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Archive for the ‘Hormone Physician’ Category

As a Doctor and Mother, Heres What I Wish People Knew About the Maternal Mortality Crisis – Self

A 28-year old woman arrived to the ER wheezing and short of breath. She had asthma and came in requesting a refill of her inhaler.

But when I examined her, I found out that something else much more serious was going on. The patients blood pressure was very high. Her legs and arms were swollen. Her lungs were filled with fluid. She told me that she had given birth a month before. During her pregnancy, she started having wheezing and trouble breathing, which she attributed to her asthma. Actually, she had untreated high blood pressure that progressed and worsened to life-threatening heart failure.

This scenario was tragically typical. As an emergency medicine physician working in ERs in Boston and Washington, D.C., I saw devastating cases like these far too often.

About 700 women in the U.S. die every year from complications of pregnancy, according to the CDC. And more than 50,000 women face severe health consequences in pregnancy. All of this is to say that women giving birth in the U.S. today are actually more likely than their own mothers to die in childbirth. In fact, more people in the U.S. are dying from pregnancy-related complications than in any other developed country, according to an investigation by NPR and ProPublica in 2017.

The public health crisis of maternal mortality is particularly acute for black women, who have three-to-four times the likelihood of dying in pregnancy and childbirth than white women. To some extent, this can be attributed to inequities in access to care, yet we know that these racial disparities persist even when controlling for all other factors. Structural racism in health care is a key contributor, as the research shows that health care providers are less likely to take the pain of black patients seriously. A recent study from the CDC found that three-in-five pregnancy-related deaths can be prevented, compounding the tragedy.

As a mother of a two-year-old, expecting my second child in March, I know that the period spanning pregnancy to parenting an infant is one of the most rewarding yet vulnerable times in a persons life. In medicine, we refer to pregnancy as a physiological stress test. A pregnant womans blood supply increases by nearly 50 percent; hormone levels fluctuate; and because of the growing uterus and increasing demands of the body, lung volumes reduce by five percent, while oxygen consumption increases. The levels of clotting factors in the blood increase in preparation for active labor, which is in itself a marathon that often lasts many hours.

The postpartum period is another time of incredible vulnerability. During this period, new mothers face a wave of new challenges that can accumulate and often compound mental health conditions like postpartum depression. After giving birth, they become full-time caregivers to a newborn, while learning breastfeeding, barely sleeping, and often navigating the return to work. In a country that lacks federal paid parental leave, many new mothers are back to work within weeks of giving birth, which can result in health consequences like maternal stress and anxiety. Medicaid coverage for new mothers, many of whom are people of color, ends at 60 days after delivery, and many people lose health insurance during this time of medical need. Through these challenges, parents often prioritize the care of their infants and push their own health aside; it is estimated that as many as 40 percent of women do not attend a postpartum visit.

In recent months, there has been increased attention to maternal deaths during childbirth. These are important calls to action, but we must also pay attention to the research that shows that the majority of maternal deaths occur outside of the labor and delivery period itself. Approximately two-thirds of maternal deaths occur before or even months after delivery, according to the CDC. These deaths are largely attributed to undertreated chronic illnesses such as heart disease, high blood pressure, and mental illness.

In order to improve maternal health, we have to focus on improving all womens health and access to carenot just during labor and delivery, but before and after pregnancy, and throughout our lives.

It is imperative that we address the barriers to access and the systemic racism that we know is contributing to our astronomically high maternal mortality rates. The onus must be on the health care system to make necessary changes. But we cant wait for systemic change to occur if we need medical care now. Here are a few crucial steps you can take to advocate for yourself and obtain the best care you can:

You can stay on top of your wellness visits. Regardless of whether or not you have given birth or plan to in the future, you can do your best to take care of your health now. Women are often caregivers for our loved ones, but we must care for ourselves to care for others. The best time to keep yourself healthy is before you get sick.

So instead of waiting for something to be up, go ahead and schedule a well-woman visit with your doctor. Your doctor can screen you for common conditions like high blood pressure and diabetes, which are associated with complications during pregnancy including heart disease, preeclampsia and eclampsia (pregnancy-related disorders of high blood pressure), placental abruption (when the placenta separates from the wall of the uterus), and gestational diabetes.

You should also get tested regularly for STIs. If left untreated, STIs can lead to pelvic inflammatory disease and ectopic pregnancy (a pregnancy that grows outside of the uterus), the most common cause of death among women during the first trimester.

Make sure that you are up-to-date with preventive testing such as Pap tests and breast screenings. Even if youre not pregnant, diagnosing and treating medical conditions now can prevent complications during a future pregnancy.

You can choose contraception if youre not looking to get pregnant. Birth control can help you plan and time your pregnancy, which can help some women get pregnant at a time that is best for them and their bodies. Experts estimate that without access to contraceptives, many more mothers would die globally from pregnancy-related complications. Another study found that increasing contraceptive use in developing countries has cut the number of maternal deaths by more than 40 percent over the past two decades.

Birth control can also be beneficial for many patients in ways that dont directly relate with becoming pregnant. It can help with symptoms of other conditions, like polycystic ovarian syndrome (PCOS) and endometriosis.

You can ask for help. This is true for all women, regardless of whether or not theyre pregnant or plan to be pregnant. But pregnancy and the postpartum period can be particularly vulnerable times for mothers, especially those experiencing a mental health condition or substance abuse or addiction.

It can be really hard to know where to turn when you need help, but one place to start would be your primary care doctor or a local health clinic. Remember that your mental health is just as important as your physical health. Tell your doctor if you have feelings of depression, anxiety, and trouble coping. If you find yourself relying on substances such as alcohol or opioids to deal with the stresses of life, you may have a medical condition that treatment can help.

If youre pregnant or have recently given birth and youre experiencing any worrying symptoms, do not hesitate to seek medical attention. For urgent concerns, go to the ER to get care.

The patient whom I mentioned earlier was in the Intensive Care Unit for a week. Though she will now always have a heart condition, she is able to live her life and care for her young daughter. Her outcome could have been vastly different had she not received care in timeand it could still have been different if her high blood pressure was treated much earlier.

Ending maternal mortality wont be easy, but as mothers, future mothers, spouses, and friends, lets start with what we can do right now. After all, to have healthy women, children, and families in the future, we must start with healthy women today.

Leana S. Wen, M.D. M.Sc. FAAEM is an emergency physician and Visiting Professor at the George Washington University Milken School of Public Health. Follow on Twitter: @DrLeanaWen.


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As a Doctor and Mother, Heres What I Wish People Knew About the Maternal Mortality Crisis - Self

My story with birth control – The Cluster


According to the U.S. Department of Health & Human Services Office On Womens Health, hormonal birth control can be broken down into two subtypes: long-acting reversible contraceptives and short-acting hormonal methods.

Suzanna Arul

According to the U.S. Department of Health & Human Services Office On Womens Health, hormonal birth control can be broken down into two subtypes: long-acting reversible contraceptives and short-acting hormonal methods.

Suzanna Arul

Suzanna Arul

According to the U.S. Department of Health & Human Services Office On Womens Health, hormonal birth control can be broken down into two subtypes: long-acting reversible contraceptives and short-acting hormonal methods.

I started taking birth control after my first ever trip to the gynecologist. I went in looking for answers to the typical questions: Why does penetration hurt? Why does my period feel like the scene in Prometheus when Noomi Rapace births an alien? It felt like I only received one question back: Why arent you on birth control?

Although I came in feeling like a strong woman taking charge of her health, I immediately felt like a teenage girl being warned not to get pregnant. My doctor took me through a birth control tour unprompted, showing off an IUD like a brand new Mercedes. I said I would think about it.

When an ultrasound technician found a cyst on my ovary, I received a phone call that amounted to: You have a cyst, were putting you on birth control. I was given no information on the type of ovarian cyst I had (there are many), no other treatment options, and no time to discuss which method was best for me.

According to the U.S. Department of Health & Human Services Office On Womens Health, hormonal birth control can be broken down into two subtypes: long-acting reversible contraceptives and short-acting hormonal methods.

Short-acting hormonal methods include the pill, shot, patch and vaginal ring. These methods work by releasing hormones into the body that thicken the cervical mucus to block sperm and can prevent ovulation altogether, according to Planned Parenthood. Long-acting reversible contraceptives such as hormonal intrauterine devices (IUD) or hormonal implants work the same way, but dont need to be used on a schedule.

I started on the combination pill, which contains estrogen and progestin. Three weeks later, during the week of my placebo pills, I got the flu. I ran a fever, had bouts of shivering so bad I couldnt walk straight, and couldnt even keep Gatorade down.

To give a better sense of just how sick I was, I alerted my roommate to check on me every few hours in case I needed to be carried to the emergency room. I paid $60 for a last-minute Tamiflu prescription and totally recovered within a week.

For the next three months, I got the flu on a consistent schedule of every four weeks. Recognizing that something was up, I made another doctors appointment (I would rack up about $350 in copayments by the end of this story).

My doctor called my case unusual, but did little more than a basic blood test before sending me home with a new prescription for a slightly lowered dosage of the same pill. Between January and April, I tried two new pills that would surely fix my mystery illness, yet I continued to get sick every month like clockwork.

I missed parties that my friends still reminisce on and full weeks of class. I showed up at one male professors office the day a paper was due, mumbling something about hormone levels and blood tests because I knew one mention of my period meant hed stop taking my problem seriously.

If youve ever suffered from a recurring health issue, you know that after a while people start to blame you for not getting better already. I felt like I was constantly over-explaining, trying to prove that I wasnt just having bad periods; I was suffering every month.

When the semester ended, I braced myself for a serious conversation with my doctor. I was leaving for a two-and-a-half-month internship in South Africa, and I couldnt miss work or a travel opportunity because I was sick.

She started me on the Nuvaring, which is a self-inserted vaginal ring containing hormones. She said that the localized hormone dispersal should make my symptoms less severe.

I got on the plane with a box full of Nuvarings and awkwardly told my new roommates that yes, there were contraceptives in the fridge. I had such high hopes for this method that when I still got sick, I called home and cried.

I stayed home instead of going to see the Southernmost tip of Africa because of my birth control. To make matters worse, I felt like my peers didnt even believe I was sick because I couldnt explain what I was sick with.

Research has shown that women are more likely to have their pain dismissed by medical professionals and less likely to receive diagnosis or treatment, according to The New York Times. I couldnt stop thinking about how maybe if birth control were a mens health issue, there would be a name and an explanation for what was happening to me.

I decided then that I would quit hormonal contraceptives cold turkey as soon as I got back to the U.S.

When I told people I was done with birth control, a lot of them responded with, What are you going to do now? in a disapproving tone, as if I couldnt be trusted to make decisions about my own body or keep myself from getting pregnant.

Increasing awareness about sexual health is a good thing, but sometimes hormonal contraceptives are painted as the only responsible option. My story with birth control has shown me that the most responsible way to approach reproductive health is to know your body and trust yourself to decide what it needs.

If you decide to use hormonal contraceptives, it should be because you want to, and it should be prescribed by a physician who will listen to, believe and treat you.

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My story with birth control - The Cluster

Parkinson’s and Prostates; Brain Cancer and Neurons; Mosquito Spray in Havana? – MedPage Today

Terazosin, a drug used to keep enlarged prostates in check, boosted dopamine output in Parkinson's models and was tied to lower rates of Parkinson's disease and slower disease progression in a review of men treated for benign prostate hyperplasia. (Journal of Clinical Investigation)

The death of a 6-month-old infant with spinal muscular atrophy in a European trial of Zolgensma, the world's most expensive drug, was not caused by a drug reaction, Novartis said. (Reuters)

The American Academy of Neurology's position on physicianassisted suicide -- which leaves the decision to practice lawful physician-hastened death to individual practitioners -- is not neutral and should be reconsidered, some members wrote. (Neurology)

In aggressive glioblastoma, cancer cells can form synaptic connections with neurons; interrupting these signals with the epilepsy drug perampanel reduced the proliferation of gliomas implanted into mice. (Nature)

Parkinson's patients with dopamine-resistant tremor may have abnormal brain activity in non-dopaminergic brain regions, such as the cerebellum. (Brain)

Melanin-concentrating hormone neurons may help the brain forget: genetically ablating them increased memory performance in mice and activating them impaired memories. (Science)

The Wall Street Journal profiles a Harvard researcher who helped design the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) trial of solanezumab -- and who also is married to one of the study's participants.

Neurotoxins from mosquito fumigation, not sonic attacks, may have caused the mysterious "Havana syndrome" -- the "concussion without concussion" symptoms afflicting embassy workers and others in Cuba -- a study commissioned by the Canadian government suggested. (BBC)

Transcranial electromagnetic treatment led to significant memory improvement in seven of eight Alzheimer's patients within 2 months, a small open-label study showed. (Journal of Alzheimer's Disease)

The FDA issued a guidance document to help advance novel treatments for amyotrophic lateral sclerosis (ALS).

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Parkinson's and Prostates; Brain Cancer and Neurons; Mosquito Spray in Havana? - MedPage Today

Will Hashimoto’s End Liam Gallagher’s Singing Career? – Medscape

The former Oasis frontman Liam Gallagher has spoken about how Hashimoto's thyroiditis might shorten his career but a specialist tells Medscape News UK the condition is very treatable.

Hashimoto's thyroiditis is typically more common in middle-aged women and can run in families.

Liam Gallagher first talked about his diagnosis and hoarse voice in 2017, including in an interview with the Guardian .

Now, ahead of a 47th birthday homecoming concert in Manchesterin an interview with Apple's Beats 1 he's talked about how the condition might end his career: "Im aint going to get any bigger. If anything, its only going to get worse. You are in that zone now, youre looking about and youre going. All right. I kind of see whats going on but, its all about the journey man.

However, he was reflective about his future career: "If it lasts 10 years, it lasts 10 years. If it lasts 5 years, it lasts 5 years. If it ends tomorrow, Ive still had a f-ing blinder do you know what I mean?"

He continued saying Hashimotos disease "makes your voice a lot hoarser. Thats some of the symptoms.

Dr Paul Jenkins is a consultant physician and endocrinologist at The London Endocrine Centre, and a board member of The Thyroid Trust. He spoke to Medscape News UK.

How can Hashimoto's affect the vocal cords?

If it's untreated, it does cause the cords to be swollen, and to result in a hoarse voice. That's one of the classic signs of an underactive thyroid.

What about the singing style?

With a change in their vocal range, the tenor of their voice, in their singing.

Effective treatment should be able to restore this but not always.

And will it, as Liam Gallagher fears, worsen over time?

No, it should not worsen over time. But most of us don't use our vocal cords so strenuously day-to-day. If you're really straining them I guess it's conceivable, but it shouldn't really worsen.

Is a 'rock-and-roll' lifestyle unhelpful for Hashimoto's?

No, I don't think you could say that. Hashimoto's disease is a very common autoimmune condition of the thyroid gland, where the body's immune system starts attacking it.

Liam Gallagher spoke of it possibly ending his career. Would a more positive attitude be helpful?

That's his thoughts on it. I can't say whether it's positive or negative, it depends on one's overall context.

He's been out of the public eye for some time. So he hasn't been singing as much as he used to.

What kind of treatment regime might he be following?

It is thyroid hormone replacement. It's taking exactly the same hormone as the body is not making butin a tiny pill form.

It is for life, because once the thyroid gland has been destroyed, it does not ever heal itself in this condition.

Are some cases more complex?

Some patients need additional treatment, not just with the thyroxin, but they can continue to have symptoms of underactive thyroid, even if they're taking apparently adequate doses of thyroxin. And we increasingly recognise that they require T3, which is the other active thyroid hormone, in addition to thyroxin.

Is Hashimoto's hard to diagnose in primary care?

No, it should not be hard to diagnose overt cases. There is, as always the grey cases, those that you're not absolutely certain about or don't tick all of the boxes. And that's when a specialist can be prepared to even just try some thyroxin to see if it helps. Certainly, specialists are needed to diagnose those individuals who don't convert the thyroxin to the T3, and who need additional T3.

That's a more controversial area but undoubtedly in my experience, very, very much does exist. And that needs specialist input.

Is it helpful for a major celebrity to come forward and talk about a condition like this?

I think it can be helpful for any celebrity to talk about their conditions, if it raises public awareness of the condition and the treatments to restore it.

So the more debate and discussion, and knowledge generally is a good thing, as long as it's responsible knowledge, and people are given the true facts about their condition.

I'm very happy for him to raise awareness of it and to discuss it.

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Will Hashimoto's End Liam Gallagher's Singing Career? - Medscape

6 Reasons for a Missed Period Why Your Period is Late, According to Doctors –

Its a real bummer when Aunt Flo arrives unexpectedly, but it can be even more panic-inducing when she doesnt show up at all. Every woman has a late or missed period at some point and the first step to figuring out why is getting familiar with your period before its missed. In order to determine your normal menstrual cycle it is important to keep track of when you have your period through a calendar or app on your phone, says Shannon Schellhammer, M.D., F.A.C.O.G., an obstetrician/gynecologist at Orlando Health.

Essentially, every womans body is different and works at its own speed. In fact, despite the popular belief that there are 28 days in a menstrual cycle, a 2019 study of more than 600,000 women in the journal Nature found that only 13% of women have 28-day cycles, and 29.3 days is actually the average length. On top of that, the International Federation of Gynecology and Obstetrics reports that a normal cycle can range anywhere from 24 to 38 days.

