that the proposed laws are not based in scientific evidence and "target women who have either a different biology or ... simply look different."

Biologists who study genetics, hormones and performance of the human body haveexaminedthis issue for many years. There might be some advantage that biological men have on average, but this does not mean that there is always such an advantage or that there is a benefit to taking a hard line on banning individuals from sports.

We know that men have, on average, an advantage in performance in athletics of about 10% to 12% over women, which the sports authorities have attributed to differences in levels of a male hormone called testosterone, says Vilain to NPR. But the question is whether there is in real life, during actual competitions, an advantage of performance linked to this male hormone and whether trans athletes are systematically winning all competitions. The answer to this latter question, are trans athletes winning everything, is simple that's not the case.

America is changing faster than ever! Add Changing America to your Facebook or Twitter feed to stay on top of the news.

Although experts have been researching hormones and athletic ability for years, theres no consensus on what really affects a persons ability to perform.

The science of whether testosterone in real life is actually providing an advantage in competition is not clearly established, says Vilain to NPR.

Theres no scientific evidence that someone who was assigned male at birth would definitively have a competitive advantage over someone who was assigned female at birth. Both women and men have a wide range of physical capabilities, and its likely that athletic performance is much more complex than hormones and genetics.

Another important point is that women who may look different may be asked to prove their sex in order to compete under these laws. In a letter to South Dakota Gov. Kristi Noem (R), the National Womens Law Center writes, the proposed ban for the state would not only exclude transgender students from sports but would also harm cisgender girls and women who fall outside stereotypical notions of femininity, simply because they are very tall or muscular, have short hair, wear masculine clothing, or otherwise choose to present in more traditionally masculine ways.

If, as many of these lawmakers claim, fairness is their goal, they should turn their attention to the unfair advantages many cisgender, white athletes receive by virtue of little more than their zip codeincluding the remaining gap in resources between boys and girls programs, according to the National Womens Law Center.

Trans youth are hearing powerful politicians say that their identities are invalid and that they are a threat to their peers, says Jack Turban, a Fellow in Child & Adolescent Psychiatry at the Stanford University School of Medicine, to The Mercury News. Though they may know this is not true, hearing it over and over takes a serious toll and can drive anxiety and depression. As a therapist who treats these young people, it is heartbreaking to see.

In Florida, the Human Rights Campaign plans to sue Gov. DeSantis over the new legislation.







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Laws banning trans athletes from competing in girls' and women's sports not grounded in science, say experts | TheHill - The Hill

Sanofi inks partners for phase 3 pivotal trial of add-on breast cancer therapy – FierceBiotech

Two weeks after saying the breast cancer hopeful amcenestrant could be at the forefront of future treatments, Sanofi has secured partners for a phase 3 trial to study the drug versus the hormone therapy tamoxifen.

The Breast International Group (BIG), the European Organization for Research and Treatment of Cancer (EORTC) and the Alliance Foundation Trials (AFT) will initiate the pivotal trial with the French Big Pharma.

The AMEERA-6 study will look at amcenestrant versus tamoxifen, a hormonal therapy approved by the FDA in 1998 for women with estrogen receptor-positive breast cancer who prematurely ended standard therapy and are susceptible to a return of the disease.

Amcenestrant, which is an oral selective estrogen receptor degrader (SERD), has the potential to become a best-in-class oral endocrine backbone therapy, said Peter Adamson, M.D., global head of oncology development at Sanofi, in a statement.

RELATED: Sanofi says early amcenestrant data could see it be endocrine backbone therapy in breast cancer

The add-on therapy aims to prevent and slow down disease progression. Current adjuvant therapies, like aromatase inhibitors, have side effects that lead some women to end medication early, said David Cameron, BIG executive board chairman, in a statement.

Sanofi will provide funding and the investigational drug for the global study as the sponsor, while Brussels-based BIG will do the study within its network. EORTC, an academic contract research organization, will manage the study, data analysis and medical management. AFT, a cancer clinical trial research organization, will handle the U.S. portion of the study.

Two weeks ago, Sanofi presented pooled data of amcenestrant from the phase 1 AMEERA-1 trial, which hit an objective response rate of 34% and a clinical benefit rate of 74% when combined with Pfizers approved breast cancer med Ibrance.

As part of the American Society of Clinical Oncology presentation last month, Sanofi said AMEERA-3, a potential registrational study attempting to show amcenestrant is superior to physicians choice in a second-line setting, was delayed from the second quarter to the latter half of this year.

Analysts from Jefferies have been impressed by the early data from the AMEERA-1 program but said the AMEERA-3 delay "does not help build confidence in establishing belief in the pipeline."

Sanofi will not be first in the SERD gameAstraZeneca'sFaslodex holds that titlebut the French drugmaker hopes to avoid the pitfalls of the 20-year-old med that had to be delivered through intramuscular injection. This painful delivery mechanism held back sales.

Jefferies estimates the SERD market is a $2 billion to $3 billionopportunity.Sanofi is going up against Roche in trying to bring a new SERD through the clinic as well as AstraZeneca, which has a second-generation therapy in the works.

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Sanofi inks partners for phase 3 pivotal trial of add-on breast cancer therapy - FierceBiotech

UK doctor banned from reversing chemical abortions – BioEdge

Dispatches from the Reproductive Revolution 2. At the request of a leading abortion provider, a doctor in the UK has been banned by the Medical Practitioners Tribunal Service from helping women to reverse the effects of their chemical abortions. He could be deregistered.

As often happens, this story is a tangled one. Bear with us.

During the UKs first lockdown, abortion providers lobbied to send chemical abortion drugs to women through the postal service. They would never see a doctor; instead, they just took two pills and waited for the foetus to be expelled.

Some women regretted their impulsive decision as soon as they had taken the first pill. For them, Dr Dermot Kearney prescribed progesterone, a hormone for treating natural miscarriages, in an attempt to cancel the effects of the abortifacient, mifepristone. This is an off-label use of progesterone.

He claims that of 73 women, 38 of them managed to hold on to their babies -- a success rate of almost 50%.

According to the Daily Mail, MSI Reproductive Choices, formerly known as Marie Stopes International, filed a complaint. It claimed that Dr Kearney inappropriately prescribed progesterone to a patient for a use not backed by evidence, failed to present a balanced picture of its benefits and risks, and imposed his anti-abortion beliefs on her.

Andrea Williams, chief executive of the Christian Legal Centre, said: Babies are alive today because mothers reached out to Dr Kearney and he provided effective and safe abortion rescue. This ruling punishes the life saver, is deeply wrong and needs to be overturned.

Dr Kearney, a cardiologist and emergency physician and the president of the Catholic Medical Association, has been told by the MPTS that he must not prescribe, administer or recommend progesterone for abortion reversal treatments. Otherwise, he can continue practicing until the hearing.

Michael Cook is editor of BioEdge

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UK doctor banned from reversing chemical abortions - BioEdge

Trodelvy Demonstrates Superior Outcomes to Standard of Care in Second-Line Treatment of Metastatic Triple-Negative Breast Cancer in Phase 3 ASCENT…

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Trodelvy More than Doubled Overall Survival as Second-Line Treatment in New ASCENT Subgroup Analysis

FOSTER CITY, Calif.--(BUSINESS WIRE)--Gilead Sciences, Inc. (Nasdaq: GILD) today announced new data from the Phase 3 ASCENT study evaluating Trodelvy (sacituzumab govitecan-hziy) in relapsed or refractory metastatic triple-negative breast cancer (TNBC). In this subgroup analysis of brain metastases-negative patients who received only one line of prior systemic therapy in the metastatic setting in addition to having disease recurrence or progression within 12 months of (neo)adjuvant chemotherapy, Trodelvy improved progression-free survival (PFS), with a 59% reduction in the risk of disease worsening or death (HR: 0.41; 95% CI: 0.22-0.76) and a median PFS of 5.7 months (n=33) versus 1.5 months with chemotherapy (n=32). Trodelvy also extended median overall survival to 10.9 months versus 4.9 months with chemotherapy (HR: 0.51; 95% CI: 0.28-0.91). The results were presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract #1080).

In patients with relapsed or refractory metastatic triple-negative breast cancer, outcomes are typically poor especially among patients who progress within 12 months of (neo)adjuvant chemotherapy, said Lisa Carey, MD, Medical Director of the UNC Breast Center, the Physician-in-Chief of the North Carolina Cancer Hospital and Associate Director of Clinical Research at UNC Lineberger Comprehensive Cancer Center. In the Phase 3 ASCENT study, Trodelvy was the first treatment to demonstrate a proven survival advantage in pre-treated patients with locally advanced or metastatic TNBC, and the analysis presented at ASCO reaffirms this benefit over standard of care with important new data in the second-line setting.

Additional results showed Trodelvy demonstrated a higher overall response rate compared with chemotherapy (30% versus 3%). Efficacy results from this subgroup were consistent with those observed in the overall ASCENT study population.

The safety profile of Trodelvy in this subgroup was consistent with prior reports. The most frequent Grade 3 treatment-related adverse reactions for Trodelvy compared to chemotherapy were neutropenia (61% versus 21%), leukopenia (9% versus 0%), diarrhea (6% versus 0%), anemia (3% versus 6%), and fatigue (3% versus 0%). One patient in this subgroup who received Trodelvy experienced febrile neutropenia. Adverse reactions leading to treatment discontinuation were low across both groups (6% in each). There were no treatment-related deaths with Trodelvy in this subgroup. The Trodelvy U.S. Prescribing Information has a BOXED WARNING for severe or life-threatening neutropenia and severe diarrhea; see below for Important Safety Information.

With Trodelvy, we continue to challenge the standard of care in locally advanced and metastatic TNBC. The efficacy observed in the second-line metastatic setting with Trodelvy is highly meaningful, since many patients will progress quickly following chemotherapy. Among these patients, we see median overall survival more than doubled where need is particularly great, said Daejin Abidoye, MD, Senior Vice President, Head of Oncology Clinical Development, Gilead Sciences. We are committed to improving the prognosis for people with this aggressive cancer, and as we continue to study Trodelvy, we are encouraged by this proven efficacy in TNBC.

Two additional ASCENT subgroup analyses that support the efficacy benefit of Trodelvy were also presented at the meeting one evaluating Trodelvy efficacy by patients age (Abstract #1011) and the other comparing Trodelvy with specific single-agent chemotherapy chosen by the patients treating physicians (Abstract #1077).

About Triple-Negative Breast Cancer (TNBC)

TNBC is an aggressive type of breast cancer, accounting for approximately 15% of all breast cancers. The disease is diagnosed more frequently in younger and premenopausal women and is more prevalent in African American and Hispanic women. TNBC cells do not have estrogen and progesterone receptors and have limited HER2. Medicines targeting these receptors therefore are not typically effective in treating TNBC.