Your period is late if you are more than five days past the expected start date of your period, says Jacqueline M. Walters, M.D., an obstetrician/gynecologist and author of the forthcoming book The Queen V: Everything You Need to Know About Sex, Intimacy, and Down There Health Care. Your period is considered missed if you have gone more than one to two weeks past the expected start date. Our bodies are so complex that the potential reasons why you might miss a period are endless, but here are a few common ones.

1. Pregnancy

The number one cause for a missed period is pregnancy! says Dr. Schellhammer. She advises taking a home pregnancy test if you are sexually active, regardless of your age and form of birth control. Once you rule out pregnancy, it is safe to wait for the next month to see if you have a normal period. However, if you are concerned or do not have a clear cause of why you missed your period, I recommend you call your OB/GYN or primary care doctor to be seen. This is especially important if you have not been seen within the last year for an annual well-woman exam.

2. Stress

Stress whether its from something great like planning a wedding, starting a job, or moving to a new house, or something not-so-great like job loss, a bad relationship, or depression can press pause on your period. The chemistry required to develop and produce a normal cycle can be influenced and delayed by high levels of cortisol and/or adrenaline, which increase in the body as a result of chronic, daily stress, says Hector O. Chapa, M.D., F.A.C.O.G., clinical assistant professor of obstetrics and gynecology at Texas A&M University College of Medicine. This delayed cycle may be your bodys way of reminding you to take care of yourself. If stress is the cause for your missed period, it should resume when things in your life calm down.

3. Polycystic Ovarian Syndrome (PCOS)

"Without a doubt, PCOS is the most common hormone imbalance in women that leads to delayed or missed cycles in women aged 18 to 44, excluding pregnancy, says Dr. Chapa. The condition occurs when a woman produces more male hormones than normal. While blood tests and a vaginal ultrasound may support a diagnosis, the diagnosis may be considered if a woman has two of these three symptoms: excess facial or male-pattern hair growth, irregular periods and ovaries that appear to have little cysts. Theres no cure, but your OB/GYN can help you find the right treatment to get your cycle back on track. If PCOS isnt the culprit, your physician can help you figure out if another hormonal imbalance caused by thyroid or pituitary problems is at play.

4. Excess exercise

Exercise is necessary for our well-being, but too much of itwithout the caloric supportcan take a toll on our bodies and trigger missed periods. The female athlete triad occurs when a female athlete has low energy intake or disordered eating, menstrual delays or absence and low bone mass, says Dr. Chapa. Along the same lines, a bodyweight thats more than 10% below the ideal weight for your height can mess with your menstrual cycle.

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5. Medications

When you put a chemical into your body (including herbal supplements), it can cause a chain reaction that spreads across different systems. Birth control, antipsychotics, antidepressants, and chemotherapy can all cause a missed period, says Dr. Walters. If you recently started a new medication and started skipping periods, bring it up with your physician to see if its a normal side effect. For instance, with some contraceptives including IUDs, the shot, and certain birth control pills your period may stop altogether.

6. Perimenopause

Unless the ovaries are surgically removed, menopause doesnt just happen, says Dr. Chapa. The interval leading up to menopause is called the perimenopause and is marked by hot flashes, mood changes, and of course, changes in the menstrual cycle called skips and delays. While the average age of menopause in the U.S. is 51, Dr. Chapa says these changes can start anytime in your 40s.

The bottom line: A missed period rarely causes immediate harm to a womans health, but it does signify something underlying, says Dr. Walters. If the pattern continues, it can affect a womans ability to get pregnant, cause bone loss, lead to ovarian cysts, and cause excessive male-pattern hair growth thinning or balding on the head and more hair on the face, chest and abdomen. No one knows your body better than you so the best thing you can do is pay attention and dont hesitate to give your OB/GYN a call if something feels off.

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Partial and Whole-Breast Radiotherapy After Lumpectomy Provide Equally Satisfying Cosmetic Results – Imaging Technology News

September 25, 2019 Whole breast radiation and partial breast radiation following a lumpectomy yield similar cosmetic outcomes for women diagnosed with early stages of cancer who wish to preserve their breasts. Findings of the new analysis from a phase III clinical trial were presented at the 61st Annual Meeting of the American Society for Radiation Oncology (ASTRO), Sept. 15-18, 2019,in Chicago.

Partial breast radiation is a good choice. Thats what Im going to say to certain subsets of my patients, said Julia White, M.D., FASTRO, a professor of radiation oncology at The Ohio State University Comprehensive Cancer Center and lead author on the abstract.

Women diagnosed with early stages of cancer (stage 2 or earlier) who undergo lumpectomies typically follow their surgery with radiation therapy to lower the risk of having the cancer return. Partial breast radiation can be an appealing treatment option, because the radiation is delivered over several days to a smaller area around the surgical site instead of 3 to 4 weeks to the entire breast.

Previously published results from this phase III trial, NRG Oncology/NSABP B39-RTOG 0413, found partial breast radiation to be only slightly less effective than whole breast radiation at reducing the risk of cancer recurring in the breast. There were no significant differences between treatment groups in overall survival rates, the time patients lived without the cancer coming back or the time patients lived without the cancer spreading to another site. In the current analysis, White and her team focused on cosmetic outcomes to help guide patients for whom both treatment choices would be equally or nearly equally effective for breast-conserving therapy.

In this analysis of 900 women with early-stage breast cancer who received either partial breast radiation (n=477) or whole breast radiation (n=423), both the patients and their physicians were asked to rate the cosmetic outcome of the treated breast, in comparison to the untreated side, as either excellent, good, fair or poor at three different times (baseline, 12 months after treatment and three years after treatment). Patients also rated their satisfaction with the outcome. Additionally, digital photos of the womens breasts acquired at each time point were rated by two teams of three physicians each who were blinded to which treatment the women received, when the photos were taken or which breast was treated.

We found that whether the women received whole breast radiation or partial breast radiation, there was an equivalent cosmetic outcome from the patients' perspective, said White. This pattern held whether the patient also received chemotherapy as well as radiation and lumpectomy. In addition, patients' satisfaction with their treatment and cosmetic outcome were equivalent for whole breast and partial breast radiation. Three years after completing radiation therapy, 81 percent and 86 percent of patients said they were totally satisfied with partial breast or whole breast radiation, respectively; 14 percent and 11 percent were somewhat satisfied; 2 percent and 3 percent were neither satisfied nor dissatisfied; 1 percent and 2 percent were somewhat dissatisfied; and less than 1 percent of patients in each group said they were totally dissatisfied with their treatment.

Treating physicians rated cosmetic outcomes from partial and whole breast radiation as equivalent at one year after treatment (p=1.00), but outcomes from partial breast radiation were considered worse at three years after treatment (p=0.001).

The physicians who reviewed digital photos without knowing if or when the breast received radiation rated cosmetics outcomes as equivalent for partial and whole breast radiation at one year (p=0.99) and three years (p=0.99) after treatment. There were differences between the ratings for patients who did or did not receive chemotherapy, however, with outcomes after partial breast treatment rated slightly worse among patients who received chemotherapy and outcomes after whole breast radiation rated slightly worse in the non-chemotherapy group.

Agreement between the patient and physician ratings was notably stronger when patients had better cosmetic outcomes after treatment. On average, patients who scored their outcomes as "excellent" or "good" (versus those who rated them as "fair" or "poor") agreed with their doctors' ratings 89 percent (vs. 45 percent) of the time and agreed with physicians making photo-based ratings 85 percent (vs. 32 percent) of the time.

White said the findings were important for women facing difficult choices after being diagnosed with breast cancer. If a patient chooses breast conservation for her treatment, she generally wants the breast to feel and look as normal as possible. It is difficult to have to say to a patient that she can have a shorter, more convenient treatment but will have to accept a cosmetic outcome that is not as nice as she would get with a longer treatment. We were relieved to find out the cosmetic outcomes are equivalent.

Understanding the physicians perspective on cosmetic outcomes as well as the patients was important, said White, because how the physician regards the results of treatment will help guide improvements in care. I am happy that the cosmetic outcomes based on the patients assessment and physician review of the digital photos were in agreement, she said. On the other hand, doctors who treat patients will ask themselves what they could have done differently to reach a better outcome or start cataloging what they did to reach the positive one, perhaps leading to innovations that improve outcomes.

The results of NSABP B39-RTOG 0413 and other randomized trials indicate that patients with Stage 0 or 1 breast cancer, who are over the age of 50 and have hormone-sensitive disease, would benefit equally well from partial or whole breast radiation for breast-conserving therapy, consistent with the ASTRO Consensus Statement for Partial Breast Irradiation. This subset of patients with breast cancer accounts for roughly 25-30 percent of new cases treated, or about 30,000 women each year, said White.

View additional coverage of ASTRO 2019

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Partial and Whole-Breast Radiotherapy After Lumpectomy Provide Equally Satisfying Cosmetic Results - Imaging Technology News

Pfizer Presents New Evidence of IBRANCE (palbociclib) Effectiveness in HR+, HER2- Metastatic Breast Cancer Patients in Four Real-World Studies at ESMO…

NEW YORK--(BUSINESS WIRE)--Pfizer Inc. (NYSE: PFE) today announced the presentation of four IBRANCE (palbociclib) real-world analyses. The studies support the effectiveness of IBRANCE combination therapy in everyday clinical practice and provide additional insights on its use in certain patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC). The posters will be presented at the European Society for Medical Oncology (ESMO) Congress 2019 in Barcelona, Spain on Sunday, September 29.

Among the data, Pfizer will share the first real-world comparative analysis of a CDK 4/6 inhibitor in combination with an aromatase inhibitor compared to an aromatase inhibitor alone.

We have an opportunity to make positive changes in cancer care by incorporating learnings from real-world data in addition to data gathered from clinical trials, said Chris Boshoff, M.D., Ph.D., Chief Development Officer, Oncology, Pfizer Global Product Development. We are pleased to share this view of the impact IBRANCE has had on patients treated outside of traditional clinical studies, as it continues to add to the body of evidence for IBRANCE and provides insights into the patient experience.

About the Real-World Comparative Analysis

In this retrospective analysis (Abstract #329P: Comparative effectiveness of palbociclib plus letrozole vs. letrozole for metastatic breast cancer in U.S. real-world clinical practices), treatment with IBRANCE plus letrozole demonstrated a statistically significant improvement in real-world progression-free survival (rwPFS) compared to letrozole alone: 24.5 months (95% CI = 20.7 32.7) versus 17.1 months (95% CI = 13.7 19.8) (HR = 0.68, 95% CI = 0.56 0.84, p = 0.0003).

To help deliver the best care to our patients, it is critical that physicians have compelling evidence of a medicines benefit on patients who resemble those who they treat every day, said Rachel Layman, M.D., Associate Professor, Department of Breast Medical Oncology at The University of Texas MD Anderson Cancer Center. The real-world evidence presented at ESMO provides a more robust understanding of the effectiveness of IBRANCE in patients who may not be reflected in the randomized trials.

The analysis compared 906 matched patients with HR+, HER2- MBC who started IBRANCE plus letrozole as initial endocrine-based therapy in the metastatic setting (n=453) or letrozole alone (n=453) from February 2015 to August 2018. rwPFS was measured by the treating physicians clinical assessment of source evidence, such as radiographic scans or pathology from the Flatiron Health longitudinal database. The most recent update for this database includes de-identified electronic health records from more than 280 cancer clinics representing more than 2.2 million cancer patients in the U.S.

The additional real-world posters at ESMO examining the use of IBRANCE in patients with HR+, HER2- MBC are:

To further educate the global oncology community about the importance of real-world data at ESMO, Pfizer is sponsoring a satellite symposium, Real World Data in Oncology: Its Growing Role in Research and Patient Care. The symposium will take place on Friday, September 27, from 6:00 8:00 pm CEST at Fira Gran Via in the Alicante Auditorium (Hall 3).

About IBRANCE (palbociclib) 125 mg capsules

IBRANCE is an oral inhibitor of CDKs 4 and 6,1 which are key regulators of the cell cycle that trigger cellular progression.2,3 In the U.S., IBRANCE is indicated for the treatment of adult patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-)advanced or metastatic breast cancer in combination with an aromatase inhibitor as initial endocrine based therapy in postmenopausal women or in men; or with fulvestrant in patients with disease progression following endocrine therapy.

The most common adverse reactions (incidence 10%) associated with IBRANCE are neutropenia, infections, leukopenia, fatigue, nausea, stomatitis, anemia, alopecia, diarrhea, thrombocytopenia, rash, vomiting, decreased appetite, asthenia, and pyrexia. Today in the U.S., IBRANCE is the most prescribed FDA-approved oral combination treatment for HR+, HER2- metastatic breast cancer.

IBRANCE currently is approved in more than 90 countries and has been prescribed to more than 230,000 patients globally.

The full U.S. Prescribing Information for IBRANCE can be found here.


Neutropenia was the most frequently reported adverse reaction in PALOMA-2 (80%) and PALOMA-3 (83%). In PALOMA-2, Grade 3 (56%) or 4 (10%) decreased neutrophil counts were reported in patients receiving IBRANCE plus letrozole. In PALOMA-3, Grade 3 (55%) or Grade 4 (11%) decreased neutrophil counts were reported in patients receiving IBRANCE plus fulvestrant. Febrile neutropenia has been reported in 1.8% of patients exposed to IBRANCE across PALOMA-2 and PALOMA-3. One death due to neutropenic sepsis was observed in PALOMA-3. Inform patients to promptly report any fever.

Monitor complete blood count prior to starting IBRANCE, at the beginning of each cycle, on Day 15 of first 2 cycles and as clinically indicated. Dose interruption, dose reduction, or delay in starting treatment cycles is recommended for patients who develop Grade 3 or 4 neutropenia.

Severe, life-threatening, or fatal interstitial lung disease (ILD) and/or pneumonitis can occur in patients treated with CDK4/6 inhibitors, including IBRANCE when taken in combination with endocrine therapy. Across clinical trials (PALOMA-1, PALOMA-2, PALOMA-3), 1.0% of IBRANCE-treated patients had ILD/pneumonitis of any grade, 0.1% had Grade 3 or 4, and no fatal cases were reported. Additional cases of ILD/pneumonitis have been observed in the post-marketing setting, with fatalities reported.

Monitor patients for pulmonary symptoms indicative of ILD/pneumonitis (e.g. hypoxia, cough, dyspnea). In patients who have new or worsening respiratory symptoms and are suspected to have developed pneumonitis, interrupt IBRANCE immediately and evaluate the patient. Permanently discontinue IBRANCE in patients with severe ILD or pneumonitis.

Based on the mechanism of action, IBRANCE can cause fetal harm. Advise females of reproductive potential to use effective contraception during IBRANCE treatment and for at least 3 weeks after the last dose. IBRANCE may impair fertility in males and has the potential to cause genotoxicity. Advise male patients to consider sperm preservation before taking IBRANCE. Advise male patients with female partners of reproductive potential to use effective contraception during IBRANCE treatment and for 3 months after the last dose. Advise females to inform their healthcare provider of a known or suspected pregnancy. Advise women not to breastfeed during IBRANCE treatment and for 3 weeks after the last dose because of the potential for serious adverse reactions in nursing infants.

The most common adverse reactions (10%) of any grade reported in PALOMA-2 for IBRANCE plus letrozole vs placebo plus letrozole were neutropenia (80% vs 6%), infections (60% vs 42%), leukopenia (39% vs 2%), fatigue (37% vs 28%), nausea (35% vs 26%), alopecia (33% vs 16%), stomatitis (30% vs 14%), diarrhea (26% vs 19%), anemia (24% vs 9%), rash (18% vs 12%), asthenia (17% vs 12%), thrombocytopenia (16% vs 1%), vomiting (16% vs 17%), decreased appetite (15% vs 9%), dry skin (12% vs 6%), pyrexia (12% vs 9%), and dysgeusia (10% vs 5%).

The most frequently reported Grade 3 adverse reactions (5%) in PALOMA-2 for IBRANCE plus letrozole vs placebo plus letrozole were neutropenia (66% vs 2%), leukopenia (25% vs 0%), infections (7% vs 3%), and anemia (5% vs 2%).

Lab abnormalities of any grade occurring in PALOMA-2 for IBRANCE plus letrozole vs placebo plus letrozole were decreased WBC (97% vs 25%), decreased neutrophils (95% vs 20%), anemia (78% vs 42%), decreased platelets (63% vs 14%), increased aspartate aminotransferase (52% vs 34%), and increased alanine aminotransferase (43% vs 30%).

The most common adverse reactions (10%) of any grade reported in PALOMA-3 for IBRANCE plus fulvestrant vs placebo plus fulvestrant were neutropenia (83% vs 4%), leukopenia (53% vs 5%), infections (47% vs 31%), fatigue (41% vs 29%), nausea (34% vs 28%), anemia (30% vs 13%), stomatitis (28% vs 13%), diarrhea (24% vs 19%), thrombocytopenia (23% vs 0%), vomiting (19% vs 15%), alopecia (18% vs 6%), rash (17% vs 6%), decreased appetite (16% vs 8%), and pyrexia (13% vs 5%).

The most frequently reported Grade 3 adverse reactions (5%) in PALOMA-3 for IBRANCE plus fulvestrant vs placebo plus fulvestrant were neutropenia (66% vs 1%) and leukopenia (31% vs 2%).

Lab abnormalities of any grade occurring in PALOMA-3 for IBRANCE plus fulvestrant vs placebo plus fulvestrant were decreased WBC (99% vs 26%), decreased neutrophils (96% vs 14%), anemia (78% vs 40%), decreased platelets (62% vs 10%), increased aspartate aminotransferase (43% vs 48%), and increased alanine aminotransferase (36% vs 34%).

Avoid concurrent use of strong CYP3A inhibitors. If patients must be administered a strong CYP3A inhibitor, reduce the IBRANCE dose to 75 mg. If the strong inhibitor is discontinued, increase the IBRANCE dose (after 3-5 half-lives of the inhibitor) to the dose used prior to the initiation of the strong CYP3A inhibitor. Grapefruit or grapefruit juice may increase plasma concentrations of IBRANCE and should be avoided. Avoid concomitant use of strong CYP3A inducers. The dose of sensitive CYP3A substrates with a narrow therapeutic index may need to be reduced as IBRANCE may increase their exposure.

For patients with severe hepatic impairment (Child-Pugh class C), the recommended dose of IBRANCE is 75 mg. The pharmacokinetics of IBRANCE have not been studied in patients requiring hemodialysis.

About Pfizer Oncology

At Pfizer Oncology, we are committed to advancing medicines wherever we believe we can make a meaningful difference in the lives of patients. Today, Pfizer Oncology has an industry-leading portfolio of 22 approved innovative cancer medicines and biosimilars across more than 30 indications, including breast, prostate, kidney and lung cancers, as well as leukemia and melanoma. Pfizer Oncology is striving to change the trajectory of cancer.

Pfizer Inc.: Breakthroughs that change patients lives

At Pfizer, we apply science and our global resources to bring therapies to people that extend and significantly improve their lives. We strive to set the standard for quality, safety and value in the discovery, development and manufacture of health care products, including innovative medicines and vaccines. Every day, Pfizer colleagues work across developed and emerging markets to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time. Consistent with our responsibility as one of the world's premier innovative biopharmaceutical companies, we collaborate with health care providers, governments and local communities to support and expand access to reliable, affordable health care around the world. For more than 150 years, we have worked to make a difference for all who rely on us. We routinely post information that may be important to investors on our website at In addition, to learn more, please visit us on and follow us on Twitter at @Pfizer and @Pfizer_News, LinkedIn, YouTube, and like us on Facebook at

DISCLOSURE NOTICE: The information contained in this release is as of September 24, 2019. Pfizer assumes no obligation to update forward-looking statements contained in this release as the result of new information or future events or developments.

This release contains forward-looking information about IBRANCE (palbociclib), including its potential benefits, that involves substantial risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. Risks and uncertainties include, among other things, uncertainties regarding the commercial success of IBRANCE; the uncertainties inherent in research and development, including the ability to meet anticipated clinical endpoints, commencement and/or completion dates for our clinical trials, regulatory submission dates, regulatory approval dates and/or launch dates, as well as the possibility of unfavorable new clinical data and further analyses of existing clinical data; the risk that clinical trial data are subject to differing interpretations and assessments by regulatory authorities; whether regulatory authorities will be satisfied with the design of and results from our clinical studies; whether and when drug applications may be filed in any additional jurisdictions for IBRANCE for potential HR+/HER2- metastatic breast cancer indications or in any jurisdictions for any other potential indications for IBRANCE; whether and when any such other applications may be approved by regulatory authorities, which will depend on myriad factors, including making a determination as to whether the product's benefits outweigh its known risks and determination of the product's efficacy and, if approved, whether such product candidates will be commercially successful; decisions by regulatory authorities impacting labeling, manufacturing processes, safety and/or other matters that could affect the availability or commercial potential of IBRANCE; and competitive developments.

A further description of risks and uncertainties can be found in Pfizers Annual Report on Form 10-K for the fiscal year ended December 31, 2018 and in its subsequent reports on Form 10-Q, including in the sections thereof captioned Risk Factors and Forward-Looking Information and Factors That May Affect Future Results, as well as in its subsequent reports on Form 8-K, all of which are filed with the U.S. Securities and Exchange Commission and available at and

____________________________1 IBRANCE (palbociclib) Prescribing Information. New York. NY: Pfizer Inc: 2019.2 Weinberg, RA. pRb and Control of the Cell Cycle Clock. In: Weinberg RA, ed. The Biology of Cancer. 2nd ed. New York, NY: Garland Science; 2014:275-329.3 Sotillo E, Grana X. Escape from Cellular Quiescence. In: Enders GH, ed. Cell Cycle Deregulation in Cancer. New York, NY: Humana Press; 2010:3-22.

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Pfizer Presents New Evidence of IBRANCE (palbociclib) Effectiveness in HR+, HER2- Metastatic Breast Cancer Patients in Four Real-World Studies at ESMO...

Is Everyone Doing Chemo Without Me? – The New York Times

Now, in addition to the nightmare of cancer, I had the nightmare of having to make a decision.

Two weeks post lumpectomy, the bruising and swelling were slowly going away. I stopped worrying about recovery and started agonizing about what lay ahead. If there were any benefit to doing chemo to decrease my chances of becoming metastatic, I should take it. I want to be alive when my kids get married and spoil my future grandchildren, even if that means torturing my body for a few months.

My husband, Kevin, a family practice physician, tried to talk me down. One-point-six percent is insignificant compared to how it could weaken your immune system, cause permanent nerve damage, osteoporosis it could even give you another cancer or kill you. You should trust your doctor. And your husband.

I wanted to. But the market researcher in me trusted information. I needed to collect qualitative and quantitative data and analyze which choice I would regret more. Which would allow me to live most fully and take care of the people I love?

At restaurants, waiters try to hide their irritation as I scroll through Yelp reviews on my phone to ensure the most popular dishes are being ordered. My notes on choosing a preschool were so robust I turned them into a how-to book. My newfound research project gave me the opportunity to feel as if I were actively doing something to heal myself.

Each night, once I heard Kevin snoring, I sat up against the headboard, turned on my iPad and lowered the screen brightness. I hurled myself down the rabbit hole of news articles, breast cancer websites and community forums. The TAILORx study was so new, however, there wasnt much information and no concrete answer.

In my support group, most of the conversation revolved around tips for getting through chemo the depression, mouth sores, numb hands and feet, and what to do when hair that fell out never grew back. I couldnt relate and didnt want to, yet somehow I envied them for being fighters.

One day I read about another test called MammaPrint. At our next appointment, my doctor happily showed me that those results also supported the argument against chemo. Time had run out and that was the final data point I needed. We arranged to start my month of radiation treatment the following week, followed by five years of daily hormone blocker pills. I apologized for second-guessing. She gave me an understanding smile and replied, Knowledge is power. She hugged me, said congratulations, and I was on my way. Decision made.

Originally posted here:
Is Everyone Doing Chemo Without Me? - The New York Times

Religion in the health professions – NDSU The Spectrum

Newman Center offering classes in bioethicsFILE PHOTO | THE SPECTRUMCatholic-specific courses held through NDSU.

Saint Pauls Catholic Newman Center, home of the bisonCatholics, has introduced a new course this semester. The ethics course, advertised for students going into the health professions, is meant to teach bioethics through the lens of Catholic dogma. The source of the course material as well as the introduction of religious ethical teachings sets an unusual, and perhaps concerning, precedent for classes at NDSU.

The course is listed as CHP 391: Fundamentals of Catholic Healthcare Ethics and Bioethics. The term Catholic bioethics and the idea of a course directed at health professionals seems like a bit of a paradox considering the churchs historical relationship with science and medicine. The full course takes place over three semesters and results in a certification from the National Catholic Bioethics Center (NCBC).

In an email sent out to bisonCatholics using NDSU logos, the course was described as follows: The National Catholic Certification Program in Health Care Ethics has been developed at the request of many bishops and administrators of health care facilities to provide a credible and systematic formation so that dioceses, hospitals and ethics committees will have advisors better qualified to apply the Catholic moral tradition to challenging contemporary issues in healthcare. For a three-semester course, which provides students with nine NDSU credits, the description is especially vague.

The class is taught by the Monsignor, Gregory Schlesselmann, using course modules developed by the NCBC; so, the question is: What is the National Catholic Bioethics Center? According to the website, the NCBC, Conducts research, consultation, publishing and education to promote human dignity in health care and the life sciences, and derives its message directly from the teachings of the Catholic Church. Again, this is a fairly vague description, but you can probably imagine what these messages from the Catholic Church might be.

The NCBC uses legislation and outreach to promote Catholic values within medical professions. Their stances on abortion and assisted-suicide can be easily imagined: strongly opposed. However, it is their views on topics such as gender identity and same-sex marriage that cause surprise and concern.

NCBC share regular updates, one such update stated: NCBC joins medical associations in advising the US Supreme Court that reinterpreting in federal law the term sex as gender creates a subjective and unworkable means of categorization. This ideology leaks into their work trying to legislate for policies that would protect medical professionals who do not want to assist patients trying to get gender reassignment surgery or hormone therapy.

They elaborate on this by saying, We believe that the best therapies for gender dysphoria will seek to make patients comfortable in their own bodies, rather than take unnecessary medical risks to attempt the impossible and make their bodies reflect their feelings. They are essentially saying that individuals who wish to go through gender reassignment surgery should instead receive psychological treatment to accept their bodies.

Another disturbing take from NCBC has to do with the medical professionals obligations to respect the marital status of same-sex couples. Their exact words on the topic were, There is a fundamental difference between the marital relationship of one man and one woman, with the ensuing rights recognized for the well-being of children and society, and committed relationships between two persons of the same sex.

With all of this information in mind, you may ask: Why should we care? Sure, its no secret how the Catholic church feels about abortion, same-sex marriage, gender identity and physician-assisted suicide. However, when a course promoting Catholic views on all these topics is being taught through NDSU, these feelings go beyond religious expression into the muddied waters of possible discrimination.

NDSU anti-discrimination policy specifically states that programs cannot discriminate on the basis of sexual orientation or gender identity; however, CHP 391 is being taught through an organization who is fighting for legislation that will discriminate on those bases specifically. The course seems to provide future medical professionals with legal tools to avoid treating certain patients. Its difficult to see how this course work will not directly contradict NDSUs own policies.

The real concern is how instituting religion-specific ethics courses, or any other courses directly in favor of a specific religion will affect the NDSU community. NDSU is at its most beautiful and progressive when multiple religions and diverse backgrounds are present. If courses are to be taught that support Catholic doctrine, where can we draw the line from stopping courses being taught which encourage other religious teachings, which propagandize certain political ideologies or that blatantly encourage the discrimination of identities held by NDSU students?

While I am not Catholic, I can say with absolute certainty that I would not want courses held at NDSU which only serve to encourage my personal beliefs. Individuals come to college to broaden their perspective and learn about disparate points of view. As of now, no rules may technically have been broken. However, the possibility that an individual may find themselves in the hands of an NDSU health professions graduate and not be served due to identity or spiritual belief should concern both the students and the administration. A precedent has been set and the resulting dangers could be substantial.

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Religion in the health professions - NDSU The Spectrum

Epigenetic Changes Linked to Hypersexual Disorder and Addictive Behaviors – Interview with:Adrian E. Bostrm MD, on behalf of the authorsDepartment of NeuroscienceUppsala University, Sweden What is the background for this study?

Response: While prevalence estimates vary, literature indicates that hypersexual disorder (HD) affects 3-6% of the population. However, controversy surrounds the diagnosis and little is known about the neurobiology behind it.

Hypersexual disorder has not previously been investigated with regards to epigenomic and transcriptomics in a hypothesis-free study approach and little is known about the neurobiology behind this disorder.We investigated whether there were any epigeneticchanges that affect gene activity and expression in hypersexual disorder (HD)patients and identified a dysregulated microRNA that is believed to influence the mechanism of action of the hormone oxytocin in brain.

Oxytocin is known to have wide-rangingbehavioral influences. To the bestofour knowledge, no previous study provided evidence for an association between DNA methylation, microRNA activity andoxytocin inhypersexual disorder.Our findings merits further research in the role of MIR4456 and especially Oxytocin in hypersexual disorder. Further studies are needed to confirm the role of Oxytocin in HDand to investigate whether treatment with oxytocin antagonist drug therapy could have beneficial effects for patients suffering from hypersexual disorder. What are the main findings?

Response: In this study we investigated over 8000 different DNA methylation sequenced in a hypothesis-free and thereby unbiased manner. Therefore, we were intrigued and surprised to identify a strongly dysregulated microRNA targeting genes primarily expressed in brain and that are involved in major neuronal molecular mechanisms thought to be relevant for hypersexual disorder, e.g. the oxytocin signaling pathway. This microRNA alsoappears to be evolutionary conserved throughout primates, which is also an interesting and unexpected finding. What should readers take away from your report?

Response: Hypersexual disorder incorporates different pathophysiological mechanisms including impulsivity, compulsivity, sexual desire dysregulation and sexual addiction. This can be interpreted such that hypersexual disorder contains addictive elements, but is not to be seen as exclusively an addiction. Our findings, in light of the crossover with alcohol dependence, suggest that MIR4456 and the oxytocin signaling pathway may be primarily involved with the addictive component of hypersexual disorder. Further studies are needed to fully confirm this. What recommendations do you have for future research as a result of this work?

Response: Our results motivates further research in the efficacy of, for example, oxytocinregulating drug therapy in hypersexual disorder whichcould contribute to novel treatment options to improve the clinical outcome of those affected. In addition, we identify a specific microRNA (miRNA)for whichfuture potentialmiRNAregulating drugs could be tested in hypersexual disorder. Is there anything else you would like to add?

Response: Our DNA is genetic code for genes that translate into different sequences of amino acids calledproteins. Proteins, in turn, constitute a main definingelement of all living things. Our DNA is inherited and does not change over time. This study, however, pertained to epigenetics, which arechanges that affect gene activity and expression. These epigenetic activitieschange over time and can be dysregulated in certain ailments. There are different epigenetic mechanisms.

In this study, we studied DNA methylation (a process known to influence gene expression, that is, the quantityof a gene that is translated into a protein)and microRNA activity(short non-coding gene segments that can influence the translation of several hundred different genes).

Comparing patients with hypersexual disorder to healthy volunteers, we identified a DNA methylation sequence to be significantly altered in hypersexual disorder. To ascertain the significance of this finding, the same DNA sequence wasfurther demonstrated to be dysregulated in subjects with alcohol dependence, suggesting it could be primarily associated with the addictive component of hypersexual disorder. The identifiedDNA methylation sequence was associated to a microRNA called (microRNA 4456; MIR4456), and further analysis showed that this DNA methylationsequence influence the quantity of MIR4456 that is produced.Furthermore, in the same study group, we demonstrate that MIR4456 exists in significantly lower quantity in hypersexual disorder as compared to healthy volunteers, strongly suggesting that altered DNA methylation patterns in hypersexual disorder influence and contributes to explaining the observed dysregulation of MIR4456.As microRNA:s theoretically are abletotarget several hundred different genes, we used computer algorithms to reveal that MIR4456 targets genes that arepreferentially expressed in brain and that are involved in major neuronal molecular mechanisms thought to be relevant for HD, e.g., the oxytocin signaling pathway. Our findings merits further research in the role of MIR4456 and especially Oxytocin in hypersexual disorder. Further studies are needed to confirm the role of Oxytocin in HDand to investigate whether treatment with oxytocin antagonist drug therapy could have beneficial effects for patients suffering from hypersexual disorder.

Yet unpublished data intended for a separate follow-up study show a highly significant increase in Oxytocin levels in patients with hypersexual disorder as compared to controls, and a significant reduction in oxytocin levels after Cognitive Behavior Therapy treatment, strongly implying a causal role of Oxytocin in hypersexual disorder andmaking the claims presented in this study much stronger. These preliminary results have been presented as a late breaking poster in Society of Biological Psychiatry meeting in May 2019 and also submitted as a poster in ACNP in December 2019.


Adrian E. Bostrm et al, Hypermethylation-associated downregulation of microRNA-4456 in hypersexual disorder with putative influence on oxytocin signalling: A DNA methylation analysis of miRNA genes,Epigenetics(2019).DOI: 10.1080/15592294.2019.1656157

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Epigenetic Changes Linked to Hypersexual Disorder and Addictive Behaviors -

Concealed Carry: Does Maryland State Police Need to Know if Permit Applicant is Taking Viagra? – Baltimore Post-Examiner

BALTIMORE With violent crime in Baltimore approaching an all-time high, its no secret that much of the malfeasance gripping the city is drug-related. But should law-abiding citizens who apply for a Maryland State Police Handgun Wear and Carry Permit be required to list anxiety, hormone, erectile dysfunction, and breast cancer medications as part of the application process? And what about banking? Should the way you handle your cash invalidate your right to self-protection?

To understand the troubling intimidation factor that intrusive medical and money questions bring to Marylands Wear and Carry Permit application process, we spoke with Post-Examiner contributor Brian Bissett. Bissett is currently appealing his second consecutive restricted Maryland concealed carry permit and has asked the Maryland State Police to open their files as a part of that appeal process.

This is the second part of a two-part interview. The first part of this interview may be found here.

BPE: Your comments in the previous article about the politics surrounding gun legislation were most enlightening. But Id like to get back to the carry permit application process with a couple of oft-asked questions. First, do you have any idea how many gang members annually apply for a carry permit?

Bissett: I have no idea, but I cant imagine it would be many.

BPE: Do you have any numbers on how many felons have attempted to lawfully purchase a gun?

Bissett: No, I dont have any statistics for those things either.