About the ASCENT Study

The Phase 3 ASCENT study, an open-label, active-controlled, randomized confirmatory trial, enrolled more than 500 patients with relapsed/refractory metastatic triple-negative breast cancer who had received two or more prior systemic therapies, including a taxane, at least one of them for metastatic disease. Patients were randomized to receive either Trodelvy or a chemotherapy chosen by the patients treating physicians. The primary efficacy outcome was PFS in patients without brain metastases at baseline, as measured by a blinded, independent, centralized review using RECIST v1.1 criteria. Additional efficacy measures included PFS for the full population, including all patients with and without brain metastases, and overall survival. More information about ASCENT is available at

About Trodelvy

Trodelvy (sacituzumab govitecan-hziy) is a first-in-class antibody and topoisomerase inhibitor conjugate directed to the Trop-2 receptor, a protein frequently expressed in multiple types of epithelial tumors, including metastatic triple-negative breast cancer and metastatic urothelial cancer, where high expression is associated with poor survival and relapse.

In the U.S., Trodelvy is indicated for the treatment of:

Beyond the regulatory approvals of Trodelvy in the U.S., regulatory reviews for Trodelvy in metastatic triple-negative breast cancer are currently underway in the EU, U.K., Canada, Switzerland and Australia, as well as in Singapore through our partner Everest Medicines. Trodelvy is also being investigated as potential treatment for hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer and metastatic non-small cell lung cancer. Additional evaluation across multiple solid tumors is also underway.

U.S. Important Safety Information for Trodelvy




Neutropenia: Severe, life-threatening, or fatal neutropenia can occur and may require dose modification. Neutropenia occurred in 61% of patients treated with Trodelvy. Grade 3-4 neutropenia occurred in 47% of patients. Febrile neutropenia occurred in 7%. Withhold Trodelvy for absolute neutrophil count below 1500/mm3 on Day 1 of any cycle or neutrophil count below 1000/mm3 on Day 8 of any cycle. Withhold Trodelvy for neutropenic fever.

Diarrhea: Diarrhea occurred in 65% of all patients treated with Trodelvy. Grade 3-4 diarrhea occurred in 12% of patients. One patient had intestinal perforation following diarrhea. Neutropenic colitis occurred in 0.5% of patients. Withhold Trodelvy for Grade 3-4 diarrhea and resume when resolved to Grade 1. At onset, evaluate for infectious causes and if negative, promptly initiate loperamide, 4 mg initially followed by 2 mg with every episode of diarrhea for a maximum of 16 mg daily. Discontinue loperamide 12 hours after diarrhea resolves. Additional supportive measures (e.g., fluid and electrolyte substitution) may also be employed as clinically indicated. Patients who exhibit an excessive cholinergic response to treatment can receive appropriate premedication (e.g., atropine) for subsequent treatments.

Hypersensitivity and Infusion-Related Reactions: Serious hypersensitivity reactions including life-threatening anaphylactic reactions have occurred with Trodelvy. Severe signs and symptoms included cardiac arrest, hypotension, wheezing, angioedema, swelling, pneumonitis, and skin reactions. Hypersensitivity reactions within 24 hours of dosing occurred in 37% of patients. Grade 3-4 hypersensitivity occurred in 2% of patients. The incidence of hypersensitivity reactions leading to permanent discontinuation of Trodelvy was 0.3%. The incidence of anaphylactic reactions was 0.3%. Pre-infusion medication is recommended. Observe patients closely for hypersensitivity and infusion-related reactions during each infusion and for at least 30 minutes after completion of each infusion. Medication to treat such reactions, as well as emergency equipment, should be available for immediate use. Permanently discontinue Trodelvy for Grade 4 infusion-related reactions.

Nausea and Vomiting: Nausea occurred in 66% of all patients treated with Trodelvy and Grade 3 nausea occurred in 4% of these patients. Vomiting occurred in 39% of patients and Grade 3-4 vomiting occurred in 3% of these patients. Premedicate with a two or three drug combination regimen (e.g., dexamethasone with either a 5-HT3 receptor antagonist or an NK1 receptor antagonist as well as other drugs as indicated) for prevention of chemotherapy-induced nausea and vomiting (CINV). Withhold Trodelvy doses for Grade 3 nausea or Grade 3-4 vomiting and resume with additional supportive measures when resolved to Grade 1. Additional antiemetics and other supportive measures may also be employed as clinically indicated. All patients should be given take-home medications with clear instructions for prevention and treatment of nausea and vomiting.

Increased Risk of Adverse Reactions in Patients with Reduced UGT1A1 Activity: Patients homozygous for the uridine diphosphate-glucuronosyl transferase 1A1 (UGT1A1)*28 allele are at increased risk for neutropenia, febrile neutropenia, and anemia and may be at increased risk for other adverse reactions with Trodelvy. The incidence of Grade 3-4 neutropenia was 67% in patients homozygous for the UGT1A1*28, 46% in patients heterozygous for the UGT1A1*28 allele and 46% in patients homozygous for the wild-type allele. The incidence of Grade 3-4 anemia was 25% in patients homozygous for the UGT1A1*28 allele, 10% in patients heterozygous for the UGT1A1*28 allele, and 11% in patients homozygous for the wild-type allele. Closely monitor patients with known reduced UGT1A1 activity for adverse reactions. Withhold or permanently discontinue Trodelvy based on clinical assessment of the onset, duration and severity of the observed adverse reactions in patients with evidence of acute early-onset or unusually severe adverse reactions, which may indicate reduced UGT1A1 function.

Embryo-Fetal Toxicity: Based on its mechanism of action, Trodelvy can cause teratogenicity and/or embryo-fetal lethality when administered to a pregnant woman. Trodelvy contains a genotoxic component, SN-38, and targets rapidly dividing cells. Advise pregnant women and females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with Trodelvy and for 6 months after the last dose. Advise male patients with female partners of reproductive potential to use effective contraception during treatment with Trodelvy and for 3 months after the last dose.


In the ASCENT study (IMMU-132-05), the most common adverse reactions (incidence 25%) were fatigue, neutropenia, diarrhea, nausea, alopecia, anemia, constipation, vomiting, abdominal pain, and decreased appetite. The most frequent serious adverse reactions (SAR) (>1%) were neutropenia (7%), diarrhea (4%), and pneumonia (3%). SAR were reported in 27% of patients, and 5% discontinued therapy due to adverse reactions. The most common Grade 3-4 lab abnormalities (incidence 25%) in the ASCENT study were reduced neutrophils, leukocytes, and lymphocytes.

In the TROPHY study (IMMU-132-06), the most common adverse reactions (incidence 25%) were diarrhea, fatigue, neutropenia, nausea, any infection, alopecia, anemia, decreased appetite, constipation, vomiting, abdominal pain, and rash. The most frequent serious adverse reactions (SAR) (5%) were infection (18%), neutropenia (12%, including febrile neutropenia in 10%), acute kidney injury (6%), urinary tract infection (6%), and sepsis or bacteremia (5%). SAR were reported in 44% of patients, and 10% discontinued due to adverse reactions. The most common Grade 3-4 lab abnormalities (incidence 25%) in the TROPHY study were reduced neutrophils, leukocytes, and lymphocytes.


UGT1A1 Inhibitors: Concomitant administration of Trodelvy with inhibitors of UGT1A1 may increase the incidence of adverse reactions due to potential increase in systemic exposure to SN-38. Avoid administering UGT1A1 inhibitors with Trodelvy.

UGT1A1 Inducers: Exposure to SN-38 may be substantially reduced in patients concomitantly receiving UGT1A1 enzyme inducers. Avoid administering UGT1A1 inducers with Trodelvy.

Please see full Prescribing Information, including BOXED WARNING.

About Gilead Sciences

Gilead Sciences, Inc. is a biopharmaceutical company that has pursued and achieved breakthroughs in medicine for more than three decades, with the goal of creating a healthier world for all people. The company is committed to advancing innovative medicines to prevent and treat life-threatening diseases, including HIV, viral hepatitis and cancer. Gilead operates in more than 35 countries worldwide, with headquarters in Foster City, California.

Forward-Looking Statements

This press release includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 that are subject to risks, uncertainties and other factors, including Gileads ability to initiate, progress or complete clinical trials within currently anticipated timelines or at all, including those involving Trodelvy; the possibility of unfavorable results from ongoing or additional trials, including those involving Trodelvy; Gileads ability to receive regulatory approvals in a timely manner or at all, including additional regulatory approvals of Trodelvy for the treatment of metastatic TNBC, metastatic breast cancer, metastatic UC, metastatic non-small cell lung cancer and other solid tumors, and the risk that any such approvals may be subject to significant limitations on use; and any assumptions underlying any of the foregoing. These and other risks, uncertainties and other factors are described in detail in Gileads Quarterly Report on Form 10-Q for the quarter ended March 31, 2021, as filed with the U.S. Securities and Exchange Commission. These risks, uncertainties and other factors could cause actual results to differ materially from those referred to in the forward-looking statements. All statements other than statements of historical fact are statements that could be deemed forward-looking statements. Investors are cautioned that any such forward-looking statements are not guarantees of future performance and involve risks and uncertainties and are cautioned not to place undue reliance on these forward-looking statements. All forward-looking statements are based on information currently available to Gilead, and Gilead assumes no obligation and disclaims any intent to update any such forward-looking statements.

U.S. Prescribing Information for Trodelvy including BOXED WARNING, is available at

Trodelvy, Gilead and the Gilead logo are trademarks of Gilead Sciences, Inc., or its related companies.

For more information about Gilead, please visit the companys website at, follow Gilead on Twitter (@GileadSciences) or call Gilead Public Affairs at 1-800-GILEAD-5 or 1-650-574-3000.

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Jacquie Ross, Investors(650) 358-1054

Nathan Kaiser, Media(650) 522-1853

Source: Gilead Sciences, Inc.

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Trodelvy Demonstrates Superior Outcomes to Standard of Care in Second-Line Treatment of Metastatic Triple-Negative Breast Cancer in Phase 3 ASCENT...

Slash Your Cancer Risk in Seconds, Say Cancer Experts | Eat This Not That – Eat This, Not That

You're about to hear advice from the last people you'd ever want to meet. Oncologists specialize in the diagnosis and treatment of cancer. If you're talking to one, and you're not at a dinner party, you might be one of the 100 million folks around the world who have it. With those staggering stats, you might think getting cancer is an inevitably. It isn't. Read onand to ensure your health and the health of others, don't miss these 19 Ways You're Ruining Your Body, Say Health Experts.