BPE: I realize it may appear that I just set up a couple of straw men for you to knock down, but dont questions such as these help us get around to the thorny issue at hand that is what kind information the State Police should and should not be tracking in the permit process?

Bissett: I believe that they have been tracking all this information for a while, and Ive been told they have a database with all of this information.

Certain information on those applications is what Im looking for.

In fairness to the Maryland State Police, it may not go back as far as I want. But they most certainly have a database for all of this permit information going back the last twenty years.

They could easily query the information Ive requested.

BPE: What sort of information are you requesting?

Bissett: Id like to look at the racial breakdown of approvals and denials, as well as the kind of personal information which has been mined and stored.

One of the things I found troubling when I first went through the permit process is, I was asked on my interview to put down every single prescription drug I am taking.

I was pretty taken aback by that. What if you are a man taking Viagra or a woman taking Avasitin for breast cancer? Should that be included on any sort of application? Come on you could never get a judge to sign a search warrant for that.

Race is one of the questions an applicant must answer on the Maryland State Police Concealed Carry Permit application.

BPE: How does the State Police application on this point compare to what you underwent for a Federal Government security clearance?

Bissett: In the Federal process, they are only allowed to ask a physician one question in regard to mental health: If the person under investigation has a condition that could impair judgment, reliability, or ability to properly safeguard classified national security information?

If the answer is No, no further questions can be asked. If the answer is Yes, only then they may ask additional questions.

Do questions about embarrassing medical or mental health conditions dissuade people from applying for a permit?

The question here is, why arent the Maryland State Police only asking, If the person under investigation has a condition that could impair judgment, reliability, or ability to properly and safely carry a firearm in public?

The fishing expedition of requiring everyone to give personal medical information including all prescription medication they are taking and any mental health diagnosis is in my opinion a violation of HIPAA and done to dissuade and intimidate those with any embarrassing medical or mental health conditions from applying for a permit.

Is it their business if someone has breast cancer, erectile dysfunction, or general anxiety disorder? Quite frankly, its amazing nobody has sued them over this issue.

BPE: Isnt it reasonable, though, to ask if the applicant is on any psychotropic medications?

Bissett: I would say no, in most cases, unless the person has a history of schizophrenia or is bi-polar. People who have some type of mental disorder tend to be victims of violent crime more than they are perpetrators.

Dont get me wrong. I believe that people who have been forcibly institutionalized because they present a danger to themselves probably shouldnt be allowed to obtain a permit. But if you are taking a prescription medication to help you relax when you fly? There they want a note from your doctor, and what doctor can predict a persons mental condition once they leave the office?

Look, people go through problems all of their life. They get divorced; they lose a loved one to death. They may be treated for depression and then they recover. Should an incident such as profound grief mean they should be denied the right to own a firearm in perpetuity?

BPE: Doesnt the Federal Background Instant Check system look at that sort of thing, too?

Bissett: Thats a very difficult question to answer, and the only reason I know this much about it is because Im presently taking a Department of Defense class.

There is not a single database or repository that a law enforcement agency can go to that will necessarily pick up every arrest and/or crime a person may have committed. The records are siloed to a certain degree. Then when it comes to mental health, youre in a whole other ball game, because those records have also been siloed. Then there is HIPPA and the Privacy Act. Most organizations will err on the side of caution because they are potentially liable for millions of dollars if they disclose certain information.

The thing that disturbs me and I know others feel this way as well is that they are effectively ending mental health treatment in this country.

When you have something like the New York Safe Act, where a mental health professional must report anybody who might be a risk, they report everyone, no matter how minute the risk, and that discourages people from seeking the treatment they need.

If you drive people underground, and they dont seek treatment, you create the potential for even greater problems.

BPE: As we are speaking, Baltimore City is quickly approaching the 250 murder mark for the year. Its also gearing up for a major election. Is anyone in the mix for political office there taking a pro-gun or a pro-self defense position?

Bissett: I wouldnt know, to be honest with you, because I dont follow city politics to that degree. The one thing I can tell you is that I often listen to an African-American talk radio station, and whenever the subject of gun ownership comes up, four out of five callers express outrage that they cannot either purchase a firearm or get a permit to carry one.

There are no shooting ranges in Baltimore City. (Wikimedia Commons)

When the state passed the Firearms Safety Act of 2013, they created a process that was much more complicated for your average person to buy a firearm. They have to take a safety course and fire one bullet out of a handgun. But there are no ranges in Baltimore City. So, you are not going to be able to fulfill that requirement using public transportation.

There is a requirement to get fingerprinted, and I dont know how many places do that in Baltimore City. Then there is the requirement to complete the application online using a credit card.

Believe it or not, there is a class of people in this country who do not use credit cards.

BPE: That would bring us back to the hypothetical case of the house-keeper or the carpenter who just deals in cash?

Bissett: Yes. Then they have to use a scanner to enter their documents. Brian Frosh says they can just go to a library, but here you have individuals who are not technically savvy, using equipment which may be on lock-down or not adequately secure. It really puts city residents at a disadvantage to buy a gun, not to mention trying to obtain a carry permit.

BPE: Wouldnt such technical requirements particularly discriminate against African-American and Hispanic city residents?

Bissett: I believe they do. Given everything we have talked about here, African-Americans and Hispanics are much less likely than a white person to be able to navigate the handgun permit process. And yet, they are more likely to be the victim of a crime.

Lets face it: The State Police have created a process that is so intricate, so complicated, so convoluted, that a recent immigrant or an uneducated person doesnt stand a chance.

Maryland Attorney Gen. Brian Frosh.

If you compare a person who went to Harvard to someone who went to Baltimore City Public Schools, the city resident is much less likely to navigate that process.

BPE: Yet the Harvard graduate isnt the one living in a dangerous neighborhood?

Bissett: Exactly, and that is where people like Civil Rights Attorney Dwight Pettit contend that this system is inherently racist.

BPE: You did a pretty thorough job of charting the correlation between strict gun laws and an increase in crime in Baltimore City. Have you looked at other Maryland Counties?

Bissett: I have not because, frankly, getting the numbers together for Baltimore and similar cities was hard enough. I knew Id be crucified for any mistake, and to date, nobody has challenged the validity of the numbers I published in the graphs. Its always been, Well, even though there may be a mathematical correlation, I dont believe this is the cause.

Thats the reason I went through the Bradford-Hill causality theorem. It shows that, more likely than not, restricting an honest persons access to a firearm is going to result in more crime. By restricting I mean going beyond checking a persons background at the point of the sale.

I support the instant background checks, which determine that this person is who they say they are; that this person is not a felon, and is qualified to own a gun. However, I dont think that stops anyone who wants to own a gun from obtaining a gun. What it does do is it prevents them from getting the gun as quickly as theyd like to. But thats a topic for another conversation.

BPE: Where are Americans today on the right to carry?

Bissett: Well, following the Florida example, weve gone from states enacting Shall Issue laws to the Constitutional Carry which means you dont need a permit to carry your firearm as long as you are a law-abiding citizen. I believe there are now thirteen states which allow you to strap it on your hip. They said the same thing about that that they did about concealed carry permits, but by and large that hasnt happened.

BPE: So, in your opinion, Maryland lags behind on idea of a Constitutional Right to carry?

Bissett: I believe the county is moving in that direction. And not just conservatives.

I have a good friend at work, and his wife has been a social worker in Baltimore City for the past 25 years. Interestingly enough, this guy is very liberal, but he and I are very good friends.

I put this friend down as a reference, when I applied for my carry permit. I was later told that when the investigator called him, he said, Let me be perfectly clear: I dont like guns, I dont own guns, I dont believe in guns. And I think the world would be a better place if there were no guns. But if anybody should be carrying a gun, its this guy.

BPE: Wow!

Bissett: Yeah, the investigator said he had never heard a reference like that before. Anyway, as I said, this mans wife has been a social worker for a long time in Baltimore City. She works with a lot of disadvantaged youth, and they have all told her the same. If youd like a gun, I can have one for you in an hour.

BPE: What does it cost to buy such a handgun in Baltimore City?

Bissett: She said the answer from all of them is also the same. That depends on how many people have been killed with it. If no one has been killed with the gun, then thats a clean gun. Those guns cost top dollar. The more crimes that can be tied to a gun, the cheaper it becomes.

(This is the second part of a two-part interview. The first part may be found here.)

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Concealed Carry: Does Maryland State Police Need to Know if Permit Applicant is Taking Viagra? - Baltimore Post-Examiner

Health briefs 09-23-19 | Healthy Living – Uniontown Herald Standard


n Crosskeys Human Resources Inc. is offering flu shots 10:30-11:30 a.m. Sept. 23 at the Brownsville seniors center, 302 Shaffner Ave., and 11 a.m. to noon Oct. 2 at the Republic facility, 36 Fairgarden St., Republic. A professional from Rite Aid in Grindstone will administer the shots. Participants must bring Medicare/other insurance cards for payment.

n Monongahela Valley Hospital will host a prostate cancer screening and education program at 5 p.m. Sept. 25 in the education conference center. The event is free. At the screening, men will be offered a digital rectal exam (DRE), the standard test for prostate cancer; a hemocult test and a Prostate Specific Antigen (PSA) blood test. The screening and education program will be conducted by MVH staff. Registration: 724-258-1333.

n Monongahela Valley Hospital will host a multiphasic blood analysis 7-10 a.m. Sept. 28 in the education conference center. This 36-function screening costs only $30 and is open to the public. Additional tests available include: Immunochemical Fecal Occult Blood, 3-D mammogram, Hemoglobin A1C, Thyroid Stimulating Hormone, Prostatic Specific Antigen, and Vitamin D. Participants are asked to provide the full name and complete address of the physician to whom their test results will be sent afterwards. Testing is by appointment only. The deadline to register is Sept. 25, and registrations must be made Monday through Friday from 8:30 a.m. to 2:30 p.m. by calling 724-258-1282.

n Medicares annual open enrollment period runs Oct. 15 through Dec. 7. For a list of enrollment centers and their dates and times open for enrollment, call Southwestern Pennsylvania Human Services, Inc. at 724-489-8080.


n Exercise classes, Tuesdays and Thursdays, Center in the Woods, 130 Woodland Court, Brownsville. Classes include chair dancing at 9:30 a.m. followed by healthy steps at 11 a.m. Information: 724-938-3554.

n Monongahela Valley Hospital will host a free talk about Gastrointestinal Reflux Disease (GERD) on Thursday, Oct. 3, at 6 p.m. in the Anthony M. Lombardi Education Conference Center at Monongahela Valley Hospital. Dr. Arshad Bachelani will discuss GERD, a digestive disorder in which the contents of the stomach flow back into the esophagus, leading to heartburn, difficulty swallowing, regurgitation of food and cough, to name a few. Long term GERD can lead to complications in the esophagus that can make swallowing difficult, cause an ulcer or the cause development of precancerous cells. Dr. Bachelani will talk about treatment options available that include medications as well as surgery. Registration: or 724-258-1333.

n Monongahela Valley Hospital will host a free talk about Cervical Disc Replacement at 6 p.m. Oct. 15, in the Anthony M. Lombardi Education Conference Center. Dr. Eric Nabors will discuss diseases that affect cervical discs, causing chronic neck and/or arm pain and treatment options. He will thoroughly cover surgical treatment option of cervical disc replacement by describing the procedure, when it is a viable option and who is a good candidate for the surgery. Registration: or call 724-258-1333.

n The four-week Smoke Free For Life program, sponsored by BREATHE Pennsylvania will be hosted by the Monongahela Valley Hospital 9-11 a.m. every Monday in September. Program participants will learn how to overcome barriers that keep them from quitting, develop a customized quit-plan that will lead to success, learn the art of positive self-talk, practice sound techniques to manage stress, develop strategies that will prevent relapse and receive support in a positive and comfortable environment. The session is broken down into four, two-hour courses. Space is limited and pre-registration is required. Registration: 724-258-1462.

n Monongahela Valley Hospital will host a Weight Control and Wellness Support Group at 6 p.m. Sept. 23 in the education conference center. The bariatric support group activities are designed to reinforce key principles of success and help participants learn concepts that are sometimes difficult to grasp after bariatric surgery. Professionals such as dietitians, psychologists and fitness instructors may be invited to speak. Other presenters may discuss topics such as grooming, dating and cooking. The ultimate purpose of the support group is to help participants achieve and maintain their goal weights in a way that is as physically and mentally healthy as possible. Registration: 724-258-1333.

n Monongahela Valley Hospital will host the course Advanced Carbohydrate Counting from 9 to 11 a.m. Sept. 26 in the education conference center. This program is a diabetes self-management class designed to educate you on how to count carbohydrate content in food to improve blood sugar control. Topics include how to track effects of carbohydrates and blood sugar, glycemic index and how to read food nutrition labels. Registration is required at least one week prior to the start of class by calling 724-258-1483.

n Monongahela Valley Hospital through the Community Care Network is offering a Smoke Free for Life program from 11 a.m. to 1 p.m. Sept. 23 and 30 in the education conference center. The four-week program is broken down into four, two-hour courses and is designed to help participants develop strategies to quit smoking, prevent relapse as well as receive support in a positive and comfortable environment. Registration: 724-258-1462.

Support groups

n Breaking Addiction, HEAL Group for Men. This small group meeting for men is designed to help those who have a desire to overcome addictions and find a new direction in life. All sessions give instruction for practical life skills through Biblical Principles found in Gods Word. Discussion and interaction are encouraged at each group meeting. They are scheduled at 7 p.m. the first, second and fourth Thursdays of the month at Eagle Ranch Ministries Inc., 1579 Pleasant Valley Road, Mount Pleasant. Registration: 724-542-7243.

n Breaking Addiction, HEAL Group for Women. This small group meeting for women is designed to help those who have a desire to overcome addictions and find a new direction in life. All sessions give instruction for practical life skills through Biblical Principles found in Gods Word. Discussion and interaction are encouraged at each group meeting. The meetings are scheduled for 7 p.m. every Tuesday at Eagle Ranch Ministries Inc., 1579 Pleasant Valley Road, Mount Pleasant. Registration: 724-244-5261 or 412-969-8520.

n Caregiver support group, 6:30-8:30 p.m., the fourth Wednesday of the month at Lafayette Manor. Classes meet in the new physical therapy department. Light refreshments are provided. Open for family and friends who have lost a loved one to cancer. Registration: or 877-771-1234.

n Mon Valley Hospital will host a Suicide Bereavement Support Group 12:30 p.m. Sept. 23 in the education conference center. This support group is a four-month program that meets the second and fourth Mondays of each month. This program is led by a licensed psychologist and is free and open to all those touched by suicide. Required registration: 724-678-3601.

n Grief support group, 6-8 p.m. first Tuesday of every month, at the St. John the Evangelist Church on West Crawford Avenue in Connellsville. The group is a collaborative effort for those facing grief due to the loss of a loved one from addiction. Information: 724-628-6840.

n Al-Anon Family Groups, 8 p.m. Wednesdays, Trinity Church parlor, Fayette and Morgantown streets, Uniontown. Please enter at the handicapped ramp entrance. A second is scheduled for 7:30 p.m. Fridays, Christian Church, Pittsburgh Street, Connellsville. These meetings are for anyone who has been affected by or is having problems from someone elses drinking. Information: or

n Survivors of Incest Anonymous group, 6:30-8 p.m. the first and third Mondays of the month, excluding holidays. This 12-step recovery program is meant for men and women aged 18 or older who were sexually abused by a trusted person as a child. The group meets at the Mount Macrina Retreat Center. A similar group, Healing Friends, is from 6:30-7:30 p.m., East Liberty Presbyterian Church in Pittsburgh, on the second and fourth Tuesdays of the month. Information:, or

n Missing Piece of My Heart support group, 6-8 p.m. the last Thursday of each month at the Crime Victims Center conference room in the Oliver Square Plaza. The group is for families who have lost a child to a violent crime. Information: 724-438-1470.

n Silver Generation Support Program, 10 a.m. to noon Wednesdays, East End United Community Center, Uniontown. The program is for ages 55 and older. Information: 724-437-1660.

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Health briefs 09-23-19 | Healthy Living - Uniontown Herald Standard

Treating Sleep Problems in Chronic Fatigue Syndrome – ProHealth

Sleep problems are one of the most common ME/CFS symptoms. Sleep dysfunction is a critical piece of the complex puzzle that is chronic fatigue syndrome, and ME/CFS (myalgic encephalomyelitis / chronic fatigue syndrome) patients are eager for treatments that will help to improve and normalize their sleep. When I was diagnosed with ME/CFS by my primary care physician, she said, The first thing to do is to correct your sleep problems. That will make all of your other chronic fatigue syndrome symptoms improve. She was right! Here are ways to help you fall asleep faster, sleep better, and wake up feeling refreshed.

In order to treat ME/CFS sleep dysfunction, it helps to understand what healthy sleep looks like. A night of refreshing sleep consists of sleep cycles, moving through various stages in a predictable pattern:

Those deep Stages 3 and 4 are especially important for immune health, endocrine (hormone) function, and energy; its when our bodies recover and rebuild.

A healthy endocrine system, which produces hormones at the right times and in the right amounts, helps regulate sleep (and everything else).

Why do ME/CFS patients feel like we are half-awake all night and still exhausted in the morning? Traditional sleep studies comparing ME/CFS patients to healthy controls often find no measurable differences in our sleep cycles, though some show reduced total sleep time and sleep efficiency. Newer studies, using entirely different ways of measuring sleep, though, are finding that ME/CFS patients have more disruptions in REM sleep and deep stage (3 & 4) sleep. Our brains will sometimes jump right from REM or even deep stage sleep into being awake or in light Stage 1 sleep, instead of cycling through each stage as is normal. These REM disruptions in the studies correlated with worse symptoms the next day.

The hormone side is also not entirely clear. The few studies of serotonin levels in ME/CFS patients have shown contradictory results, though some do show abnormal serotonin function, indicating our bodies arent controlling serotonin the way a healthy body should. This matters because sleep deprivation causes a multitude of serious health problems, worsening every aspect of ME/CFS.

When an ME/CFS patient mentions sleep problems, doctors usually send him/her for a sleep study. The problem is, as noted above, that even carefully controlled scientific studies often fail to show abnormalities in our sleep using standard measures. Sleep studies do have an important function, though. They are designed to diagnose primary sleep disorders, like sleep apnea, restless legs syndrome, and narcolepsy. Plenty of ME/CFS patients also have a sleep disorder (some studies indicate we have a greater risk of primary sleep disorders), and its important to diagnose and treat those. Consider a sleep study to diagnose or rule out a primary sleep disorder, but dont expect it to find much with respect to your ME/CFS sleep dysfunction.

The key to correcting our sleep problem at its source is to target those hormones that are responsible for good quality sleep. This is different than taking sedatives to knock you out; it means actually correcting the problem so that your sleep feels normal and natural, and you wake up feeling refreshed. There are different ME/CFS treatment approaches to try, and it often takes some trial and error, sometimes combining treatments, to find what works best for you. Work with a doctor to find the right combination and to prevent increasing serotonin too much.

My son and I both have ME/CFS, plus tick infections, but I listened to my doctor all those years ago and treated sleep dysfunction first. Once my son got sick, we did the same for him, and we have both been sleeping a solid 9-11 hours of good quality, normal-feeling sleep every night for over twelve yearsand waking up feeling refreshed most mornings.

I first tried amitriptyline at its lowest dose, but it left me groggy in the morning. Next, I tried nortriptyline liquid in tiny doses (we started with that for my son) and gradually increased the dose as needed, until we each leveled out at an effective dose; then we switched to more convenient capsules. After a year or two, the nortriptyline wasnt working quite as well, so we added trazodone, again starting low, at just 25 mg. We both ended up (hes an adult now) at a combination of 50 mg nortriptyline and 100 mg trazodone (low doses compared to what is used for depression). We both also take melatonin supplements (5 mg for me and 8 mg for him), and I have a prescription for low-dose Ambien that I only use rarely, when I travel. We both also take plenty of magnesium, B6, and the other nutrients listed above.

Although the sleep dysfunction of ME/CFS cant be corrected just with standard guidelines for sleep hygiene, you do need to promote better sleep, in addition to whatever treatments you try. As one sleep expert explains, getting a good nights sleep requires an intricate coordination of many different elements, including some of the basics:

Myalgic encephalomyelitis and chronic fatigue syndrome are a complex web of intricate causes and effects, involving every system in the body. When sleep is disrupted, problems in the endocrine, immune, and nervous systems occur, worsening all ME/CFS symptoms. Similarly, when you treat sleep problems in ME/CFS, there will be improvements in all of these systems, leading to improved symptoms. Best of all, improving those systems will lead to even better quality sleep, in a positive domino effect. The best treatment approaches not only help you fall asleep and stay asleep but improve the quality of your sleep so that you wake up feeling refreshed and ready for a new day.

Suzan Jackson, a frequent ProHealth contributor, is a freelance writer who has had ME/CFS since 2002 and also has Lyme disease. Both of her sons also got ME/CFS, in 2004, but one is now fully recovered after 10 years of mild illness and the other just graduated from college, with ME/CFS plus three tick-borne infections. She writes two blogs, Living with ME/CFS at and Book By Book at, and wrote an upcoming book being released in fall 2019, Finding a New Normal: Living with Chronic Illness. You can follow her on Twitter at @livewithmecfs.


Trazodone (Desyrel) Is. Phoenix Rising website.

Alban, D, Alban P. Use Tryptophan to Boost Serotonin for Better Mental Health. Be Brain Fit website (April 3, 2019).

Bell, D. Sleep in CFS. Lyndonville News (January 2005) 2(1).

Castro-Marrero, J, SezFrancs, N, et al. Treatment and Management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: All Roads Lead to Rome. British Journal of Pharmacology (March 2017) 174(5), pp. 345-369.

Cleare, A. The Neuroendocrinology of Chronic Fatigue Syndrome. Endocrine Reviews (April 1, 2003) 24(2), pp. 236-252.

Field, T, Hernandez-Reif, M. et al. Cortisol Decreases and Serotonin and Dopamine Increase Following Massage Therapy. International Journal of Neuroscience (July 7, 2009), pp. 1397-1413.

Jackson, ML, Bruck, D. Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review. Journal of Clinical Sleep Medicine (December 15, 2012) 8(6), pp. 719-28.

Kishi, A. Presentation: Sleep Disturbances in ME/CFS. The National Academies of Science, Engineering & Medicine Health and Medicine Division. May 5, 2014.

Kishi, A., Natelson, BH., et al. Sleep-stage Dynamics in Patients with Chronic Fatigue Syndrome with or without Fibromyalgia. Sleep (November 1, 2011) 34(11), pp. 1551-60.

Lapp, C. Using Antidepressants to Treat Chronic Fatigue Syndrome. CFIDS Chronicle (Summer 2001).

Morillas-Arques, P,Rodriguez-Lopez, CM,et al. Trazodonefor the treatment offibromyalgia: an open-label, 12-week study. BMC Musculoskeletal Disorders(Sep 10, 2010) 11, p. 204.

Rowe, PC, Underhill, RA, et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: a Primer. Frontiers in Pediatrics (June 19, 2017).

Yamamoto, S, Ouchi, Y, et al. Reduction of Serotonin Transporters of Patients with Chronic Fatigue Syndrome. NeuroReport (December 3, 2004) 15(17), pp. 2571-4.

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Treating Sleep Problems in Chronic Fatigue Syndrome - ProHealth

AI in smart toilets- could identify signs of diseases – AI Daily

Bathrooms are one of the only places where we can expect to have complete privacy. In todays world, we bring technology with us everywhere we go. The bathroom is the last sacred place where some of us leave technology behind and completely disconnect. Not for long...

For a while, determined Japanese companies have been bringing innovation to a niche market; the smart toilet market. They have been up to selling high-tech toilets at exorbitant prices since the 1980s. Meanwhile, on the other end of the globe, the Western world has been ignoring a much-needed toilet upgrade. Some of the earliest innovations in the Japanese toilet industry include heated seats to make you as comfortable as possible, remote controls that let you flush the toilet and close the lid with the press of a button and the use of ultraviolet rays to clean the toilet bowl and get rid of bacteria.

How could AI possibly contribute to improving your toilet? Toilets will now be equipped with Amazons Alexa so you can finally order you it to play music, close the lid, flush etc with voice commands, completely hands-free. These toilets are sold, randing from 1000 up to TOTOs 10000 toilet. TOTO was the first company to create smart toilets and they have mastered this market space. An American based company called Kohler has started making their own range of smart toilets which are becoming increasingly popular in the western world, shifting more people away from using traditional toilets.

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AI in smart toilets- could identify signs of diseases - AI Daily

Kaplan USMLE Step 1 prep: Woman has amenorrhea after birth of baby – American Medical Association

If youre preparing for the United States Medical Licensing Examination (USMLE) Step 1 exam, you might want to know which questions are most often missed by test-prep takers. Check out this example from Kaplan Medical, and read an expert explanation of the answer. Also check outall posts in this series.

A 32-year-old woman comes to the physician because of amenorrhea for the past 15 months after delivering a baby. She says that she has also had fatigue, facial swelling, cold intolerance and has gained an additional 4.5 kg (10 lb) since her baby was born. A review of her records shows that the delivery was complicated by severe hemorrhage. Laboratory studies of serum show:

LH <1 IU/L

Estradiol 5 pg/mL (normal 20100 pg/mL)

TSH 0.1 U/mL

Injection of 500 g of TRH fails to produce an increase in either serum TSH or prolactin. Assay of other hormones is most likely to show normal levels of which of the following hormones?

A. Aldosterone

B. Cortisol

C. Follicle-stimulating hormone (FSH)

D. Gonadotropin-releasing hormone (GnRH)

E. Growth hormone

The correct answer is A.

Sheehan syndrome is hypopituitarism caused by ischemic damage to the pituitary resulting from excessive hemorrhage during parturition. The pituitary is enlarged during pregnancy; it is more metabolically active and more susceptible to hypoxemia. The blood vessels in the pituitary may be more susceptible to vasospasm because of high estrogen levels. In about 30 percent of women who have excessive hemorrhage during parturition, some degree of hypopituitarism eventually manifests.

The symptoms depend on how much of the pituitary is damaged and what cell types are destroyed. Although some pituitary hormones may be unaffected, even in severe hypopituitarism, pituitary hormones and the hormones controlled by them are more likely to be reduced than hormones that are not primarily controlled by anterior pituitary function. Our patient has amenorrhea (decreased LH) and symptoms of hypothryoidism (decreased TSH). Aldosterone secretion is relatively independent of adrenocorticotropic hormone; it is controlled mainly by angiotensin II and plasma potassium concentration. Aldosterone is least likely to be reduced by hypopituitarism. Treatment is replacement of thyroid hormone and cortisol.

Read these explanations to understand the important rationale for each answer to help you prepare with future studying.

Choice B: Cortisol is controlled by pituitary production of ACTH; because ACTH is often impaired in Sheehan syndrome, reduced secretion of cortisol is likely.

Choice C: The pituitary necrosis that is the root cause of Sheehan syndrome is highly likely to reduce secretion of follicle-stimulating hormone (FSH). The observation of reduced estradiol in this patient strongly suggests that FSH is low because estradiol increases as follicular development occurs.

Choice D: The presence of the depressed levels of estradiol and leuteinizing hormone (LH) in this patient releases hypothalamic secretion of GnRH from its normal feedback control. GnRH levels are likely to increase above normal.

Choice E: Growth hormone is very likely to be reduced by the pituitary necrosis.

For more prep questions on USMLE Steps 1, 2 and 3, viewother posts in this series.

The AMA selected Kaplan as a preferred provider to support you in reaching your goal of passing the USMLE or COMLEX-USA.AMA members can save 30% on access to additional study resources, such as Kaplans Qbank and High-yield courses. Learn more.

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Kaplan USMLE Step 1 prep: Woman has amenorrhea after birth of baby - American Medical Association

It’s officially autumn..see how autumn weather may affect your health! – Roya News English

Monday, September 23 marks the next equinox and the start of Autumn season in the Northern Hemisphere, where days will begin to get shorter, nights get dark earlier, and the temperatures will drop.

Monday marks Autumnal Equinox, one of two days when the sun is located exactly above the Earths equator and day and night are roughly equal.

Fall is an easy season to love. One thing you might not realize, though, is that the change in temperature has some effects on your health.

Here are 19 surprising ways fall weather affects your wellbeing, according to msn.

1. Your risk of heart attack increases

Your heart definitely isnt a fan of that chill in the air. "In colder weather, we typically see rates of heart attacks go up," says New York City-based internist and cardiologist Edo Paz, MD, a doctor with K Health. "There are various reasons for this, including increased blood pressure and increased risk of blood clots. The best way to mitigate this risk is to dress warm."

2. Your eyes get dry

The cold, dry air of the fall has a tendency to dry your eyes out and leave a burning sensation in its wake. "Seasonal changes like dryer air make dry eye worse," according to the experts at Piedmont Eye Care in Charlotte, North Carolina. Thats because they either "cannot produce enough tears or they produce low-quality tears."

When your eyes are begging for moisture, you can get some relief by using artificial tears or getting some eye drops from your doctor. The optometrists at Piedmont also suggest getting a humidifier, protecting your eyes outside with either a hat or sunglasses, staying hydrated, taking breaks from screen time, and trading in your contacts for glasses.

3. Your skin becomes cracked and dry

Cold weather doesnt just bring on eye dryness. It also dries out your skin, says Paz. To combat the problemand make sure youre not itchy and cracked all season longuse plenty of lotion, load up on sunscreen, and skip the long, hot showers and baths, which only dry your skin out even more.

4. You experience more aches and pains

Always feel more achy in the colder months? Youre not alone. Research has shown there may be an association between colder temperatures and an increase in aches and pains, particularly in the back and neck areas.

There are multiple theories behind this, but one prominent one, according to University of Chicago Medicine rheumatologist Anisha Dua, MD, MPH, is because of the "drops in barometric pressure, which causes tendons, muscles, and the surrounding tissues to expand." According to Dua, "because of the confined space within the body, this can cause pain, especially in joints affected by arthritis."

5. Your vitamin D levels plummet

In the summertime, all that sunshine you absorb gives you more than enough vitamin D. However, once the season shifts, thats not quite the case anymore.

"In the fall, our vitamin D levels fall rapidly," says Kristine Blanche, PhD, RPA-C, owner of the New York-based Integrative Healing Center. According to Blanche, as your vitamin D levels fall, youre not only more susceptible to colds and the flu, but this can also affect your hormone levels.

6. You feel depressed

Fall should bring on joy in the form of fun family-centric holidays and cozy movie nights by the fire. However, its also known to bring on the seasonal affective disorder (SAD), which "can cause depression symptoms typically due to less exposure to sunlight, says Paz. His advice? "Stick to a regular workout routine" to keep your endorphin levels up.

7. And you lack energy, too!

SAD doesnt just affect your mood. It also affects your energy levels. Along with making you depressed, the seasonal disorder can also cause you to feel sluggish and agitated come fall, according to the Mayo Clinic. If this is the case for you, chat with your doctor about treatment options so the changing seasons dont dampen your spirits.

8. You have trouble breathing

Once the air gets cold, you might have a harder time breathing. According to the American Lung Association, cold, dry air can irritate the airways of those who are already dealing with breathing issues from asthma or chronic obstructive pulmonary disease (COPD). If you know you have airway issues, always make sure youre bundling up and avoid exercising outdoors when the air is especially dry.

9. Youre at a higher risk of getting sick

When the temperature drops and youre spending more time indoors, youre at a higher risk of coming down with a cold or the flu. According to Berkeley Wellness at the University of California, people pick up viruses in the fall not from the weather itself, but from the subsequent time spent indoors in close proximity to others. Of course, sitting within close range of someone whos sick increases your chances of picking up their germs.

10. Your allergies take a turn

Your allergies are inevitably going to be impacted by the fall weather. However, whether thats for the better or for the worse depends on what exactly youre allergic to.

"The arrival of fall weather will bring relief for some, and a worsening of symptoms for others," says California-based physician Alexandra Stockwell, MD. "Anyone who suffers from an allergy to pollen will start to feel some relief when temperatures drop, humidity improves, and pollen is no longer in the air. And for anyone allergic to mold, the fall weather can exacerbate symptoms. Mold thrives in leaf piles, compost piles, and anywhere organic matter is decomposing. Because its airborne, you can be negatively impacted by mold from surrounding areas."

11. You get more headaches

Its not uncommon for cold weather to cause headaches. Thats because, according to the Mayo Clinic, the fall season is full of migraine triggers, ranging from dry air to barometric pressure changes.

12. You sleep better

When you get enough sleep every night, your mood improves, your energy levels increase, and you have fewer junk food cravings. And the transition from summer to fall could be the key to finally helping you get on a solid sleep schedule.

"Going to bed earlier as it gets dark earlier results in better quality sleep, better insulin control, and feeling rested enough to work out the next day," says Monica Auslander Moreno, MS, RD, LD/N, nutrition consultant for RSP Nutrition in Miami Gardens, Florida. Its a win in the bedroom that translates to more success in the kitchen, at the gym, and pretty much everywhere else.

13. You experience hair loss

According to The Choe Center For Hair Restoration in Virginia Beach, Virginia, people typically lose between 50 and 100 strands of hair a day. However, in the fall monthstypically in October and Novemberthis number tends to be closer to 100. If you notice some extra shedding in the shower or when youre brushing your hair in the fall, its likely nothing to worry about.

14. Your diet could get better

During the summer months, its fun to get out and enjoy the warm weather at outdoor bars and restaurants. In the fall, however, youre much more inclined to make the most of your kitchen, which is great news for both your wellbeing and your waistline.

"The cooler temperatures make fall a great time to hit up the farmers markets and add some local and seasonal foods into your diet," says Sheli Msall, RDN, the dietitian behind Nutritionist Abroad. "Its also a fun season to cook and bake in, as you dont mind warming up the kitchen now that its getting cooler outside."

15. Or you might pack on the pounds

While fall can bring on healthy eating habits, the change in season can also have the opposite effect. "When the weather turns colder, we generally adjust our eating styles to warm comfort foods associated with family events and holidays," says Brenda Rea, MD, DrPH, PT, RD, family and preventive medicine physician at Loma Linda University Health in Loma Linda, California. "This often can result in more hot and sugary drinks, hot soups laden with saturated fat and salt, and, of course fruit pies with sugar, saturated fat, and refined flour."

Luckily, Rea says that these comfort foods can easily be replaced with similarand much healthier!alternatives that are just as satisfying. "Hot sugary drinks can be replaced with hot green tea or lemon water; soups can have less salt and no added fats while still maintaining a fabulous taste, and fruit can be consumed fresh and made into a fruit compote with dates for sweetening," she suggests.