"I am very careful about keeping up with proven cancer screening interventions," says Amy Tiersten, MD, clinical breast medical oncologist at Mount Sinai. She stays current on preventative tests like colonoscopy, skin cancer exams, and gynecologic follow-ups.

Late diagnoses are a leading cause of premature death due to cancer. Interventions, like those Dr. Tiersten recommends, allow for early detection and diagnosis where patients can start treatment earlier. This is especially impactful in breast, cervical, and colorectal cancers.

The American Cancer Society recommends:

Ten years after the HPV vaccine was introduced, there is "compelling evidence" that we're on track "to eradicate cervical cancer within decades." A June 2019 study reviewed 60 million individuals', mostly girls and women, eight-year post-vaccination status and found that the vaccine has exceeded expectations.

The CDC recommends both boys and girls get the HPV vaccine at ages 11-12, with the second dose within a year. It's recommended up to age 26 for women and age 21 for men.

Newer versions of the vaccine require two doses instead of three, ensuring adherence to the full vaccination schedule. As well, it's gender-neutral and targets more HPV strains.

Exercise every single day that's the walk Kathryn Schmitz, Ph.D., a leading exercise oncology researcher at Penn State University, walks and talks. "We oncologists run, walk, or roll our way to cancer prevention," she said, citing research that supports a relationship between physical activity and cancer prevention. She's the biggest proponent of strength training, something she introduced in the chemo lab at Penn State Cancer Institute and shares as "exercise snacks" each week on her Instagram. "I try to exercise 30 minutes a day to stay fit. We know that regular physical exercise does reduce cancer risk in many cases. Decreasing your body weight, even by 5%, can make a big difference in terms of cancer risk," says Xavier Llor, MD, Medical Director of the Cancer Screening and Prevention Program.

RELATED: The #1 Reason You Could Get Cancer, According to Science

"Embrace your social networks; recognize who loves you and let them in," is how Dr. Don Dizon, MD, FACP, FASCO, director of medical oncology at Rhode Island Hospital and Professor of Medicine at Brown University prevents cancer. He says it's well-established that whether your social network includes a spouse, kids, best friend, or church, these connections are key to good health and that social isolation is associated with an increased risk of death.

"In one study, social isolation scores were associated with risk of death from heart disease and in all-cause mortality. This was true for men and women, Blacks and whites."

As an oncology clinical pharmacist, there are several things Allison Baxley, PharmD, BCOP of Stephenson Cancer Center does to prevent cancer. She recognizes that many elements are out of our control, like genetics, so she does all she can to reduce the risk through things she can control.

"Working primarily in GI oncology, I'm very aware of the link between colon cancer and processed and red meat consumption. I eat these in moderation, and rarely if ever eat highly processed meat like hot dogs and bacon."

She avoids what Micahel Pollen has called "edible food-like substance," which is the majority of what's in the center aisles of the grocery store.

RELATED: Signs You're Getting One of the "Most Deadly" Cancers.

Our daily diet choices play a powerful role in cancer prevention, reminds Dr. Terry Wahls, author of The Wahls Protocol series. For optimal cancer prevention, she aims for 9 cups of plant-based foods each day: 3 cups of greens, 3 cups of sulfur-rich foods like cabbage, onions, or mushrooms, and 3 cups of color from berries.

"We can choose to eat more greens and non-starchy vegetables and berries to markedly reduce the risk of developing cancer (and surviving cancer if it is diagnosed)," she explains. "Or we can choose the standard American diet, full of sugar and flour, which drives up insulin and insulin-like growth hormone and have a much higher risk of pre-cancers and overt cancers."

LaShyra "Lash" Nolen, an MD candidate at Harvard Medical School, points out that Black women have a disproportionately higher rate of mortality from breast cancer than white women, according to 2016 research.

"Therefore, I think it is so important for me, as a young Black woman, to take agency over my body," shared Nolen. "One way I do this is by regularly performing a physical exam of my breasts to search for abnormalities or unusual lumps."

She adds that, sometimes, women allow others to know their bodies better than they do themselves, but that this has to change in order to detect cancers at earlier stages and improve outcomes.

As an American Cancer Society Research Professor and Associate Dean for Oncologic Sciences at Brown University, Dr. Wafik El-Deiry says it's important to remember that half of all cancer is preventable. One of his preventive efforts is to limit or moderate alcohol consumption, as alcohol has been linked to cancers of the mouth, throat, liver, colon, breast, and others.

"Be aware and keep in the back of your mind that this is a substance that can do harm," he advises. El-Deiry says there's a lot of evolving and emerging data on the association between alcohol and cancer, but that the relationship does exist.

How much is too much? The American Cancer Society advises no more than 2 drinks per day for men and 1 drink per day for women.

Jeffrey Meyerhardt, MD, MPH, medical oncologist for the Dana-Farber Cancer Institute, works hard to maintain a healthy body weight. He cites consistent evidence in observational studies that link obesity and higher BMI with a variety of cancers, including colorectal, ovarian, and pancreatic.

In particular, he cited a 2003 study that analyzed the relationship between body weight and mortality from cancer in nearly one million American adults. When the heaviest participants had a BMI of 40, death rates from all cancers were 62% higher in women and 52% higher in men when compared to those of "normal weight."

RELATED: The #1 Cause of Obesity, According to Science

"I eat a balanced diet of real food. The less processed, the better!" says Allison Betof Warner, MD, Ph.D. of Memorial Sloan Kettering Cancer Center. Of course, this melanoma medical oncologist splurges and doesn't always eat healthy (like the rest of us!), but when she does, moderation is key.

While no single food can prevent cancer, a well-rounded diet with a variety of vegetables, fruits, and grains can go a long way toward risk reduction.

"I try to live by the 80/20 rule," she caveats. That's 80% whole, healthy foods in balanced proportions and 20% treats and other "less" healthy stuff.

"I make sure to get plenty of Vitamin D," says Kevin Dawravoo, MD, hematologist and medical oncologist at Northwestern Medicine Cancer Center Warrenville. He cites numerous studies that support the anti-cancer effects of this nutrient. Anyone can check for a vitamin D deficiency with a simple blood test at their doctor's office. That deficiency was linked in a 2014 study to a greater risk for more aggressive prostate cancer.

The best source for vitamin D is the sun, but new research says sunblock does not compromise the absorption of the vitamin. Fish is the best food source for vitamin D, including salmon, rainbow trout, and swordfish, as well as fish oil/cod liver.

Most Americans are "woefully sleep deprived," says Dr. Stephen C Schimpff, MD, MACP. Board certified in medical oncology, Schimpff is sure to "get enough sleep" each night. It's a subject important enough that he addresses it in his book, Longevity Decoded The 7 Keys to Healthy Aging.

"Inadequate sleep predisposes to high blood pressure, stress, overeating [in general] and the wrong foods, obesity, and hence predisposes to cancer," he continued

Monisha Bhanote, MD, FASCP, FCAP meditates regularly, a practice she says can "help balance life's daily stressors." The most benefit is gained from daily practice, even if just five minutes, than if done sporadically.

The triple board certified physician at Baptist MD Anderson Cancer Center says, "Managing stress is important for preventing chronic disease and predisposing one to cancer. Stress weakens the immune system and lowers its defenses to fight diseases." Consistent meditation can move the body into a parasympathetic state (rest and energy conservation) as opposed to a continuous sympathetic state (aka fight or flight).

Bhanote cited a 2004 study that found chronic stress can impair the body's immune response and contribute to the development of cancer.

A variety of sources like cell phones, wifi, power lines, and battery-powered cars bombard us every day with EMFs, or electromagnetic fields. Dr. Jonathan Stegall, an integrative oncologist and medical director of The Center for Advanced Medicine in Atlanta, says he tries to limit his exposure to EMFs.

"I recommend that my patients not hold a cell phone up to the ear, and instead hold it away from the body using speaker phone. This significantly minimizes the amount of radiation absorbed by the body," advises the author of the bestselling book Cancer Secrets. He also recommends installing a timer on any WiFi modem/router at home so that it turns off while you are sleeping.

RELATED: The #1 Reason You Could Get Cancer, According to Science

It's family first for Dr. Timothy S. Pardee, chief medical officer, Rafael Pharmaceuticals and oncologist and director of Leukemia Translational Research at Wake Forest Baptist Health. He believes this time is super important, and notes that familial relationships can reduce stress and increase overall well being.

A global study found that larger families, those with many children, have a reduced risk of cancer. And that's not just the nuclear family. Larger household sizes with multiple generations living together enjoy that same protective benefit. The study authors cite the "special emotional environment" as having a positive effect that contributes to disease resistance, as well as the benefit of family members supporting each other in a healthy lifestyle.

Did you know you can get paid to prevent cancer? Roshni Rao, MD, Chief of the Division of Breast Surgery at New-York Presbyterian Hospital and Columbia University Medical Center and says even she participates in clinical trials. "I was part of an MRI trial where I was in [the] machine for over an hour, and I got paid $25!," she said.

She's also participating in the T-MIST trial, a national study working to identify how often women should get mammograms and what type of mammogram to get. Rao says this trial is currently open at Columbia and seeking up to 165,000 women to participate.

"I drink a few cups of green tea or coffee every day," says William W. Li, MD, author of Eat to Beat Disease: The New Science of How Your Body Can Heal Itself. After 20 years of cancer prevention research, he says he's well aware of the scientific evidence that points to tea and coffee doing the body good.

They each "contain different types of polyphenols (micronutrients from plant-based food), but they all activate our body's key health defense systems (starving cancer, feeding our healthy gut bacteria, repairing damaged DNA, improving immunity) that help us resist cancer. From lab studies to clinical trials to large-scale public health studies showing that tea or coffee lowers risk across different forms of cancers, I consider it a no-brainer to drink these beverages." And it's a cherry on top that he loves the taste!

The lead authors of a large-scale study from the University of Glasgow in 2018 now know it's best to keep screentime to a minimum. They analyzed nearly 400,000 people and found a strong correlation between higher screentime and a higher risk of all-cause mortality, cardiovascular disease, and cancer. This was independent of known cancer-causing factors like smoking, BMI, and diet.

The more discretionary, or leisure, time spent on tablets, smartphones, and other media devices directly contributes to a sedentary lifestyle, the result of which is lower physical fitness, grip strength, and overall poor health.

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Nearly half the deaths from an astounding 12 different cancers can be attributed to smoking cigarettes: liver, colorectal, lung, oral and throat, esophageal, larynx, stomach, pancreas, bladder, kidney, cervix, and acute myeloid leukemia. That's why it's a smoke-free life for Dr. Wafik El-Deiry, Associate Dean for Oncologic Sciences at Brown University. While fewer people smoke in 2019, plenty are still addicted to one of the single-most unhealthy habits.