16. You could inadvertently be warding off inflammation

Chronic inflammation can lead to a long list of health problems, from heart disease to autoimmune disorders. The good news? Having the urge to sip on some tea during the chilly fall months could help fight it off. "Fall teas and spices are anti-inflammatory," says Moreno. Sip on green tea, turmeric tea, and ginger tea for the best results.

17. You might become more active

During the summer, the sun is strongoften too strong to allow for a run or any other type of outdoor workout. Once fall hits, though, the weather cools down a little, making it a great time to up your activity levels before winter hibernation hits.

"As the weather cools, its a perfect opportunity to bike, walk, or run outside in the crisp fall weatherespecially in the mornings before work and on weekends," says Moreno. "Who doesnt like to ogle the beautiful foliage?"

18. But you could also become more sedentary

Though for some people the tepid temperatures of fall are ideal for outdoor activities, for others, its quite the opposite. The cooler weather could send you straight into hibernation-mode, causing you to abandon your exercising habits in favor of lounging on the couch.

If youre avoiding the outdoors, make sure youre at least incorporating some at-home exercises into your routine. There are plenty of different apps, online workout programs, and free videos on YouTube to take advantage of.

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It's officially autumn..see how autumn weather may affect your health! - Roya News English

BREAKING NEWS: FDA Approves Apalutamide (Erleada) for the treatment of metastatic hormone-sensitive prostate c – Prostate Cancer Foundation

September 18, 2019 Last night the U.S. Food and Drug Administration (FDA) approved apalutamide (Erleada) for the treatment of metastatic hormone-sensitive (aka, castration-sensitive) prostate cancer (mHSPC). Apalutamide has previously received FDA-approval for the treatment of non-metastatic castration-resistant prostate cancer (nmCRPC).

PCF funded the initial synthesis of apalutamide at UCLA by chemist Michael Jung, PhD, in collaboration with prostate cancer physician-scientist Charles Sawyers, MD (now at Memorial Sloan Kettering Cancer Center).

mHSPC refers to men whose prostate cancer has spread to areas of the body outside of the prostate itself, and who are responsive to testosterone-lowering agents. This may refer to men who have had prior surgery or radiation and recurred, or men who were initially diagnosed with disease that was already metastatic (outside the prostate). Patients who are hormone-sensitive may have previously received androgen deprivation therapy (ADT) for a certain amount of time, but their cancer has not yet developed resistance to ADT.

This approval is based on results from the randomized phase 3 TITAN clinical trial, which was presented at the 2019 American Society of Clinical Oncology (ACSO) Annual Meeting, held in June, and published in the prestigious medical journal, The New England Journal of Medicine.

The TITAN trial, led by PCF-funded investigator Dr. Kim Chi, MD, of the Vancouver Prostate Centre, tested the addition of apalutamide versus placebo, to ADT in 1,052 men with mHSPC. Patients on this trial could have previously received ADT for no more than 6 months for mHSPC or no more than 3 years if used as adjuvant therapy for localized prostate cancer, and were not on ADT at the time of disease progression and trial enrollment. Patients could also have previously received docetaxel chemotherapy for no more than 6 cycles, and could not have progressed on that treatment.

Compared with a placebo, the addition of apalutamide to ADT significantly reduced the risk of death by 33%, and reduced the risk of radiographic disease progression (tumors growing on scans) or death (whichever came first) by 52%. Apalutamide also significantly delayed the average time to PSA progression, use of chemotherapy, and pain progression. Apalutamide was shown to prolong survival of patients with both low and high volume metastatic disease. The treatment combination of apalutamide and ADT was considered tolerable, and quality of life in patients receiving apalutamide was similar to those receiving placebo in addition to ADT. Adverse effects that were higher in patients receiving apalutamide vs placebo included rash (27% vs. 8.5% of patients), hypothyroidism (6.5% vs. 1.1% of patients), and fractures (6.3% vs. 4.6% of patients).

More information on this approval can be found here.

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BREAKING NEWS: FDA Approves Apalutamide (Erleada) for the treatment of metastatic hormone-sensitive prostate c - Prostate Cancer Foundation

Conference Highlights: ASTRO 2019 – Physician’s Weekly

New research was presented at ASTRO 2019, American Society for Radiation Oncology Annual Meeting, from September 15-18 in Chicago. The features below highlight some of the studies that emerged from the conference.

With survival of HPV-positive oropharyngeal cancer patients having improved remarkably over the past 2 decades, efforts are now being made to reduce long-term adverse effects of treatment in this population. Options include reducing chemotherapy, radiation, or both while hoping to maintain optimal outcomes. To test the validity of doing so, researchers assigned mostly non-smoking patients with low-risk human HPV-positive head and neck cancer to lower-dose intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy or IMRT alone. Rates of progression-free survival at 2 years were 90.5% in the combination group and 87.6% in the IMRT alone group. A pre-specified threshold for swallowing-related quality of life on the 100-point MD Anderson Dysphagia Inventory was surpassed by both groups, with scores of 85.3 in the combination group and 81.8 in the IMRT along group; these scores were down 5.6 and 6.2 points from baseline, respectively. Local recurrence rates at 2 years were 3.3% in the combination group and 9.5% in the IMRT group, while distant metastasis rates were 4.0% and 2.1%, respectively.


Although the standard of care for early-stage favorable Hodgkins lymphoma (HL) includes radiotherapy, small studies suggests that metabolic response assessment after two cycles of chemotherapy using FDG-PET (PET-2) can predict the individual outcome and PET-2 negativity might allow reducing the overall treatment intensity. To assess whether omitting consolidating radiation therapy in patients with negative PET-2 is feasible without loss of efficacy as determined by progression-free survival (PFS), researcher randomized adults with newly diagnosed, early-stage favorable HL to standard combined modality treatment (CMT) or PET-guided treatment, whereby radiation therapy was restricted to those with a positive PET after CMT. The researchers found that omitting radiotherapy worsened disease control. Rates of 5-year PFS were 93.4% in standard therapy group and 86.1% in the de-escalation group. However, estimated 5-year overall survival rates were about the same in both groups. Among PET-2-negative and -positive patients, estimated 5-year PFS rates were 93.2% and 88.1%, respectively. In early-stage favorable HL, radiation therapy cannot be safely omitted from standard CMT without a clinically relevant loss of tumor control in patients with negative PET-2, conclude the study authors.


Prior research has raised concerns about the cosmetic outcomes associated with partial breast irradiation (PBI), with one study finding adverse cosmetic rates to be higher in those treated with PBI than in those treated with whole breast irradiation (WBI). To compare outcomes with PBI versus WBI in women who underwent lumpectomy, researchers asked these patients and their physicians to rate the cosmetic outcomes of the procedure on the treated breast (vs the untreated breast) as excellent, good, fair, or poor at baseline, 12 months post-treatment, and 3 year post-treatment. At 3 years, reports of total satisfaction were 81% in PBI group and 86% in the WBI, while rates of somewhat dissatisfied were 1% and 2%, respectively and less than 1% in both groups were totally dissatisfied with their treatment. Treating physicians rated outcomes as comparable at 12 months but thought them to be better for WBI at 3 years, while physicians blinded to the therapy who reviewed photos of the patients breasts rated outcomes as equivalent at both 1 and 3 years.


Prior studies suggest that the addition of high doses of radiation to immunotherapy in some cases results in a therapeutic synergy in which some tumors not targeted by radiation will shrinkthe abscopal effect. To determine if adding a high dose of radiation in just a few fractions to a single site of disease could reinvigorate the immune response in patients who progress on immunotherapy, study investigators looked for the abscopal effect in patients with non-small cell lung cancer (NSCLC) and at least two measurable tumors whose cancer progressed after pembrolizumab treatment. Among 50 patients who were immunotherapy-nave and began pembrolizumab when the trial started, 16 experienced disease progression and were treated with stereotactic body radiotherapy (SBRT) and six had progressed on anti-PD-1 therapy at the time of enrollment in the trial and were immediately treated with SBRT. Of these 22 patients, 9.52% achieved a partial response that was sustained beyond 1 year and 47.62% achieved stable disease. Patients with elevated tumor infiltrating lymphocytes scores (2 or 3 on a 0-3 scale) showed improved progression-free survival compared with patients who had lower scores (0-1), with a mean of 215 versus 59 days, respectively.


Men should be offered hormone therapy while undergoing salvage radiotherapy (SRT) following prostate cancer surgery and subsequent biochemical recurrence, according to current treatment guideline recommendations. However, such therapy has been associated with adverse events but no overall survival benefit in those treated with early SRT. Thus, researchers conducted a secondary analysis of the study on which the guideline recommendation is based to determine if a patients pre-SRT PSA level could serve as a prognostic and predictive biomarker of benefit or harm from anti-androgen therapy. While overall survival was significantly improved in men with a PSA greater than 1.5 ng/mL following hormone therapy, those with a PSA level below 1.5 ng/mL experienced no significant overall survival benefit. In fact, men with PSA levels of 0.6 ng/mL were nearly twice as likely to die from non-cancer causes with the addition of hormone therapy, and between three and four time more likely to experience a combination of severe cardiac events and neurologic issues.

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Conference Highlights: ASTRO 2019 - Physician's Weekly

Could a Hormonal Imbalance Be Affecting Your Fertility? Here’s What You Need to Know – Yahoo Lifestyle

There's nothing more frustrating than waiting month after month for those two pink lines to pop up. Struggling with infertility can be a heartbreaking experience, but in many cases, the solution may be more simple than you realize.

One of the things that can affect your chances of getting pregnant is an imbalance of hormones. Now, you can take matters into your own hands by using an at-home hormone test to find out if your hormone levels are the source of the problem.

Here, experts give you a better understanding of the key hormones that can affect your fertility and explain how to have your levels tested.

While it's true that we have tons of different hormones coursing through our bodies, only a few come into play when we're trying to conceive. Below, we've listed some of the key fertility hormones you'll want to get familiar with if you suspect a hormone imbalance might be affecting your ability to get pregnant. The good news is, a hormone test will give you insight into these important hormones.

FSH is of the most important hormones for fertility, FSH or follicle-stimulating hormone is responsible for maintaining cycle regularity and producing healthy eggs.

LHor luteinizing hormone, may sound familiar; it's the hormone that's measured in at-home ovulation predictor kits (OPKs). LH is the hormone that tells your body to release an egg that's ready to be fertilized.

AMH, also called anti-Mullerian hormone, is responsible for maintaining the immature eggs your body has. If you come across a hormone test that measures your ovarian reserve, or how many eggs you have left, it's measuring AMH.

Progesteroneis a key player both in preparing the body for pregnancy and for helping a new pregnancy to continue. Often when a woman suffers repeated miscarriages, plummeting progesterone levels are the culprit.

Prolactin If you're thinking that this hormone is the one that handles milk production, you're correct! But it's also a key player in ensuring your cycle stays regular, which is essential when trying to conceive.

T3 and T4 Many women don't realize this, but these thyroid hormones have a major influence on the ability to get pregnant. In fact, Dr. Elena Villanueva with Modern Holistic Health, says, "The thyroid gland, female reproductive organs, and adrenal glands are intricately connected. If there is an issue with either the thyroid or the adrenals, becoming pregnant can be a challenge. The good news is a hormonal imbalance test for thyroid or adrenal dysfunction can reveal issues that can be easily fixed in most cases. Many women find that when their thyroid is brought back into healthy hormone range they easily become pregnant."

First, it's important to know that if your hormones are out of whack, it's not your fault, and you're not doing anything wrong.

"For better or worse, there are very few things we can do lifestyle-wise that negatively (or positively) impact hormone production and balance," says Dr. Emily Jungheim, a board certified reproductive endocrinologist and fertility expert at the Women & Infants Center in St. Louis, Missouri. "One lifestyle factor that can be important though is obesity. Extreme athletes can also have issues as low body fat can impact a woman's menstrual cycles and ovulation."

Medical conditions affecting the thyroid and adrenal glands can also affect hormones. In fact, the thyroid is so important to sustaining a healthy pregnancy that it's considered one of the biggest causes of hormone imbalance in women. Another is PCOS, which stands for Polycystic Ovary Syndrome. PCOS is a condition that affects between 6% and 12% of women of childbearing age, according to theCDC. It's characterized by irregular cycles, excess male-pattern hair growth, and infertility.

Other causes of hormone imbalance include the following:

If you've been trying to conceive for more than a few months and you're otherwise healthy, it may be time to consider your hormone levels. Below is a list of symptoms that may indicate a hormone imbalance, courtesy of Dr. Villanueva.

If you've realized by now that fertility isn't exactly a one-size-fits-all thing, you're right! Each woman is different, which can make it tough to determine when it's time to take action. But in general, Dr. Jungheim suggests that if you haven't conceived after 6-12 months of trying (it's fine it keep it to only 6 months if you're over 35), your cycles are totally irregular and unpredictable, or if you have symptoms of PCOS or a thyroid condition, it's wise to get checked.

Another scenario where hormone testing totally makes sense? If you're planning to have your eggs frozen for later use. "An AMH level can be helpful in understanding how many oocytes one might expect to get during a banking cycle or during IVF," she says.

There are two basic methods: you can have your doctor order the tests and have your blood drawn at a lab, or you can try an at-home hormone testing kit. More and more women are turning to at-home testing solutions as a way to kick-start their fertility journey.

It used to be that in order to get a hormone blood test, couples would first have to endure months of not getting pregnant, then schedule a visit to a reproductive endocrinologist. Now, at-home hormone tests for women are allowing couples to take back control and present their findings to their doctor as a first step in determining whether they're dealing with an easily solvable hormone imbalance or something more serious.

Hormones can be measured in blood, hair, urine or saliva, and each at-home hormone test functions a little differently. There are benefits and drawbacks to each method; while a hormone blood test is the traditional method, saliva hormone testing is becoming a widely accepted way of testing, since it gives a better average over time by collecting several different samples of spit in a single day (gross, we know).

If you decide to try an at-home test, it's a good idea to discuss your findings with your own doctor, especially if anything unusual pops up. Not only will they want to add the information to your medical history, but they may want to perform their own tests to confirm. Due to the nature of their profession, doctors are natural skeptics of any at-home test.

"There are a number of at-home hormone tests. Some are reliable and some are not, but all should be confirmed and interpreted with a medical provider if someone is concerned about an underlying medical condition or if someone is struggling with fertility," says Dr. Jungheim. That's why we recommend using at-home hormone tests in conjunction with your doctor's care rather than in lieu of it.

Here are a few of the top hormone level tests you can buy to measure your hormones in the comfort of your own home:

Proovis an at-home hormone test that uses urine to detect levels of progesterone in the bloodstream. In a typical cycle, progesterone is a hormone that's released immediately after ovulation; it's critical for a healthy pregnancy to occur.

Everlywell hormone test for women measures many of the fertility hormones mentioned above, like estradiol, FSH, AMH and LH with a simple finger prick in the comfort of your home. Results are promptly reviewed by a board-certified physician.

Modern Fertility uses a simple but effective private dashboard to deliver results, this hormone test measures different hormones based on whether and what type of birth control you use. Testing can be performed at home or in a designated lab.

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Could a Hormonal Imbalance Be Affecting Your Fertility? Here's What You Need to Know - Yahoo Lifestyle

Cancer Hormone Therapy Market 2019 By Demand Services, Developments, Advancements, Application, Platforms Types, Industry Growth Drivers and…

Hormones are natural substances made by our glands in our body and the network of glands that make hormones is termed as endocrine systems. These hormones are carried through bloodstream and act as a messenger between one part to another part of our body. Hormone therapy is one of the major modalities of medical treatment for cancers which involves manipulation of the endocrine systems through exogenous administration of steroid hormones or drugs inhibiting or interrupting activities of specific hormones. Surgical removal of certain endocrine organs for instance oophorectomy can also be employed as a part of hormone therapy. In hormone therapy physician generally start with hormone receptor test that let caregivers to measure amount of cancer proteins or hormone receptors within a cancer tissue. By estimating the amount of hormones such as estrogen or progesterone the test either can be positive or negative. A positive test indicates growth of cancer cells with the help of hormones. In such cases physician divert the hormone therapy by blocking the interaction of hormones with the hormone receptor. Alternatively, in case of negative hormone receptor test which signifies null effect of hormones in growth and development of cancer cells other effective treatments can be rendered to cure cancer.

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A hormone therapy can be rendered either before or after a primary treatment. In case it is rendered before the primary treatment it is medically termed as neoadjuvant treatment which kills. Neoadjuvant treatments help to kill cancer cells and contribute to the effectiveness of the primary therapy. If hormone therapy is given after the primary cancer treatment, it is called adjuvant treatment. Adjuvant therapy is given to improve the chance of a cure. Now a day hormone therapy is widely used in treating breast and prostate cancer. In breast cancer the female hormone estrogen are primarily responsible for stimulating the growth and development of breast cancer cell in majority of cases. Recently in 2014, aromatase inhibitors such as Arimidex and Femara have been approved for treating breast cancers through hormone therapy. Apart from these FDA approved Zoladex Lupron can also be used in curing breast cancers through hormone therapy. In case of prostate cancer a variety of medications can be used as hormone therapy. Male hormones, such as testosterone, stimulate prostate cancer to grow. Hormone therapy is given to help stop hormone production and to block the activity of the male hormones. Some of the antiandrogens used as inhibitors of prostate cancer cell growth encompass flutamide, enzalutamide, bicalutamide, and nilutamide among others. some of the other cancers to which hormone therapy is gaining acceptance now a day include womb cancer, kidney cancer, ovarian cancer among others.

Major drivers to global cancer hormone therapy include rising incidences of cancer across globe. Statistically according to WHO cancer accounts for 8.2 million deaths in 2012 and it is estimated that annual cancer cases is expected to rise from 14 million in 2012 to 22 million by 2022. Rising awareness among physician and patients towards alternative cancer therapy processes such as target therapy, immunotherapy or hormone therapy is likely to uplift the market in forthcoming years. Side-effects associated with hormone therapy are major restraints to growth and acceptance of therapy. Some of the common side-effects associated with hormone therapy for cancer include nausea, vaginal spotting, irregular menstrual periods, skin rashes, loss of appetite, vaginal dryness, impotence and male breast enlargement among others.

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Prominent companies operating the global cancer hormone therapy market include AstraZeneca plc, Novartis International AG, Merck & co., QuatRx Pharmaceuticals and Pfizer, Inc. among others.This research report analyzes this market on the basis of its market segments, major geographies, and current market trends. This report provides comprehensive analysis of Market growth drivers Factors limiting market growth Current market trends Market structure Market projections for upcoming years

This report is a complete study of current trends in the market, industry growth drivers, and restraints. It provides market projections for the coming years. It includes analysis of recent developments in technology, Porters five force model analysis and detailed profiles of top industry players. The report also includes a review of micro and macro factors essential for the existing market players and new entrants along with detailed value chain analysis.

Reasons for Buying this Report This report provides pin-point analysis for changing competitive dynamics It provides a forward looking perspective on different factors driving or restraining market growth It provides a six-year forecast assessed on the basis of how the market is predicted to grow It helps in understanding the key product segments and their future It provides pin point analysis of changing competition dynamics and keeps you ahead of competitors It helps in making informed business decisions by having complete insights of market and by making in-depth analysis of market segments It provides distinctive graphics and exemplified SWOT analysis of major market segments

Note: Although care has been taken to maintain the highest levels of accuracy in TMRs reports, recent market/vendor-specific changes may take time to reflect in the analysis.

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Cosmetic Outcomes Equal After Partial vs Whole Breast Radiation – Medscape

CHICAGO Women with breast cancer who want to take advantage of the more convenient course of partial breast irradiation (PBI) can now rest assured they are not going to have worse cosmetic outcomes by foregoing whole breast irradiation (WBI). This is the conclusion from the final report from the pivotal phase 3 trial (RTOG 0413) that compared the two approaches.

"I think this trial has confirmed the ASTRO consensus statement" that describes the patient population that is suitable for PBI, commented lead author Julia White, MD, professor of radiation oncology at the Ohio State University Comprehensive Cancer Center.

"A good population for PBI includes women over the age of 50 who have stage 1 breast cancer that is hormone sensitive, who take endocrine therapy for it, as well as ductal carcinoma in situ (DCIS) patients whose tumors are less than 2.5 cm in size," she said.

"These patients, who represent probably around 30,000 women a year, need to know that PBI is a good alternative for their cancer outcome and now, I don't think concern about cosmetic outcomes should be a barrier," she added.

White was speaking here at a press briefing at the American Society for Radiation Oncology (ASTRO) annual meeting, where she presented the final report from this trial.

The NRG Oncology/NSABP B39-RTOG 0413 study involved more than 4000 women with stage 0, I, or II breast cancer who had undergone a lumpectomy and were randomly assigned to either WBI or PBI.

WBI was administered at a dose of 50 Gy at 2.0 Gy/fraction or 50.4 Gy at 1.8 Gy/fraction to the whole breast, followed by an optional boost to 60 Gy for 5 to 6 weeks.

Women assigned to the PBI arm received 10 fractions, twice a day, for 5 to 8 days at a dose of 34 Gy in 3.4 Gy fractions. PBI was delivered via interstitial brachytherapy or by mammosite balloon catheter or in a dose of 38.5 Gy in 3.85 Gy delivered in 3-dimensional conformal radiotherapy.

Previously reported oncological outcomes from this trial showed that breast recurrence rates after PBI were within 1% of breast recurrence rates after WBI.

"The really good news was that 95% of all women had no recurrence out to 10 years," White added, "and the risk for distant metastases after each procedure was also pretty close at between 1% to 2% between the two approaches," she said.

At the ASTRO meeting, White presented results from a quality of life substudy that showed that cosmetic outcomes were equivalent between WBI and PBI as well.

In the substudy involving 900 women, breast cosmesis was assessed by the patients themselves, as well as by the accruing-site physician and by central review of digital photos by physicians blinded to the randomized treatment arm. Digital photos of the breasts were collected at baseline, and at 1 and 3 years after patients received either WBI or PBI.

The goal of the current substudy was to see if PBI induced changes in breast appearance that were equivalent to those induced by WBI as assessed by the 3 separate groups using the Global Cosmetic Score (GCS).

"Patients were stratified by chemotherapy use and no-chemotherapy use," the investigators noted. Just under half (47%) of the group had received chemotherapy.

Based on the patients' own assessment, changes in cosmetic outcomes at 36 months were equivalent for women who received WBI or PBI based on GCS scores in both chemotherapy recipients and nonchemotherapy recipients at 0.06 vs 0.04, respectively.

When the two groups were combined, change in cosmetic outcomes at 36 months were again equivalent at a GCS of 0.045, as White reported.

Judged by accruing-site physicians, change in the GCS again at 36 months was not quite equivalent in chemotherapy receipts who received PBI compared with WBI, and the same was true in nonchemotherapy recipients. In both groups, cosmetic outcomes were judged to be slightly worse following PBI compared with WBI, White reported.

However, when the two groups were combined, GCS changes were equivalent between PBI and WBI at a change in GCS score of 0.045, she observed.

When the digital photos were assessed by central reviewers, cosmetic outcomes were not equivalent among chemotherapy users, where PBI was deemed to be inferior to WBI.

However, the reverse was true for patients who did not undergo chemotherapy, among whom cosmetic outcomes in breasts treated with WBI were judged to be worse than they were for breasts treated with PBI.

Again, however, when the two groups were combined, cosmetic outcomes as assessed by central reviewers were felt to be equivalent for PBI and WBI, at a change in GCS of 0.028.

White also noted that there were no significant differences in mean changes in GCS as assessed by both patients and by digital photos reviewers at each time point that cosmesis was assessed during the study interval.

The only differences observed between mean changes in GCS at each time point of assessment were seen among accruing-site physicians who, at 36 months, rated changes in cosmetic outcomes at 0.43 for breasts treated with PBI vs 0.17 for breasts treated with WBI, which was statistically significant (P = .001).

On the other hand, patient satisfaction with cosmetic outcomes in those who had received chemotherapy, those who had not received chemotherapy, and the combination of the two groups were all equivalent between those who had undergone WBI and those who had received PBI.

"I think this is the link we were waiting for," White observed.

White noted that an earlier, similarly designed study referred to as the RAPID trial again demonstrated that the accelerated PBI regimen used in the trial was noninferior to WBI in preventing local recurrence, but there was an increase in late normal tissue toxicity and cosmetic outcomes were judged to be worse with PBI than with WBI.

"Thus, there was concern that women would have to sacrifice the appearance of their breast to undergo more convenient radiation," White said.

"But from our analysis, we feel pretty confident that from a patient perspective, there was no difference between treatment arms, and that one arm did not cause more change [in cosmetic outcomes] than the other," she concluded.

Commenting on the findings, Wendy Woodward, MD, professor of radiation oncology, MD Anderson Cancer Center in Houston, Texas, told the press briefing that the outstanding question at the time the RTOG 0413 trial was designed was whether there would be a similar detriment in cosmetic outcomes following PBI as was shown in the RAPID trial.

"Looking at the data very granularly, it is patient satisfaction and patient-reported outcomes that really matter and in this trial, [and these assessments] were completely equivalent," Woodward said.

"So I think this study is a cornerstone for highlighting that PBI is now standard of care for eligible patients and, ultimately, we will see these papers published and we will see practice change as PBI becomes a standard-of-care option," she concluded.

White disclosed travel expenses from IBA and Qfix. Woodward declared she has served as a consultant for Global Health International.

American Society for Radiation Oncology (ASTRO) 2019 Annual Meeting: Abstract #5. Presented September 16, 2019.

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Cosmetic Outcomes Equal After Partial vs Whole Breast Radiation - Medscape

A Doctor Explains The True Risk of ‘Natural’ Treatments Like Green Tea Supplements – ScienceAlert

A few weeks ago, a patient came to me complaining of nausea, muscle weakness and fatigue. Her urine was tea-colored despite drinking loads of water. A middle-aged woman, she seemed worried she had cancer or some deadly disease.

Her lab tests revealed significant liver dysfunction. But her symptoms were not due to liver cancer, hepatitis or other disease. It turned out she had liver toxicity from a green tea supplement that she'd heard was a "natural" way to lose weight.

When she stopped taking the supplement at my suggestion, her liver tests gradually normalized and she felt better over the course of a few weeks

I've seen the green tea issue in patients before and often witness the real-life pitfalls of eschewing traditional medicine, science and facts in favor of supplements, herbs and cleanses in the name of "natural" healing.

In an effort to be healthy, patients can easily become ensnared in the potential dangers of alternative medicine or homeopathy.

Let's be clear: Nature has a lot to offer patients.

The Greek physician Hippocrates is said to have reported on the use of St. Johnswort, a flowering plant, for mood disturbances in the 5th century BC Digoxin, a well-studied medicine used to treat heart failure, is derived from the foxglove plant.

Parkinson's patients are often commonly treated with the medication L-dopa, which comes from the plant Mucuna pruriens. Moreover, research repeatedly shows that consuming fruits and vegetables, getting adequate sleep and regular exercise, and spending time outdoors have myriad health benefits.

But nature isn't always so well-intended.

Spoiler alert: Arsenic, cyanide, asbestos and snake venom derive from nature. Refined sugar, a naturally occurring substance and one that lives in most Americans' pantries, is in large part responsible for our country's obesity epidemic. Simply because a substance comes from nature does not mean it is good for us.

An important key to health is using nature appropriately.

And in the case of my patient, she was able to lose weight when we made a clear plan to alter her basic human behaviors. Before she started taking the green tea extract, she was skipping breakfast, drinking the equivalent of two Venti coffees before noon, eating takeout meals for lunch, washing down her late-night dinner with two glasses of wine, sleeping restlessly, and spending too much time sitting and indoors.

Green tea extract was never going to be the quick fix that she - and other patients I have seen - had hoped. It may be attractive as a natural cure for extra body fat, but this promise has not been shown in any studies, according to the National Center for Complementary and Integrative Health at the National Institutes of Health.

The key to helping my patient was pretty basic: looking at her lifestyle, her stress, and creating some structure and accountability for important lifestyle changes.

While she wasn't able to eat like Gwyneth Paltrow would recommend (who can eat Pinterest-perfect meals like that as a mere mortal?), my patient took my advice to heart that she begin eating breakfast, packing healthy leftovers for lunch at work, cutting back the wine to weekends only, and getting more exercise on weekends.

As a result, she started sleeping better and feeling more energetic. Eventually, the weight started coming off, too.

Particular patients seem to be more susceptible to the lure of "naturopathic" medicine or homeopathy. Patients who have vague symptoms that do not fit tidily into a box, for example, are often the ones combing the Internet for answers to their health woes and spending hundreds of dollars on unproven and insufficiently regulated supplements and herbs.

According to the 2012 National Health Interview Survey (NHIS), which included a comprehensive poll on the use of complementary health approaches by Americans, 17.7 percent of American adults had used a dietary supplement other than vitamins and minerals in the past year.

That number is probably larger now: The total sales of herbal and dietary supplements in the United States were estimated to be more than US$8 billion in 2017, the 15th consecutive year of sales growth, according to a market research report. And women were more likely than men to use these products as well as people with more education.

Scientific data is often not the reason patients are drawn to herbal or "natural" supplements, Harvard School of Public Health researchers said. Of supplements users surveyed in 2001, 72 percent said they would continue using supplements despite a negative government scientific study. Patients reported getting much information about herbs from family, friends, advertisements and the Internet.

My patients often consider herbal remedies to be free of side effects, but many "natural" products can lead to toxicity and can dangerously interact with prescription medications.

Compounding the problem is that herbal and dietary supplements are not subject to the same strict regulatory standards as prescription drugs. On its website, NIH's Office of Dietary Supplements says the products "are not required to be reviewed by the FDA for their safety before they are marketed because they are presumed to be safe based on their history of use by humans."

Last year, another patient came in to see me complaining of fatigue, joint pains and abdominal bloating. She had seen a naturopath for these symptoms, who told her she had "chronic Lyme" disease and gave her multiple rounds of antibiotics and a bag full of daily herbal supplements. She said she didn't feel any better.

When we met, she told me she was certain she had Lyme disease that wasn't being adequately treated. In fact, the antibiotics she had been given had only worsened her abdominal issues and caused a new problem: an intestinal infection that causes bad diarrhea.

After 10 days of appropriate antibiotic treatment, her diarrhea was gone but she was back to her tired and achy self. At my recommendation, she stopped the supplements, and her fatigue abated somewhat.

When we discussed her situation further, she revealed to me she suffered from a love-hate relationship with sugar.

Like many of my patients, when she was stressed out she binged on sugar. For most people, ingesting sugar provides a quick hit of the pleasure hormone dopamine, and for some people that rush of dopamine and the accompanying instantaneous boost of energy can become addicting.

The problem is that a high sugar load causes a surge in the hormone insulin, which then results in a sudden drop in blood sugar - which can promote fatigue, weakness and irritability, among other symptoms.

If consumed in excess over time, such dietary sugar can cause abdominal distress, bloating and joint aches. This is what was probably causing my patient's symptoms.

So we made a plan for her to not only cut back on sugar but also fill her diet with healthy stuff to get ahead of hunger and avoid binges. I also recommended she work with a therapist to deal with stress-eating. Her joint aches went away and her energy improved after about two weeks, and she continues to see a therapist for stress-eating issues.

Food - and added support to use it properly - was the fix.

Symptoms such as fatigue, headaches, joint pains and irregular bowel movements are some of the most common complaints I see in my office. They can be challenging for physicians to figure out, largely because they require careful and attentive listening by the doctor.

And since more than 40 percent of patients do not tell their doctors about their use of complementary or alternative medicine (including 25 percent who takesupplements and/or herbs), physicians can be bewildered when trying to pin down a root cause for a patient's complaints.

Indeed, these patients are not easily diagnosed after a single lab test - and they are not easily fixed with a supplement.

Occasionally, it takes time with the patient, careful attention to the patient's story, and asking the right questions to get to the bottom of the problem. Often, the solution is right under our nose.

Nature is indeed wonderful, but it doesn't always come in a pill.

Lucy McBride is an internist based in the District.

2019 The Washington Post

This article was originally published by The Washington Post.

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A Doctor Explains The True Risk of 'Natural' Treatments Like Green Tea Supplements - ScienceAlert

Dr. Kevin Most: Blood Tests – WGN Radio – Chicago

How many times has your doctor said, we will get some blood tests and you are handed a piece of paper that looks like a foreign language or a menu from another country. Often we blindly take the paper order go to the lab and let them take tubes of blood out of us, with many concerned that all their blood will be gone.

I thought we would take a few minutes and discuss common blood tests, what to expect, what tests should you have, and what is new and exciting in blood testing.

First a little trivia for you, the average sized adult has about 1.5 gallons of blood in their body, that comes out to 12 pints of blood. Blood is made from within our bones, the kidney will actually secrete a hormone to tell the body it is time to make more blood. The average age of a blood cell is 120 days after which point it is removed from circulation by the spleen. The spleen acts a recycling plant by keeping the important parts of the red blood cell to be used again. For those of you who donate blood, the blood you donate is totally replaced in your body within 4- 8 weeks. For a simple blood draw of a few tubes of blood, that blood is replaced within days and makes no impact on your total blood volume.

When we say blood, it is often used as a generic word. Our blood actually is a lot more than red blood cells. It can be broken down to red blood cells, white blood cells, plasma and platelets. Each portion of our blood has important roles. Red blood cells carry oxygen to the body and return carbon dioxide to the lungs, White blood cells fight infections and act as a major portion of our immune system, platelets stop bleeding from advancing and plasma carries other factors needed to clot blood. When the blood is clotted we are left with serum which contains, lipids, electrolytes, hormones, proteins and antibodies to list a few.

You may notice when the tech is drawing your blood that they are using tubes with different color tops. The reason for this is that the tubes are treated with chemicals to make sure that the component you are measuring will be accurate. For example, if the tube has no chemicals in the tube, the blood will clot as it should, however if we are looking at components that allow the blood to clot we dont want them all used up, or if we want to count red blood cells we cant count them if they are all clotted and clumped together. So next time you have blood drawn watch as they change tubes and look for the different colors. You will now know why they do that.

So when you hear you are going to have blood tests it is important to understand exactly what they are testing for. The tests are done for many reasons and are specific for the indication being tested for. For example if we are concerned about an infection we will often do a White Blood cell count. We do this because when the body is under stress from an infection it will produce more white Blood cells to help fight the infection, so our WBC count will go up and give the doctor an idea as to how severe the bacterial infection is. What is unique is that viral infections actually cause the WBC count to drop in many cases as the virus impacts the production of WBCs for a short time.