He does note that quitting smoking can have a positive impact, but that the risk never fully goes away compared to the general population. It can take 8-10 years to truly minimize the risks associated with cigarette smoking.

Likewise, Dr. El-Deiry isn't vaping, either.

"The message needs to get out that [vaping] is potentially cancer causing and we have to be aware," he warns. "The more we talk about itto save anyoneis worth it."

He says the more we learn about vaping the more we realize how unsafe it is in different ways. The vapor exposes users to chemicals known to cause cancer, for instance. And while e-cigs have their place for smokers trying to quit, the vape pens aren't benign. El-Deiry reminds that no substantial research has yet been completed on the relationship between vaping and cancer.

The National Institutes of Health warns that teens are vaping in record numbers; higher than opioid or marijuana use.

Dr. Katherine Crew, director of the Clinical Breast Cancer Prevention Program at New York-Presbyterian and Columbia University Medical Center, walks at least a mile every day. "For a busy oncologist, it's not always easy to find time to lead a healthy, active lifestyle, but I try to incorporate it into my daily routine."

Each of those steps is worth the time. Walking a single mile each day at a moderate 20-minute pace can reduce mortality in breast cancer patients by as much as 40% and almost 30% in prostate cancer patients. Risk for endometrial cancer is also reduced by a moderate intensity walking regimen.

Dr. Crew also takes the stairs "whenever it's humanly possible" to gain an extra burst of physical activity in her day.

RELATED: 9 Everyday Habits That Might Lead to Dementia, Say Experts

As an exercise oncologist, Kathryn Schmitz, PhD gets as much movement as she recommends. Before heading outdoors though, "I slap on the sunscreen, since exercise increases the risk of melanoma by 28%." While this 2016 study found that exercise reduces the risk for 10 different cancers, it increased risk for malignant melanoma significantly.

Schmitz echoed the researchers' assumption that increased time exercising or enjoying leisure physical activity increased exposure to the sun, which in turn increased the incidence of skin cancer. If you're spending time outside, be sure to wear a broad spectrum sunblock with SPF 30 or higher and remember that "water resistant" is not the same as "waterproof."

Making "greener" choices can ultimately support everyone's goal to reduce their risk of cancer. Climate change is having a negative impact on more than just the earth's health and sustainability. Human life is taking a negative toll, too.

Stratospheric ozone depletion is implicated in an increase in skin cancer incidence, like melanoma, and scientists expect to see a continuation over the next couple of decades.Exposure to air pollution increases the risk of breast cancer in premenopausal women. And the very air we breathe has been deemed carcinogenic by WHO, citing a direct correlation to nearly a quarter-million lung cancer deaths in 2010 alone.

How much "good" fat do you have in your diet? It's something Dr. Stephen C Schimpff, MD, MACP, author of Longevity Decoded The 7 Keys to Healthy Aging, prioritizes in his own diet. He recommends avocado, nuts and seeds, olive oil, and fish like tuna and salmon.

What makes a fat good for you? These unsaturated fats remaining liquid, not solid, at room temperature and are generally derived from plants.

Tree nuts like almonds, walnuts, and pecans can decrease your risk of colon cancer, which is why Kevin Dawravoo, MD, hematologist and medical oncologist at Northwestern Medicine Cancer Center Warrenville, makes them a regular part of his diet.

For men and women, a 2018 study found a "statistically significant" link between eating nuts three times per week and a reduction in colorectal cancer risk.

Another 2018 study found that stage 3 colon cancer patients who had two 1-ounce servings of tree nuts (which included walnuts, cashews, almonds, pistachios, hazelnuts, pecans macadamia nuts, and Brazil nuts) each week were 42% more likely to experience disease-free survival and 57% greater chance of overall survival.

Turn up the flavor experience of roasted vegetables, rice, soup, smoothies, and tea by adding turmeric. This Indian spice, most common in curries, has an earthy sweet-pungent flavor and bright orange hue that can truly transform any food. That, and the cancer-preventative benefits, are why Roshni Rao, MD, Chief of the Division of Breast Surgery at New-York Presbyterian Hospital and Columbia University Medical Center, loves to eat turmeric-laden foods.

"Most of the studies do show a benefit from this anti-inflammatory, and there is no study that shows that it is detrimental," she says.

A 2015 study reviewed the multifaceted role of curcumin (the source of turmeric) in cancer prevention, and found that it can "suppress initiation, progression, and metastasis of a variety of tumors."

The plastics we brush our teeth with, eat and drink from, build toys with, type on, and so much more inundate every aspect of our lives, but the chemicals within are taking away our health and mortality. Especially when plastics are heated or scratched, they can leach the chemicals used to develop the products. Once inside our bodies, these chemicals, like BPA, disrupt the natural role of hormones and create an imbalance that can ultimately lead to cancer.

"BPA has been shown to play a role in the [development of]hormone-dependent tumors such as breast and prostate cancer," states a 2015 study that reviewed the health risks associated with exposure to bisphenol A.

Avoid plastics whenever possible by looking for BPA-free products and carrying reusable glass or steel drinking vessels. Do not cook or reheat food nor store hot food in plastic containers.

"Especially important in the summertime is decreasing charred food consumption," says Kevin Dawravoo, MD of Northwestern Medicine Cancer Center Warrenville. Reminding that the blackened char marks on grilled meat is a known carcinogen. It's something he rarely eats.

The concern is that when meat is cooked over open flame, and burned or blackened, chemicals known as HCAs and PAHs develop. When consumed these can alter a person's DNA which increases the risk of cancer.

In rodent studies, HCAs developed tumors breast, colon, liver, skin, lung, prostate, and other tumors. Similar rodent studies found that PAHs caused leukemia, and identified gastrointestinal and lung tumors. In epidemiologic studies, higher consumption of well-done and "barbecued" meat was linked to increased risk of colorectal, pancreatic, and prostate cancers.

RELATED: Everyday Habits That Make You Look Older, According to Science

You might be bored answering all of your doctor's questions about your parents' and grandparents' health, but it truly matters. Dr. Wafik El-Deiry, Associate Dean for Oncologic Sciences at Brown University, knows his family history and strongly recommends that you do the same.

"Illnesses that are found in the family can be a major clue to what risks there are," he says, adding that a history of cancer is usually well known and not difficult to learn about.

Sharing your family history with your doctor means they can do additional screening sooner, and work to catch symptoms and tumors earlier, which is key in treating and curing cancer.

"This knowledge may also direct patients to genetic testing that can further help to figure out different options to manage the risks," he added.

"Read your mammography results letter. In many states, including Connecticut, we, as radiologists are required to inform the patient whether or not her breast tissue is dense. If your breast tissue is dense, talk to your doctor about whether you need additional tests: a screening ultrasound or possibly even a screening MRI, the latter being a useful complementary screening tool in some women at higher than average risk of developing breast cancer. Please note that screening ultrasounds and screening MRIs do not replace mammography; rather, they are a complement to it," says Liva Andrejeva-Wright, MD, a Yale Medicine radiologist who specializes in breast imaging.

"It is important to know that screening mammograms do not prevent breast cancer. They do help by detecting cancer early in many cases, before it becomes palpable, however, and therefore prevent disease and treatment related morbidity that would have occurred if the cancer was detected later by the patient or her doctor," she added. And to get through this pandemic without catching coronavirus, don't miss this essential list: Most COVID Patients Did This Before Getting Sick.

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GlucoFort Reviews: Does GlucoFort Work? What They Won’t Say! – Homer News

Cases of type 2 diabetes have been significant and on the rise within the past decade. This condition is restrictive in some ways. Individuals are deprived of the ability to enjoy their preferred foods and are likely to experience intense symptoms (i.e., thirst, hunger, faintness, and blurred vision, among others). Several solutions have come and gone, but one natural supplement appears to have taken a unique approach that might end up reversing diabetes altogether. This supplement is none other than Glucofort.

Glucofort is an advanced blood sugar support that eliminates the supposed root cause of type 2 diabetes: ceramides. As explained by the creators of this solution, Andrew Freeman and Dr. Jun, ceramides push fat cells into the bloodstream, forcing vital organs to clog up. This prevents the pancreas from producing the insulin hormone, a crucial component that redistributes glucose to other body areas. It is only when these foreign invaders are eliminated from the body that diabetes might be reversed altogether. Hence, the reason for Glucofort.

The Glucofort formula has been split into a vitamins and minerals blend and a proprietary blend. The first includes Vitamin C (50mg), Vitamin E (15mg), Biotin (300mcg), Magnesium (125mg), Zinc (7.5mg), Manganese (1mg), Chromium (76mcg) and Vanadium. As for the proprietary ingredients blend, individuals can familiarize themselves with Guggul, Bitter Melon, Licorice, Cinnamon, Gymnema Sylvestre, Alpha Lipoic Acid, Banaba, Yarrow, Juniper, White Mulberry, L-Taurine, and Cayenne.

Guggul: According to a 2020 article in the International Journal of Research in Pharmaceutical Sciences, Guggul divided into nine groups, rats were given Diabetes mellitus, over a 28 week period, Blood collected showed that guggul did not reveal toxicity in the rats, and guggul formulations improved oral glucose tolerance in the diabetes-induced rats and after the end of the study resulted in significant reductions in serum glucose levels.

Bitter Melon: The US National Library of Medicine National Institutes of Health states that medicinal plants are important cost-effective worldwide to treat diabetes and are considered therapeutic aids in alleviating ailments in humans. Bitter melon is reported to possess pancreatic cell regeneration, insulin-releasing, and fighting insulin resistance.

Licorice Root: An herb that has been used for decades to treat many health ailments. Scientists have identified a group of natural substances with anti-diabetic effects found in the licorice root.

Cinnamon Bark: Known as true cinnamon, studies show that cinnamon can effectively manage blood sugar issues, such as lower blood sugar, and may help control high blood glucose levels in the brain.

Gymnema Sylvestre: Supports lowering of high blood sugar levels. And may play a role in diabetes treatment, as it may regenerating pancreas islet cells and stimulate insulin secretion, which help lower blood sugar levels.

Alpha Lipoic Acid: Can break down carbs and make energy for use in other organs in the body, and an antioxidant.

Banaba: The banaba leaf has been used in folk medicine for decades to treat diabetes used for its impressive anti-diabetic properties, antioxidant, cholesterol-lowering, and anti-obesity health benefits.

Yarrow: Used to regulate blood sugar in diabetes, protect the gallbladder and liver, and as immune-system support.

Juniper Berry: May hold antidiabetic properties and used in traditional medicine to treat diabetes, with recent studies confirming that they may have anti-diabetic properties.

White Mulberry: Used to treat high cholesterol, common colds, high blood pressure, joint, and muscle pain caused by arthritis. White mulberry can be used against hair loss and premature graying, constipation, dizziness, and ringing in the ears.

L-Taurine: Taurine can helps by avoiding the damaging effects of fat, glucose, and excess insulin levels; it also protects and strengthens the heart muscle cells.

Cayenne: Scientifically proven to boost metabolism, lower blood pressure with the capsaicin found in cayenne peppers can also reduce hunger.

Generally speaking, Glucofort is deemed 100% natural, safe, and effective to take. In fact, this formula has supposedly undergone testing with 160 men and women who were either pre-diabetic, diabetic, or have had diabetes for some time now. The study results suggest that glucose levels improved, weight and fat loss were attained, blood pressure and sugar levels were lowered, and cardiovascular and cognitive health bettered with time. That said, no side effects were reported. All things considered, a health practitioners opinion should be gathered before adding any extra supplements.

Given that one capsule should be taken per day and each bottle contains 30 capsules, individuals can expect to invest roughly $69 per bottle. Bulk orders such as purchasing 3 or 6 bottles at once will come out to $59 and $49 each, respectively. Luckily, all unused bottles have been protected by a 60-day money-back guarantee, making Glucofort risk-free.

Blood sugar is a health biomarker that needs to be taken care of, as it can easily worsen and lead to unwanted health implications. With a solution like Glucofort, symptoms may be eased in the short run and reversed in the long run. In this case, patience is key, and everyone will need to consider their health conditions and possible medication interactions beforehand. To find out more about Glucofort, visit here>>>.

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Please understand that any advice or guidelines revealed here are not even remotely a substitute for sound medical advice from a licensed healthcare provider. Make sure to consult with a professional physician before making any purchasing decision if you use medications or have concerns following the review details shared above. Individual results may vary as the statements made regarding these products have not been evaluated by the Food and Drug Administration. The efficacy of these products has not been confirmed by FDA-approved research. These products are not intended to diagnose, treat, cure or prevent any disease.

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GlucoFort Reviews: Does GlucoFort Work? What They Won't Say! - Homer News

Neoadjuvant Androgen Deprivation Therapy Effects on Perioperative Outc | RRU – Dove Medical Press


Prostate cancer is the fifth most common cancer in Thai men,1 and the number of cases continues to increase despite active screening. Radical prostatectomy (RP) is the standard of care in the management of clinically localised cancer and also an option for the treatment of locally advanced prostate cancer. RP can be performed using open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robotic-assisted laparoscopic radical prostatectomy (RALRP) techniques.

Another recognised treatment for regional and metastatic prostate cancer is androgen deprivation therapy (ADT). ADT is also a beneficial supplement to external beam radiation therapy (EBRT).2 However, the use of neoadjuvant androgen deprivation therapy (NADT) prior to RP as a perioperative treatment is still controversial.2 Previous research has demonstrated that NADT lowers the positive margin status, but this benefit has not translated into improvements in long-term PSA-free survival.3 NADT is also associated with worrisome side effects, such as osteoporosis, hot flashes, sexual dysfunction, metabolic syndrome, gynecomastia, anaemia and cardiovascular mortality. For all these reasons, current guidelines recommend against the use of NADT prior to RP.2,4,5

In the past few years, a growing trend has emerged towards the utilization of NADT, as it can provide a pathological complete response,6 a potentially positive impact on recurrence rates,7 a significant decrease in prostate cancerrelated death8 and fewer long-term effects on quality of life.9 The aim of the present study was to determine the benefit of NADT prior to RP in terms of perioperative outcomes.

Between January 2008 and July 2018, 718 prostate cancer patients were treated by RP at Ramathibodi Hospital in Thailand. Of these patients, 138 had undergone NADT (NADT group) and 580 had not undergone neoadjuvant ADT (non-NADT group). The remaining 2 patients were excluded from the study due to incomplete data. The principles of the Helsinki Declaration were followed during the study, consent and the confidentiality of the patients data was maintained by the authority of the Committee for Research of the Faculty of Medicine, Ramathibodi Hospital, Mahidol University (date of approval: 20 February 2020, ID MURA2020/298).

The ORP was performed in a retropubic fashion via low midline incision (Figure 1). A retzius space was approached with blunt and sharp dissection along the outside of left umbilical ligament. Endopelvic fascia on both sides were bluntly opened, puboprostatic ligament was dissected and dorsal venous complex was sutured and ligated using Vicryl No.1. The bladder neck was incised with monopolar cautery then foleys catheter was pull and traction. The seminal vesicle and vas deferens were dissected. Denonvilliers fascia was opened and the posterior surface of prostate was freed. The lateral prostatic pedicles were dissected with monopolar cautery and ligated without nerve sparing, followed by incised of urethra by Metzenbaum scissor. An urethrovesical anastomosis was performed with interrupted sutures, using Vicryl 3/0 6 stitches. Before the last stitch was performed, new 20 Fr Foleys catheter was inserted via urethra into bladder. Bleeding was checked and stopped. Silastic drain was placed in cul-de-sac.

Figure 1 Incision of open radical prostatectomy.

The LRPs were performed in an extraperitoneal fashion using 5 trocars with some modification in port position to facilitate the prevention to graft injury (Figure 2). Subumbilical incision was done and extraperitoneal space was created using kidney-shaped balloons with (PDB, Covidien, United States). Retropneumoperitoneum was performed by CO2 insufflation to create at an abdominal pressure of 15 mmHg, followed by port placement as Figure 2, all trocars were inserted under direct visualization. Thirty-degree standard Trendelenburg position was used with cushioning for dependent zone. A Retzius space was developed. Endopelvic fascia on both sides were opened, followed by puboprostatic ligament was dissected and dorsal venous complex was controlled using Vicryl No.1 CT-1 needle. The bladder neck was incised with monopolar cautery then foleys catheter was pull and traction. The seminal vesicle and vas deferens were dissected. Denonvilliers fascia was opened and the posterior surface of prostate was freed. The lateral prostatic pedicles were controlled by Hem-o-lock clip and dissected with vessel sealing device (LigaSure Impact Curved, Large jaw, Medtronic, United Kingdom) without nerve sparing, followed by incised of urethra by cold scissor. An urethrovesical anastomosis was performed with continuous watertight sutures, using Vicryl 3/0. Before passing the anterior stitch, the 20 Fr Foleys catheter was passed into the bladder and the anastomosis was completed. A closed suction drain was placed in cul-de-sac. The specimen was retrieved with the use of laparoscopic bag through a subumbilical incision.

Figure 2 Port placement of laparoscopic radical prostatectomy.

The RALRPs were performed with transperitoneal fashion using the da Vinci Si Surgical System, with 5 trocars. We place the trocars medially than the standard port site to deliver sufficient access without graft injury (Figure 3). The pneumoperitoneum pressure of 15 mmHg was created after subumbilical puncture with Veress needle. A 12 mm subumbilical trocar was inserted into abdominal space and was used as a camera port. Two robotic trocars were placed on the right side with at least 8 cm apart from each other (Arm 1, Arm 3). On the left side, a robotic trocar was placed (Arm 2), and the assistance 12 mm trocar was inserted between the second port and camera port as Figure 3, all trocars were inserted under direct visualization. Each arm was equipped with Monopolar scissor (Arm 1), Bipolar Maryland (Arm 2) and Prograpse (Arm 3). Thirty-degree standard Trendelenburg position was used with cushioning for dependent zone. A Retzius space was developed. Endopelvic fascia on both sides were opened, followed by puboprostatic ligament was dissected and dorsal venous complex was controlled using barbed suture No.1 (V-Loc PBT wound closure device, Medtronic, United Kingdom). The bladder neck was incised with monopolar and bipolar cautery then foleys catheter was pull and traction. The seminal vesicle and vas deferens were dissected. Denonvilliers fascia was opened and the posterior surface of prostate was freed. The lateral prostatic pedicles were controlled by Hem-o-lock clip and dissected with monopolar and bipolar cautery with 1 case of interfacial nerve sparing and 2 case of non-nerve sparing, followed by incised of urethra by cold scissor. An urethrovesical anastomosis was performed with continuous watertight sutures, using barbed suture 3/0 (V-Loc PBT wound closure device, Medtronic, United Kingdom). Before passing the anterior stitch, the 20 Fr Foleys catheter was passed into the bladder and the anastomosis was completed. A closed suction drain was placed in cul-de-sac. The specimen was retrieved with the use of laparoscopic bag through a subumbilical incision.

Figure 3 Port placement of robotic-assisted radical prostatectomy.

Nerve-sparing RPs were performed in some cases, except when biopsy specimens revealed extensive cancer or in cases of preoperative poor-quality erections, current and future lack of a sexual relationship, or other medical conditions that could adversely affect erections (eg, hypertension, diabetes mellitus, neurologic diseases, psychiatric diseases or medications that produce erectile dysfunction). However, we shared the decision-making with the patients and the surgeon.

Six instructor surgeons participated in this study. Two surgeons always performed ORPs over 25 years, while the other four surgeons performed all three techniques as shown in Table 1. The procedure techniques were decided by shared decision-making with patients.

Table 1 Surgeons Participation

In this study, both gonadotropin-releasing hormone (GnRH) analogues, such as degarelix, and GnRH antagonists, such as leuprolide, goserelin and triptorelin, were used for the ADT. The choice of medication depended on the patients insurance and the surgeon preference. The duration of NADT was 3 months, since some evidence indicates that this is the optimum duration.10,11

The decision was made upon the discussion between patients and physicians. Since the specific criteria for selection have not been officially stated, we typically advise the NADT for those patients who a. associated with high or very high-risk disease and b. are on the waitlist for surgery longer than three months.

The following data were collected from all patients: age, body weight (kg), height (cm), body mass index (BMI), prostate-specific antigen (PSA) level, underlying disease, clinical stage (TNM classification), prostate cancer risk group (National Comprehensive Cancer Network [NCCN] classification),2 and the Gleason score (GS) of the biopsy specimen.

Perioperative outcomes included operative time (minutes); estimated blood loss (EBL) (mL); perioperative complications, including transfusion rate; adjacent organ injury of the bladder, rectum, ureter, bowel, or blood vessel; and length of hospital stay (days) (determined by subtracting the date of admission from the date of discharge).

All specimens were evaluated in accordance with the NCCN guidelines by an experienced uropathologist, who reported the prostate weight (g), pathological stage, GS of the specimen and the margin status. A positive surgical margin (PSM) was defined as cancer cells extending to the inked surface of the specimen.12

A descriptive study was performed. The data were analysed using a Wilcoxon rank-sum (MannWhitney) and Fishers exact test to identify the statistical significance of the difference in means standard deviation, median (interquartile range), and proportions. Analysis was performed using Stata version 14 software, with a p-value of <0.005 considered to be statistically significant.