Doctors will order blood tests that give them specific information to a condition that they are concerned about. What about when you are having a physical and the doctor orders basic tests, what are they looking for? The doctor at this time is looking at your body as a whole and not honing in on any specific disorder. In these cases he is essentially doing the same as your car dealer does with their multipoint inspection.

Lets go over the most common tests your doctor may order and what the doctor is checking with each.

1.Comprehensive metabolic Panel- this is a panel of tests that may include close to 30 different tests. These tests will give a snapshot of your kidney function, your liver function, your gall bladder function, your nutritional status, diabetes and your cholesterol. They can do all of these tests out of a simple tube of blood. They will ask you to fast for this as some portions of your cholesterol as well as your blood sugar will be impacted with any recent food intake.2.Complete blood count- this test will look at your White Blood cells, including the number of WBCs as well as what type of white blood cells. Red Blood cells are counted as well including both number of red blood cells but also sizes of the red blood cells. It will also look at how many platelets we have, which is important for blood clotting. These tests are not only signals of general health but also for leukemia, anemia and iron deficiency.3.Lipid Panel- this test looks at our cholesterol and takes it beyond just a total value for our cholesterol. The test breaks it down into our good cholesterol- HDL, our bad Cholesterol LDL and our very bad cholesterol- VLDL. HDL is good cholesterol as it removes harmful material from our blood. The bad cholesterols are bad because they need to blockage in our arteries.4.Hemoglobin A1c- we discussed how eating can impact your blood sugar level for a period of time while the body reacts to the intake. Patients with diabetes work to keep their blood sugar level in a tight range by checking their sugars throughout the day with finger sticks to check the glucose levels. This test will give an idea of a sugar range that your body has been in for the past 120 days as it measures how much sugar is in the Red Blood Cells which circulate for 120 days. This gives the doctor and the patient a better idea as to how well their blood sugar is doing for a long period of time5.Thyroid Function we dont discuss the thyroid much, that small gland that sits in our neck and is the powerhouse for our energy. If the thyroid is working well our energy level is where we need it. When it is not functioning at the right level, often low level, or hypo thyroid, we feel sluggish, fatigued and sometimes depressed. When it is working too much or hyperthyroid our heart may race, we may feel anxious and we may struggle to keep on weight.

These are just a few of the common tests that a physician may order as part of your checkup. It is important that you understand why a test is being done, when you will get the results back and who will explain them to you. Also you want to know how the results compare with your previous tests as slight changes may show a trend that needs more evaluation , intervention or possibly medication. It is good to have your own copy of your test results, with the electronic health record these are often available to you on your phone, in some cases as soon as the test is completed. For some individuals this is good as they know the goal for their diabetes or cholesterol, for others it is not great as many jump to conclusions after seeing a single blood test and then running off to Google the results. Abnormal results should be discussed with your physician or nursing staff, this should include a discussion of what the results mean, what you need to do, and what is the follow up on this abnormal result.

What is on the horizon for blood tests- some very exciting news

There are a few new blood tests worth discussing, three were reported recently.

ABBOTT Concussion blood test

2 weeks ago, Abbott reported the results of a study that showed their blood test for concussions could detect a concussion even when it was not noted on CT Scan. The blood test looks for proteins that are only found in the brain unless there is damage to the brain which allows it to be found in circulating blood stream. The test can be done in real time and takes about 15 minutes to get results, even on the sidelines of a football game or in the ER following some trauma. This test is very important as it may give a definitive answer to the question of a concussion. This information is very important as the current concussion testing is not completely accurate. An accurate diagnosis is key as removing the individual from activities that may result in another concussion is very necessary to minimize long term effects. This study showed that the test was much more accurate than any cognitive and physical exam screening and was also more exact than a CT scan. The test is not commercially available in the US yet but is expected to be soon.

This is important as a study out last week shows that repetitive mild impact to head is causing damage to the blood vessels in the brain. The study reports that repetitive impacts to the head not necessarily the big concussive blows are likely to changes to the micro vessels that deliver blood to our brain. If this blood test can identify those individuals as well we may see a much safer and accurate way to prevent the long term effects of concussions


Cancer SEEK is a blood test that we have discussed in the past. It is a blood test that is being developed to identify 8 cancers from a single tube of blood. Essentially a liquid biopsy. The test will look for known DNA fragments from cancers that would be circulating in the blood stream. What is more interesting is the cancers this test may be able to identify. The current list includes Breast, lung, colon, ovarian, liver, stomach and pancreatic. As you look at this list, imagine that the test is perfected to a point where it can identify the cancer before traditional ways of testing, identify it earlier and more accurately.

The list includes some cancers that when identified are beyond the option for successful treatment. Lung cancer, ovarian cancer and pancreatic cancer comes to mind. Think about being able to eliminate the need for mammograms or colonoscopies to diagnose those two common cancers. The current stand is that this test will complement the current screening tools

Is this futuristic or is it something we will see soon? It may be here sooner than we think. It is currently in a large study and earlier studies have shown it to be quite good. The study that came out last year showed it to be quite accurate for ovarian, liver, pancreas, stomach and esophageal cancer, each of these very important as there are currently no screening test for each of these. The proposed price for this test is $500, which is a very appealing price for both patients and insurers. The ability to identify these cancers early will be lifesaving and game changing. Look for more information on this as well as the ability to potentially participate in a clinical trial, as they work to perfect this test.


The other test is a bit more controversial, a group of researchers in Europe, are looking to design a blood test that could predict your lifespan as you age. The study is taking data from close to 45,000 individuals aged 18-109. During the follow up period 5,500 of the individuals had passed away. The researchers then looked at biomarkers in the blood and took that data to see if they could create a scoring system that would predict when a person might die. The researchers identified 14 different biomarkers in the blood, when some were found at low levels the chance of death was high, while other biomarkers when found at higher levels were associated with a lower chance of death. The data is being reviewed to see if levels could predict within a timeframe what the future life expectancy would be.

This obviously will be met with resistance from ethical view from a psychological view and from a healthcare utilization view. The concern about rationing health care would be raised quickly, along with utilization. If someone had this test and the results showed a predictive score that the patient would die within 5-10 years what would we do differently? Would we not do some surgery, would we not use expensive medications, would we give limited resources to an individual who had a better score. Would individuals make other life changing decisions based on the knowledge that they have a high chance of dying within the next 5 years. Many may argue that this is good information and that if we can predict our life span why wouldnt we want to know. It would allow us to make choices on work life balance, allow us to make financial decisions, and family and friend decisions.

Probably the biggest issue as this research is more publically available, would be can we change our lifestyle to change these biomarkers and improve or extend our lives. Would we start to track things we never thought were important, like our levels of leucine or valine. Would we find medications that could lower inflammation should be used as regularly as statin drugs are now.

There will be more to come on this study and how its results will be used in routine care in the future.

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Digital Pregnancy Test Kits Market: Strategic Analysis to Understand the Competitive Outlook of the Industry, 2026 – ScoopJunction

Pregnancy test is an indicative marker test for determination of pregnancy, which measures the human chorionic gonadotropin (hCG) in urine samples. The hCG hormone is present in the human body only during pregnancy, which makes it possible for the test to provide accurate results. Various types of pregnancy tests are available in the market, the common one being the home pregnancy test (HPT), which offers benefits of pregnancy testing at home, without the need to visit a physician or gynecologist. Recent technological advancements in home pregnancy test have led to the emergence of digital pregnancy test kits. These test kits offer quick results in a digital format (pregnant / not pregnant) which eliminates the need for interpretation of results by the women, thereby improving accuracy of the test.

Rise in awareness among general population regarding pregnancy test kits and increase in pregnancy rates among women in emerging countries have boosted the adoption of pregnancy test kits globally. Conventional pregnancy test kits, including strip test kits and cup test kits, offer symbolic results of the test (lines or color code format), which need to be interpreted by the user. This increases chances of human error while interpretation of results. Digital pregnancy test kits have eliminated this possibility by offering a digital response (in yes or no format). These distinct benefits of digital pregnancy test kits over the conventional ones have propelled the adoption of digital pregnancy test kits in the global market, thereby driving the consumption and subsequent growth of the product in the global market during the forecast period. Moreover, incorporation of new technologies in the digital pregnancy test kits, such as indication of the pregnancy month of the woman, has been another major factor eliminating the undesired need to undergo ultrasound scans, thus reducing the health care cost of the patient and driving the adoption of these kits in the global market. However, higher price of digital pregnancy test kits than that of conventional ones, along with their unavailability in the emerging countries, is anticipated to restrain the growth of the global digital pregnancy test kits market in 2018.

The global digital pregnancy test kits market can be segmented into product type, distribution channel, and region. Based on product type, the global market can be divided into kits with week indicator and kits without week indicator. Based on distribution channel, the global digital pregnancy test kits market can be classified into institutional sales and retail sales. The institutional sales segment can further be categorized into maternity centers, gynecology clinics, and others. The retail sales segment can be bifurcated into hospital pharmacies, online pharmacies, and retail pharmacies & drug stores.

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In terms of region, the global digital pregnancy test kits market can be segmented into North America, Europe, Asia Pacific, Latin America, and Middle East & Africa. North America dominated the digital pregnancy test kits market in 2017, and was closely followed by Europe, in terms of revenue. Rise in adoption of new and advanced test kits owing to higher awareness among people regarding pregnancy test kits and adequate reimbursement policies for digital pregnancy test kits in the U.S., Canada, and European countries are some of the major factors contributing toward the prominent share of these regions in the global market. Asia Pacific is projected to register a comparatively higher CAGR from 2018 to 2026, owing to higher pregnancy rate in emerging countries, such as China, India, and other Southeast Asian countries and rising adoption of digital pregnancy test kits in these countries.

Key players operating in the global digital pregnancy test kits market include SPD Swiss Precision Diagnostics GmbH, Church & Dwight Co., Inc., Gregory Pharmaceutical Holdings, Inc., and Sugentech, Inc.

The report offers a comprehensive evaluation of the market. It does so via in-depth qualitative insights, historical data, and verifiable projections about market size. The projections featured in the report have been derived using proven research methodologies and assumptions. By doing so, the research report serves as a repository of analysis and information for every facet of the market, including but not limited to: Regional markets, technology, types, and applications.

The study is a source of reliable data on: Market segments and sub-segments Market trends and dynamics Supply and demand Market size Current trends/opportunities/challenges Competitive landscape Technological breakthroughs Value chain and stakeholder analysis

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The regional analysis covers: North America (U.S. and Canada) Latin America (Mexico, Brazil, Peru, Chile, and others) Western Europe (Germany, U.K., France, Spain, Italy, Nordic countries, Belgium, Netherlands, and Luxembourg) Eastern Europe (Poland and Russia) Asia Pacific (China, India, Japan, ASEAN, Australia, and New Zealand) Middle East and Africa (GCC, Southern Africa, and North Africa)

The report has been compiled through extensive primary research (through interviews, surveys, and observations of seasoned analysts) and secondary research (which entails reputable paid sources, trade journals, and industry body databases). The report also features a complete qualitative and quantitative assessment by analyzing data gathered from industry analysts and market participants across key points in the industrys value chain.

A separate analysis of prevailing trends in the parent market, macro- and micro-economic indicators, and regulations and mandates is included under the purview of the study. By doing so, the report projects the attractiveness of each major segment over the forecast period.

Highlights of the report: A complete backdrop analysis, which includes an assessment of the parent market Important changes in market dynamics Market segmentation up to the second or third level Historical, current, and projected size of the market from the standpoint of both value and volume Reporting and evaluation of recent industry developments Market shares and strategies of key players Emerging niche segments and regional markets An objective assessment of the trajectory of the market Recommendations to companies for strengthening their foothold in the market

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Cushings Disease Treatment Market Size & Share Expanding Across The Globe By 2025 – Rapid News Network

Cushing disease is caused by tumour in the pituitary gland which leads to excessive secretion of a hormone called adrenocorticotrophic (ACTH), which in turn leads to increasing levels of cortisol in the body. Cortisol is a steroid hormone released by the adrenal glands and helps the body to deal with injury or infection. Increasing levels of cortisol increases the blood sugar and can even cause diabetes mellitus. However the disease is also caused due to excess production of hypothalamus corticotropin releasing hormone (CRH) which stimulates the synthesis of cortisol by the adrenal glands. The condition is named after Harvey Cushing, the doctor who first identified the disease in 1912. Cushing disease results in Cushing syndrome. Cushing syndrome is a group of signs and symptoms developed due to prolonged exposure to cortisol. Signs and symptoms of Cushing syndrome includes hypertension, abdominal obesity, muscle weakness, headache, fragile skin, acne, thin arms and legs, red stretch marks on stomach, fluid retention or swelling, excess body and facial hair, weight gain, acne, buffalo hump, tiredness, fatigue, brittle bones, low back pain, moon shaped face etc. Symptoms vary from individual to individual depending upon the disease duration, age and gender of the patient. Disease diagnosis is done by measuring levels of cortisol in patients urine, saliva or blood. For confirming the diagnosis, a blood test for ACTH is performed. The first-line treatment of the disease is through surgical resection of ACTH-secreting pituitary adenoma, however disease management is also done through medications, Cushing disease treatment market comprises of the drugs designed for lowering the level of cortisol in the body. Thus patients suffering from Cushing disease are prescribed medications such as ketoconazole, mitotane, aminoglutethimide metyrapone, mifepristone, etomidate and pasireotide.

Cushings disease treatment market revenue is growing with a stable growth rate, this is attributed to increasing number of pipeline drugs. Also increasing interest of pharmaceutical companies to develop Cushing disease drugs is a major factor contributing to the revenue growth of Cushing disease treatment market over the forecast period. Current and emerging players focuses on physician education and awareness regarding availability of different drugs for curing Cushing disease, thus increasing the referral speeds, time to diagnosis and volume of diagnosed Cushing disease individuals. Growing healthcare expenditure and increasing awareness regarding Cushing syndrome aids in the revenue growth of Cushings disease treatment market. Increasing number of new product launches also drives the market for Cushings disease Treatment devices. However availability of alternative therapies for curing Cushing syndrome is expected to hamper the growth of the Cushings disease treatment market over the forecast period.

The Cushings disease Treatment market is segment based on the product type, technology type and end user

Cushings disease Treatment market is segmented into following types:

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By Drug Type Ketoconazole Mitotane Aminoglutethimide Metyrapone Mifepristone Etomidate Pasireotide

By End User Hospital Pharmacies Retail Pharmacies Drug Stores Clinics e-Commerce/Online Pharmacies

Cushings disease treatment market revenue is expected to grow at a good growth rate, over the forecast period. The market is anticipated to perform well in the near future due to increasing awareness regarding the condition. Also the market is anticipated to grow with a fastest CAGR over the forecast period, attributed to increasing investment in R&D and increasing number of new product launches which is estimated to drive the revenue growth of Cushings disease treatment market over the forecast period.

Depending on geographic region, the Cushings disease treatment market is segmented into five key regions: North America, Latin America, Europe, Asia Pacific (APAC) and Middle East & Africa (MEA).

North America is occupying the largest regional market share in the global Cushings disease treatment market owing to the presence of more number of market players, high awareness levels regarding Cushing syndrome. Healthcare expenditure and relatively larger number of R&D exercises pertaining to drug manufacturing and marketing activities in the region. Also Europe is expected to perform well in the near future due to increasing prevalence of the condition in the region.

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Asia Pacific is expected to grow at the fastest CAGR because of increase in the number of people showing the symptoms of Cushing syndrome, thus boosting the market growth of Cushings disease treatment market throughout the forecast period.

Some players of Cushings disease Treatment market includes CORCEPT THERAPEUTICS, HRA Pharma, Strongbridge Biopharma plc, Novartis AG, etc. However there are numerous companies producing branded generics for Cushing disease. The companies in Cushings disease treatment market are increasingly engaged in strategic partnerships, collaborations and promotional activities to capture a greater pie of market share.

The research report presents a comprehensive assessment of the market and contains thoughtful insights, facts, historical data, and statistically supported and industry-validated market data. It also contains projections using a suitable set of assumptions and methodologies. The research report provides analysis and information according to categories such as market segments, geographies, types, technology and applications.

The report covers exhaustive analysis on: Market Segments Market Dynamics Market Size Supply & Demand Current Trends/Issues/Challenges Competition & Companies involved Technology Value Chain

Regional analysis includes North America (U.S., Canada) Latin America (Argentina, Mexico, Brazil, Rest of Latin America) Europe (Germany, Italy, France, U.K., Spain, Russia, Rest of Europe) Asia Pacific (China, India, Japan, Rest of APAC) Middle East and Africa (Rest of MEA, S. Africa)

The report is a compilation of first-hand information, qualitative and quantitative assessment by industry analysts, inputs from industry experts and industry participants across the value chain. The report provides in-depth analysis of parent market trends, macro-economic indicators and governing factors along with market attractiveness as per segments. The report also maps the qualitative impact of various market factors on market segments and geographies.

Report Highlights: Detailed overview of parent market Changing market dynamics in the industry In-depth market segmentation Historical, current and projected market size in terms of volume and value Recent industry trends and developments Competitive landscape Strategies of key players and products offered Potential and niche segments, geographical regions exhibiting promising growth A neutral perspective on market performance Must-have information for market players to sustain and enhance their market footprint.

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Cushings Disease Treatment Market Size & Share Expanding Across The Globe By 2025 - Rapid News Network