The demographic data and preoperative parameters are presented in Table 2. The non-NADT and NADT groups were not statistically different in terms of median age (68 vs 68 years; p = 0.819), median body weight (67.1 vs 67.1 kg; p = 0.807), median height (165 vs 165 cm; p = 0.403) or median BMI (24.4 vs 24.3 kg/m2; p = 0.218). The pre-operative PSA level and GS of the biopsy specimens were statistically significantly higher in the NADT than in the non-NADT group (33.4 [16.256.6] vs 10.1 [7.215.2]; p = <0.001 and 8 [79] vs 7 [67]; p = <0.001). The clinical stage differed significantly between the two groups (p = <0.001).

Table 2 Demographic Data and Pre-Operative Parameters of Non-NADT and NADT

The perioperative outcomes (Table 3) showed that the operative time was significantly lower in the NADT than in the non-NADT group (185 vs 195 minutes; p = <0.018). The EBL was also significantly lower in the NADT than in the non-NADT group (300 vs 500 mL; p = <0.001), but no difference was noted in the blood transfusion rate between the two groups. No statistically significant differences were detected between the NADT and non-NADT groups for adjacent organ injury rate (2.9% vs 2.2%; p = 0.999) or length of hospital stay (6 vs 6 days; p = 0.184). The most common site of injury was the rectum (11 patients).

Table 3 Perioperative Outcomes of Non-NADT and NADT

The pathological outcomes (Table 4) revealed significant differences in pathological stage between the two groups (p = 0.001). The GS of the specimens was significantly higher in the NADT group than in the non-NADT (7 [79] vs 7 [77]; p < 0.001). The specimen weight was significantly lower in the NADT than in the non-NADT group (34.8 vs 39.5; p = 0.014). The PSM did not differ significantly between the NADT and non-NADT group (36.4% vs 43.9%; p = 0.131).

Table 4 Pathological Outcomes of Non-NADT and NADT

Subgroup analysis for perioperative and pathological outcomes of the non-low risk prostate cancer patients are presented in Table 5. The perioperative outcomes, which included operative time, EBL, blood transfusion rate and length of hospital stay, were significantly better in the NADT than in the non-NADT group. Only adjacent organ injury rate showed no significant difference in the two groups. The pathological stage was significantly different in the two groups (p < 0.001). The GS of the specimens was significantly higher in the NADT group (7.5 [79] vs 7 [78]; p < 0.001) and the specimen weight was significantly lower in the NADT group (35 [29.144] mL vs 40 [32.251.5] mL; p = 0.002). However, the PSM still did not show a significant difference between the NADT and non-NADT groups (43.6% vs 47.8%; p = 0.506).

Table 5 Perioperative Outcomes and Pathological Outcomes of PCa Non-Low Risk Group

Neoadjuvant therapy is the current standard of care for several solid tumour malignancies, including bladder, breast, and rectal cancer. NADT prior to surgery may downstage a malignancy to facilitate surgical resection, thereby lowering the positive surgical margin rate and improving perioperative outcomes.13,14 In our study, the median operative time was significantly lower in the NADT than in the non-NADT group (p=0.018) and a lower EBL was also observed in the NADT group (p<0.001).

Androgen deprivation therapy affects tumour behaviour and biology by changing the metabolic patterns of atrophy, lowering serum PSA level and reducing histopathologic atrophy.3 These tumour responses may have contributed to the smaller prostate volume in the NADT group than in the non-NADT group (39.5 vs 34.8 g, p = 0.014), since enlarged prostate glands usually have more vascularity and a wider resection margin.1517

The transfusion rate did not differ significantly between the two groups (p = 0.091). This may reflect the practice in our hospital of having the anaesthesiologist initiate transfusion when the haematocrit drops below 30. Consequently, some patients with a higher baseline haematocrit would be less likely to receive a transfusion.

The length of hospital stay also did not differ statistically between the two groups. However, the hospital stays were longer in the present study than in a previous study by Wallerstedt et al,18 who reported lengths of hospital stay of around 3.34.1 days. This discrepancy can be attributed to an institutional practice where patients are routinely discharged after the closed-suction pelvic drain is removed. However, many other factors, such as socioeconomic status, inexpensive room rates, anxiety and patient pain tolerance, might affect the length of a hospital stay.

No pathological down-staging could be demonstrated in the present study because of the limited pre-operative T clinical staging. In our setting, pre-operative imaging is not generally affordable for all patients, so many patients are classified as T1c (91.4%). Nevertheless, the data show a decrease in the median GS in the NADT group from the pre-operative biopsy specimen score of 879 to the post-operative specimen score of 7.79

The oncological control of RP in prostate cancer can be measured by the PSM, biochemical recurrence (BCR) rate, time to biochemical recurrence, local recurrence and distant metastasis.19 Sachdeva et al20 and other researchers2124 have shown that a PSM in prostate cancer is considered an adverse oncologic outcome and is associated with an increased likelihood of BCR. However, the significant predictors of BCR are tumour volume, a high GS and a high pre-operative PSA level. In our study series, no statistically significant difference was noted in PSM between both groups, which is consistent with the results of many guidelines and the current literature.2,4,5 The PSM rate in large series data ranged from 11% to 50%11 and from 12.1% to 41.3% in a recent meta-analysis.12 The PSM rate in our study was higher, which may reflect the participation of multiple surgeons in this study, as each surgeon may have had a different learning curve. For example, in the present study, two new instructor surgeons had just started performing RALRP in 2016. In addition, after the subgroup analysis, most of the PSMs were in the T3 stage, indicating that PSMs could result from the nature of the cancer that had extended beyond the prostatic capsule.

The subgroup analysis revealed that the perioperative and pathological outcomes significantly better almost all parameters in the non-low risk NADT group. This can be related to the fact that study was heterogenous and not weighted towards those who may benefit the most from NADT.

Patients with PSM are typically given two treatment options: external beam radiation therapy (proton beam radiation) with or without androgen deprivation therapy (ADT) or observation. Unfortunately, data related to the rate of conversion and catheterisation time could not be collected to determine our patient outcomes, as this study was retrospective. The functional outcomes, such as incontinence and erectile dysfunction, are presently being assembled by the authors, who will report on these findings in a subsequent study.

Author want to underline some interesting upcoming trend from the Pignot and Walz,25 and we comply with their findings that the multimodal approach including both local and systemic treatment neoadjuvant may be an option for selected patients especially with non-low risk prostate cancer. However, there is still not enough data to conclude when is the best setting for treatment (Neoadjuvant/adjuvant) and who would really benefit from treatment.

The present study has some limitations. One was its retrospective nature, which compared the effect of NADT with non-NADT but did not include data regarding the type of ADT, since no standard regimens for NADT currently exist. Consequently, the choice of treatment for each patient is highly heterogeneous and depends on patient insurance and physician preference. A second limitation is that all RPs were performed by different surgeons, raising the possibility of bias in the process of evaluating the procedure outcomes. A third limitation is that this study lacked data about the oncological and functional follow-ups. A fourth limitation is that this study had some significant differences in baseline characteristic, approach, PSA pre-op and GS from biopsy (33.4 [16.256.6] vs 10.1 [7.215.2]; p = <0.001 and 8 [79] vs 7 [67]; p = <0.001), as a result of the selection bias by physician typically offer treatment with NADT in high or very high-risk disease and the trend toward the Robotic-assisted era which can confound the effect of NADT. The findings of the present study would be strengthened by conducting a prospective randomised study with a higher case volume, as this would reduce biases and provide much more accurate results.

This study has demonstrated the long-term data on the use of NADT prior to RP and has shown an association between NADT and a positive effect on perioperative outcomes in the prostate cancer non-low risk group. Further randomized, prospective studies are needed to elucidate the true effect of NADT on perioperative outcomes, pathological outcomes and survival benefit.

This work was supported by Wijittra Matang, Yada Phengsalae and Kornkanok Somboonpun. The authors thank Wijittra Matang, Yada Phengsalae and Kornkanok Somboonpun for continued support and encouragement.

The authors declare no conflicts of interest in this work.

1. National cancer institute Doms, Thailand. Hospital base cancer registry 2015. 2017.

2. network NCC. Prostate cancer (Version 1.2020). Available from: Accessed May 14, 2021.

3. Meng MV. Treatment of Locally Advance Prostate Cancer. 12th ed. Partin AW, editor. Elsevier; 2020:2.

4. Sanda MG, Chen RC, Crispino T, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO guideline; 2017. Available from: Accessed May 14, 2021.

5. Mottet N, Bellmunt J, Briers E, et al. EAU ESTRO ESUR SIOG guidelines on prostate cancer; 2020. Available from: Accessed May 14, 2021.

6. Montgomery B, Tretiakova MS, Joshua AM, et al. Neoadjuvant enzalutamide prior to prostatectomy. Clin Cancer Res. 2017;23(9):21692176. doi:10.1158/1078-0432.CCR-16-1357

7. McKay RR, Montgomery B, Xie W, et al. Post prostatectomy outcomes of patients with high-risk prostate cancer treated with neoadjuvant androgen blockade. Prostate Cancer Prostatic Dis. 2018;21(3):364372. doi:10.1038/s41391-017-0009-6

8. Tosco L, Laenen A, Briganti A, et al. The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer. Prostate Cancer Prostatic Dis. 2017;20(4):407412. doi:10.1038/pcan.2017.29

9. Chen MC, Kilday PS, Elliott PA, et al. Neoadjuvant leuprolide therapy with radical prostatectomy: long-term effects on health-related quality of life. Eur Urol Focus. 2020. doi:10.1016/j.euf.2020.03.001

10. Meyer F, Bairati I, Bedard C, Lacombe L, Tetu B, Fradet Y. Duration of neoadjuvant androgen deprivation therapy before radical prostatectomy and disease-free survival in men with prostate cancer. Urology. 2001;58(2 Suppl 1):7177. doi:10.1016/S0090-4295(01)01245-6

11. Soloway MS, Pareek K, Sharifi R, et al. Neoadjuvant androgen ablation before radical prostatectomy in cT2bNxMo prostate cancer: 5-year results. J Urol. 2002;167(1):112116. doi:10.1016/S0022-5347(05)65393-1

12. Silberstein JL, Eastham JA. Significance and management of positive surgical margins at the time of radical prostatectomy. Indian J Urol. 2014;30(4):423428. doi:10.4103/0970-1591.134240

13. Gmez Veiga F, Lorenzo Patio MJ, Daz Bermdez J, et al. [Effect of complete androgen block before radical prostatectomy for cancer of the prostate]. Arch Esp Urol. 1997;50(4):355363.

14. Polito M, Muzzonigro G, Minardi D, Montironi R. Effects of neoadjuvant androgen deprivation therapy on prostatic cancer. Eur Urol. 1996;30(Suppl 1):2631. doi:10.1159/000474242

15. Frota R, Turna B, Santos BM, Lin YC, Gill IS, Aron M. The effect of prostate weight on the outcomes of laparoscopic radical prostatectomy. BJU Int. 2008;101(5):589593. doi:10.1111/j.1464-410X.2007.07263.x

16. Hsu EI, Hong EK, Lepor H. Influence of body weight and prostate volume on intraoperative, perioperative, and postoperative outcomes after radical retropubic prostatectomy. Urology. 2003;61(3):601606. doi:10.1016/S0090-4295(02)02422-6

17. Kim MS, Jang WS, Chung DY, et al. Effect of prostate gland weight on the surgical and oncological outcomes of extraperitoneal robot-assisted radical prostatectomy. BMC Urol. 2019;19(1):1. doi:10.1186/s12894-018-0434-4

18. Wallerstedt A, Tyritzis SI, Thorsteinsdottir T, et al. Short-term results after robot-assisted laparoscopic radical prostatectomy compared to open radical prostatectomy. Eur Urol. 2015;67(4):660670. doi:10.1016/j.eururo.2014.09.036

19. Akand M, Celik O, Avci E, Duman I, Erdogru T. Open, laparoscopic and robot-assisted laparoscopic radical prostatectomy: comparative analysis of operative and pathologic outcomes for three techniques with a single surgeons experience. Eur Rev Med Pharmacol Sci. 2015;19(4):525531.

20. Sachdeva A, Veeratterapillay R, Voysey A, et al. Positive surgical margins and biochemical recurrence following minimally-invasive radical prostatectomy an analysis of outcomes from a UK tertiary referral centre. BMC Urol. 2017;17. doi:10.1186/s12894-017-0262-y

21. De La Roca RL, Da Cunha IW, Bezerra SM, Da Fonseca FP. Radical prostatectomy and positive surgical margins: relationship with prostate cancer outcome. Int Braz J Urol. 2014;40(3):306315. doi:10.1590/S1677-5538.IBJU.2014.03.03

22. Meeks JJ, Eastham JA. Radical prostatectomy: positive surgical margins matter. Urol Oncol. 2013;31(7):974979. doi:10.1016/j.urolonc.2011.12.011

23. Pettenati C, Neuzillet Y, Radulescu C, Herve JM, Molinie V, Lebret T. Positive surgical margins after radical prostatectomy: what should we care about? World J Urol. 2015;33(12):19731978. doi:10.1007/s00345-015-1580-x

24. Yossepowitch O, Briganti A, Eastham JA, et al. Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol. 2014;65(2):303313. doi:10.1016/j.eururo.2013.07.039

25. Pignot G, Walz J. Identifying the relevant population for neoadjuvant chemo-hormonal therapy combined with radical prostatectomy. Gland Surg. 2020;9(2):495497. doi:10.21037/gs.2019.12.22

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Mackinac Island Businesses And Staff Save A Wedding Reception –

Many have heard about the fire that caused $1 million dollars of damage to the very large residential home called Brigadoon Cottage on Mackinac Island on the evening of Sunday, May 30, 2021. What you may not have heard is the great news of the businesses and their staffs on Mackinac Island that came together to save a wedding reception.

A couple had gotten married that day and had just started their wedding reception next door to the Brigadoon Cottage at the Mackinac Island Yacht Club. MLive is reporting just after the guest were seated about a minute into the father-of-the-bride speech they noticed the fire.

What happened next is all good news and something you would see in a movie.

The Yacht Club staff called the Mission Point Resort staff and arranged for the wedding reception to be moved to their facility down the road. They used carriages, bikes and whatever else they could to move all of the necessary items from the Yacht Club to Mission Point.

We are told that within 30 minutes the reception was back on at Mission Point.

Many pitched in to help this couple on their wedding day. Even a local restaurant opened up their kitchen so the Yacht Club chefs could finish preparing the dinner for the guests. The article even states the staff from Mission point who was not working that day heard about what happened and came to help however they could.

The bride, Elizabeth Landuyt said they were very grateful and very blessed.

Her newly minted husband, Jake Landuyt put it this way:

We were blown awayTo see all our guests basically in the same spot as we had set up before. It was disbelief and overwhelming in the positive way. To go from that same state of disbelief to the exact opposite, were just so blessed to have friends and family there that were willing to do it.

Mission Points vice president of sales and marketing, Liz Ware said:

We love being a part of the amazing Mackinac Island community, where people and fellow businesses can come together to make magic happenOur entire team at Mission Point was proud to be a part and followed our brand pillars in delivering hospitality from the heart and to always do the right thing. Our core values include going the extra mile and working hard together with a great sense of Michigan pride, and we believe this is one of the reasons the Landuyts wedding reception was a truly celebratory occasion.

What a great story they will have to remember for the rest of their lives and what a great story to start our Friday and weekend off with.

Share the love and share this story.

The Live with Renk show airs Monday through Friday from 9 a.m. tonoon, to let me know your thoughts call (269) 441-9595

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Dale Toney: A ‘wake up call’ for diabetes talk to your doctor about prevention and treatment – User-generated content

An estimated 88 million Americans have prediabetes, and just over 1 in 10 have been diagnosed with type 2 diabetes. In Kentucky, nearly 12 percent of the adult population is affected by this disease. Week after week, Kentucky physicians care for patients with type 2 diabetes and the potentially debilitating complications it can cause. Unfortunately, it is also well-documented that pre-existing conditions such as diabetes can put patients at high-risk for complications should they contract COVID-19.

March 23, is American Diabetes Alert Day, and the Kentucky Medical Association (KMA) and its thousands of physician members are encouraging Kentuckians to learn more about their risk factors and family history of the disease, and to talk to their doctor about prevention and treatment options.

Dr. Dale Toomey

Diabetes is the condition in which the body does not properly process food for use as energy. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesnt make enough insulin or cant use its own insulin as well as it should. This causes too much sugar to build up in your blood. In those with type 1 diabetes, the body completely stops producing insulin, and this usually occurs in childhood or early adulthood. With type 2 diabetes, the body produces insulin, but the cells dont respond to insulin the way they should.

Prediabetes occurs when a patient has a higher-than-normal blood sugar level. Its not high enough to be considered type 2 diabetes yet, but without lifestyle changes, adults with prediabetes are more likely to develop type 2 diabetes. More than 8 in 10 American adults with prediabetes dont know they have it. These patients are also at risk for developing other serious health problems like heart disease and stroke.

The first step in preventing or delaying type 2 diabetes and related health problems is to screen and test for prediabetes. Patients are encouraged to talk to their physician during their annual well-visits about being screened for type 2 diabetes. Your physician can order a simple blood test for patients with risk factors for prediabetes and type 2 diabetes, which include anyone 45 years of age or older, those who are overweight or obese, people with a family history of type 2 or gestational diabetes, and those who are physically active less than three times per week.

Patients diagnosed with prediabetes can be referred to the National Diabetes Prevention Program (DPP) lifestyle change program to prevent or delay type 2 diabetes. Programs are conducted by lifestyle coaches who are trained on an evidence-based curriculum. The coach can engage and guide you through makingand sticking withlifestyle changes. When patients join the program, they get a full year of support to make their new, healthy habits stick and keep them from slipping back into old habits. Kentucky also offers diabetesself-management education and support (DSME) groups, which can help you learnto manage your diabetes as part of your daily life. More information on these programs is available here.

Type 2 diabetes prevention is a priority of Kentucky physicians. As a focus of its AIM for Better Care: Administrative Improvements in Medicine initiative, KMA seeks to eliminate barriers to care for diabetes and to provide patients with the most updated resources and education to help prevent and manage this disease.

On American Diabetes Alert Day, consider this a wake up call to talk to your physician about diabetes prevention and treatment and get on the right path to a healthier tomorrow.

Dale Toney, M.D. is President of the Kentucky Medical Association. He is a board-certified internist in Lexington and is employed by the University of Kentucky Albert B. Chandler Hospital, is an Associate Professor at the University of Kentucky College of Medicine and serves as the Division Chief of General Internal Medicine and Womens Health.

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Milford OB/GYN to close womens health care practice after over 30 years – Milford Daily News

MILFORD Pelvic exams, in vitro fertilization and childbirth typically aren't comfortable procedures for any woman, but Dr.Mitchell Bellucci seeks toensure that patients are secure and that he is positive but especially calm.

So calm thatpatients sometimes askhim if he'sabout to head out for vacation after work.

Everyone would always say, Well, geez, you look like youre going on vacation, said Bellucci during an interview in his office on Friday afternoon, wearing a loose-fitting button-up shirt withthe top fourbuttons undone. For me, it was convincing myself that everything was cool, even if sometimes it wasnt.

Hes been the doctor to more than 10,000 patients and has helped deliver more than 3,500 babies in his career, he said.Known for his cowboy boots, Bellucci, 66, also frequently wore flip flops and casual Hawaiian shirts.

He has a faded 1988 newspaper clipping from the Daily Newsof himself wearinga pair offull-quill ostrich boots. Those cost him around $400, he said. He wore cowboy boots so much, he ended up developing plantar fasciitis, which causes a lot of pain in the heel.

Thecowboy boots have been retired, and Bellucci is poised to do the same.

More: U.S. Rep. Clark aims to build child care into infrastructure debate

Bellucci is retiring next month after 40 years as an OB/GYN. He'splanning to close hiswomens health care practice at 192 West St. after opening it 33 years ago. He's selling the space, which is part of the Westview Professional Building.

Over four decades, Bellucci has made his mark in advancingwomens health care, including setting up the first bone density unit at Milford Regional Medical Center, bringing womens health innovations to local television, patenting medical devices for newborns, training medical doctors on advanced laparoscopyand establishing scholarships for nurses and pre-med students.

He's gone from the swimming pool into the delivery room a few times, too.

Ive delivered no less than two dozen kids in my Speedos... well, they were swim trunks, said Bellucci, who moved to Milford to be close to the hospital (and his practice) if he was needed immediately. He has a pool athome, and has raced from there to Milford Regional several timeswith just enough time to towel off.

It's a career field he never intended to enter, but he's glad he did, he said.

Training as a medical studentwas a pivotal time for Bellucci. While growing up onLong Island, New York, knew he wanted to be surgeon, but didn't want to docancer surgery, which he thought was depressing.

From there, it was process of elimination. He thought he would be an orthopedist performing bone surgery, but found most of his time would be spentdoing hip surgery for elderly patients who stayed at the hospital for weeks, he said. Hand surgery was too long to train forand general surgery seemed too boring, he said. He considered urology, but "didnt want to look at penises and prostates all day."

Then he tried obstetrics and gynecology.

Reproduction and bringing new life into the world especially intrigued Bellucci, who has a daughter, Laura, who's 33 and a bartender in New Orleans. But on abulletin board in the hallway of his office, she's a child, peeringinto the lensof anunderwater camera. Surrounding her are photos of dozens of other babies Belluccihas helped deliver, some also now in their 30s.

Youre there at the most important timeof their lives, man. And youre part of it, he said. What other doctor gets to be with a woman in pain for eight hours, she pushes for two hours, you catch the baby, and youre the hero?Its such a neat thing to experience.

Plus, most if not all of the patients he sees are healthy and have insurance.

I like explaining things, and you have to be direct and have to not overreact, he said about making patients feel comfortable and reassured. The office even has a therapy dog "Charlie," a cockapoo who comes in occasionallyand is adored by patients, said Bellucci.

He also has aletter froma patient, written in 1994, that still makes him smile.

Hehelped a woman deliver her first baby, but she moved and delivered her second baby elsewhere. That experiencewas very upsetting, she wrote him, and said her doctor lacked a sympathetic bedside manner.

But her experience with Bellucci in Milford,by contrast, was wonderful, she wrote.She said he remained positive throughout the ordeal and joked with her to make her feel more relaxed. She wrote that she and her husbandstill laugh years later recalling when a nurse in the delivery room strapped a maxi pad to Belluccis forehead to soak up some of his sweat.

Opinion: 2020 saw great strides for women, but it also exposed inequities we should fix in 2021

When I went into it, there were five guys to one woman. Now theres five women and no guys, said Bellucci.

In the 1970s, about 7% of American gynecologists were female, according to the American College ofObstetricians and Gynecologists.Today, about 82%of OB/GYN residents throughout the nation are women.

About a decade ago, Bellucci wasapproached by Bryant University in Rhode Island to teach male physician assistant students who weredenied access to learn inside other women's health care practices. For about nine years, he taught one student a month.

Moremen are turning away fromobstetrics and gynecology, said Bellucci, and its still difficult for them togain accessinto that space. The upside is that physician assistants aren't going into delivery rooms anymore with positions like midwives and nurse practitioners. Rather, male physician assistants today are going into settings like emergency rooms or family practices, he said.

More healthcare news: Dr. Dennis Plante, who grew up in Worcester, dies of COVID-19 in Texas

When most women hit age 50 many of his patients are about thatage their estrogen drops, he said. He realized bone density was an important component to womens health, because while estrogenis the key regulator ofbonemetabolism in both men and women, menopause leads to decreased estrogen, which is associated with decliningbonemineraldensity.

Milford Regional Medical Center didnt have a bone density unit at that time, so he helped create one, he said, and he taught primary care doctors the value of testing for it.

He also helped developthe CO2 Surgical Laser,designed to treat pre-cancerous conditions like warts and lesions, and is known for his Mona Lisa Touch.

That machine, created inItaly, is a laser treatment for symptoms somewomen experience after menopause, such as painful sex. It's an alternative to hormone treatment, which can be risky for some.

A lot of women who have these problems have had breast cancer, and what do (many doctors)do? They put you on anti-estrogen and they save your life, he said. But then you say, 'Well, what about my sex life?' I think we should address that.

If you didn't see "Dr. B" at his medical practice, you might have seen him on "Pasta Playoffs," a cooking show that aired on community access television.

I used to say, If you think you can cook good food, you should go one-on-one against Grandma," said Bellucci, who enjoys cooking Italian food. "And that was the premise of the show."

Various "grandmas" competed against Bellucci in making a pasta sauce, which was thenjudged by three randomly selected customers at Caff Sorrento in Milford, said Bellucci. The showlasted five episodes, and eventually morphed into "Cooking Against Cancer," specificallybreast cancer.

Opinion: We need to help women during the pandemic and beyond

Bellucci isexcited aboutretirement and has had a rewarding career, but said itll be a tough goodbye to his practice. After closing and selling it, he's moving toRhode Island to be with his girlfriend Mary, where hell spend most of his time boating, fishing, possibly offering consulting services in the medical device industry and writing screenplays drawing from his medical knowledge.

And finally, the next time he wears a Hawaiian shirt and pair of flip flops, he really will be on vacation an extended one.

Lauren Young writes about business and pop culture. Reach her at 774-804-1499 Follow her on Twitter @laurenwhy__.

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Beshear ceremonially signs 13 health bills, including one that caps price of insulin – Hoptown Chronicle

Gov. Andy Beshear signed 13 health bills into law Monday, highlighting one that caps insulin costs for about 30% of Kentuckians who need the life-preserving hormone.

The limit is $30 for a 30-day supply. This is the right thing to do and its a game-changer for those who rely on insulin to live, Beshear said. Until now, a single dose of insulin which cost between $2 and $7 to manufacture could sell for an average wholesale price of around $300 per vial.

Beshear noted that in a lawsuit he filed against insulin companies while attorney general over their unconscionable overpricing,revealed that over 10 years, the price of one insulin product went up 311%, and another rose 285%, including a rise from $325 per package in 2011 to $530 in 2017.

While these companies work to increase bottom lines and sustain market shares, he said. Kentucky families hit hardest by this price gouging can be paying more than $1,000 a month on insulin just to stay alive.

House Bill 95, co-sponsored by Reps. Danny Bentley, R-Russell, and Patti Minter, D-Bowling Green, will cap the monthly out-of-pocket cost for a 30-day supply of insulin at $30 for Kentuckians covered by state-regulated employer health plans or plans purchased on the marketplace exchange.

Minter, whose son has Type 1 diabetes,has saidthe bill will cover about 30% of insulin-dependent Kentuckians. It doesnt cover Medicare, Medicaid or self-funded employer plans except the one for state employees.

I want to be very clear, this is only a first step, Minter said. There is much more work to do but today is a very big deal. It will save lives and it will give people hope. She said that for many families, it will make the difference between bankruptcy and keeping a child alive.

In a video, Angela Lautner,Kentucky #insulin4alllegislative lead, expressed her gratitude to the lawmakers for the bill, but she too warned that more work needs to be done, saying it will help about 22,000 people.

Much more has to be done, butHB 95is a step forward, said Lautner, My chapter is here for insulin for all and thats why we must continue this momentum into the next session with urgency, with priority.

More than half a million Kentuckians have diabetes, and Kentucky ranks seventh-highest in the U.S. for diabetes prevalence. Lautner said more than one in four insulin-dependent people ration insulin due to cost.

The price cap will apply regardless of the amount or type of insulin the person with diabetes needs.

In addition to capping the price, HB 95requires health plans to provide the equipment, supplies and outpatient training and education needed to help diabetics stay healthy, and forbids any reductions from this coverage by others involved in coverage.

Thefiscal impact statementattached to the bill says it will increase premiums for health benefit plans, not including the state employee plan, by about 80 cents a month.

Bentley said thats a small price to pay to make sure diabetics keep getting their insulin because without it they can suffer amputations, loss of vision, neuropathy, ketoacidosis and even death. The costs on the medical side is much more than the cost that were going to have by helping people with insulin, he said.

Beshear also signed bills addressing these health topics:

HB 140, sponsored by Rep. Deanna Frazier, R-Richmond, will permittelehealth servicesthat were allowed to expand due to the pandemic to remain in place. The bill requires reimbursement for telehealth to be equivalent to reimbursement for the same service provided in person. I think its one of the most important bills that have been passed, Beshear said.

HB 219, sponsored by Bentley, allows pharmacies to sell hypodermic syringes and needles without a prescription. The aim is to increase access to clean supplies for people who inject drugs, which will help to decrease the risk of blood-borne diseases such as hepatitis C and HIV/AIDS.

SB 55, sponsored by Sen. Stephen Meredith, R-Leitchfield, abolishes co-payments required by Medicaid.

HB 183, sponsored by Rep. Brandon Reed, R- Hodgenville,will allowKentucky hospitals to get more money from Medicaid, based on an average commercial rate instead of the current Medicaid rate, which is often below that amount. The program would not cost the state anything, because Kentuckys hospitals have agreed to cover the cost. To get the money, hospitals will have to abide by higher quality standards that are still being decided by theKentucky Hospital Associationand theCabinet for Health and Family Services.The bill is expected to help many of the states rural hospitals; arecent reportshows that 16 of them are at risk of closing.

HB 108, sponsored by Melinda Gibbons Prunty, R-Belton (Muhlenberg County), codifies current Medicaid coverage of colorectal cancer, including screenings starting at 45 for most people and genetic cancer-risk testing, to align Medicaid and commercial coverage.

HB 50, sponsored by Rep. Kim Moser, R-Taylor Mill, will make health-insurance plans comply with a 2008 federal law that requires them to treat mental health conditions and substance use disorders the same as physical health. It also requires health insurers to file annual reports with the state to show how they are complying with federal law.

HB 276, sponsored by Moser, allows Kentuckians trained as temporary COVID-19 personal-care attendants under an executive order to apply their supervised training toward their Registered Nurse Aide certification. About 300 personal-care attendants work in Kentucky long-term care facilities, Moser said while presenting the bill to the House in February.

SB 154, by Sen. Tom Buford, R-Nicholasville, lets advanced practice registered nurses and physician assistants prescribe and supervise home-health services, as federal law has allowed them to do in the pandemic. An emergency clause ensures there would be no gap in care if the federal rule ended.

HB 448, sponsored by Rep. Bill Wesley, R-Ravenna, expands the definition of qualified mental-health professional so that it fits the states juvenile code, allowing those who work in private agencies to testify in child-welfare hearings, especially around issues of emotional injury.

SB 74, by Sen. Ralph Alvarado, R-Winchester,createsbut does not fund a dementia services coordinator in the heath cabinet to manage theAlzheimers Disease and Related Disorders Council, the state plan to address Alzheimers in Kentucky, and apply for federal funding.

HB 75, sponsored by Rep. Shawn McPherson, R-Scottsville, prohibits insurance companies from increasing rates on organ donors or dropping their coverage. It would also encourage the cabinet to develop educational materials relating to organ donation.

SB 163, sponsored by Sen. Alice Forgy Kerr, R-Lexington, expands the definition of charitable health care provider to include those that provide invasive or surgical procedures. This change was needed to allow the non-profit surgery program Surgery on Sunday in Lexington to be reimbursed for liability insurance premiums.

Beshear alsovetoed five billsthat would strip power from the governor or the executive branch. None were related to health.

(Kentucky Health Newsis an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.)

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A potential role for insulin treatment during pregnancy in reducing postpartum psychological distress in maternal obesity: an administrative…

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A potential role for insulin treatment during pregnancy in reducing postpartum psychological distress in maternal obesity: an administrative...