Archive for the ‘Hormone Physician’ Category

There's more than 100 different types of cancers and pancreatic canceris considered one of the deadliest because there's oftentimes no early warning signs. It's not diagnosed until a later stage, which makes treatment challenging. Dr. Tomi Mitchell, a Board-Certified Family Physician with Holistic Wellness Strategies tells us, "Pancreatic cancer is one of the most aggressive and difficult-to-treat forms of cancer. Unfortunately, it is also one of the most common types of cancer, with over 60, 000 new cases diagnosed each year in the United States alone. While many risk factors for pancreatic cancer, some lifestyle choices can increase the likelihood of developing the disease. Here are five lifestyle choices that have been linked to an increased risk of pancreatic cancer." Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Mitchell says, "Pancreatic cancer is a type of cancer that starts in the pancreas. The pancreas is a gland located in the abdomen, behind the stomach. The pancreas has two main functions: to produce enzymes that help digest food and hormones, such as insulin, that regulate blood sugar levels. Pancreatic cancer usually starts in the cells lining the pancreas' ducts. These cells are called exocrine cells. Less often, pancreatic cancer begins in the hormone-producing cells of the pancreas, called islet cells. When pancreatic cancer begins in the exocrine cells, it is called exocrine pancreatic cancer. When it starts in the islet cells, it is called an islet cell tumor or neuroendocrine tumor. Most pancreatic cancers are exocrine tumors."6254a4d1642c605c54bf1cab17d50f1e

Dr. Mitchell states, "Pancreatic cancer is a very aggressive form of cancer and is difficult to treat. It seldom causes symptoms in its early stages, so it is often not discovered until it has spread to other body parts. By the time most people are diagnosed with pancreatic cancer, the disease has already spread beyond the pancreas and cannot be cured. However, treatment may help people live longer and improve their quality of life. Pancreatic cancer is one of the few cancers for which there is no widely available screening test, so it is essential to be aware of the signs and symptoms of the disease. If you have any concerns, please consult your doctor. Early diagnosis and treatment of pancreatic cancer can improve survival rates."

"According to the American Cancer Society, smokers are two to three times more likely than nonsmokers to develop pancreatic cancer," Dr. Mitchell shares. "Smoking is thought to be responsible for approximately 25% of all pancreatic cancers. The link between smoking and pancreatic cancer is thought to be due to the many harmful chemicals found in tobacco smoke. These chemicals damage DNA, leading to the development of cancerous cells. Smoking damages the pancreas, making it more difficult for this vital organ to function correctly. This can lead to chronic inflammation, which further increases the risk of pancreatic cancer. Quitting smoking is the best way to reduce the risk of developing this deadly disease."

Dr. Mitchell emphasizes, "Obesity is a major risk factor for pancreatic cancer. Obese people are nearly twice as likely to develop pancreatic cancer as those of average weight. There are several ways in which obesity increases the risk of pancreatic cancer. First, excess fat tissue produces hormones that can promote the growth of cancer cells. Second, obesity increases inflammation throughout the body, which is known to play a role in cancer development. Finally, obesity makes it more difficult for the body to process sugar, leading to insulin resistance and an increased risk of pancreatic cancer. By maintaining a healthy weight, you can help reduce your risk of this deadly disease."

"There is a strong link between diabetes and pancreatic cancer," Dr. Mitchell explains. "People with diabetes have a two- to three-fold higher risk of developing pancreatic cancer than those without diabetes. The link between diabetes and pancreatic cancer is likely due to the high levels of blood sugar associated with diabetes. High blood sugar levels can damage cells and lead to inflammation, both of which can increase the risk of cancer. Pancreatic cancer is also more common in people with type 2 diabetes, the most common form of the disease. This may be because type 2 diabetes is often associated with obesity, another risk factor for pancreatic cancer. If you have diabetes, it's important to control your blood sugar levels and maintain a healthy weight to lower your risk of pancreatic cancer."

Dr. Mitchell says, "A healthy diet is essential for many reasons, including reducing your risk of developing pancreatic cancer. Pancreatic cancer is more common in people who are overweight or obese, and those who consume a diet high in sugar and fat are also at an increased risk. While the exact cause of pancreatic cancer is unknown, it is thought that excess insulin production may play a role. Insulin is a hormone that helps to regulate blood sugar levels, and when blood sugar levels are constantly high, it can damage cells and lead to cancer. A diet high in sugar and fat raises blood sugar levels, increasing pancreatic cancer risk. Additionally, eating a lot of red and processed meats has also been linked to an increased risk of pancreatic cancer. So, if you want to reduce your risk of this disease, it's essential to maintain a healthy weight and eat a balanced diet low in sugar, fat, and red meat."

"A sedentary lifestyle has been linked to an increased risk of pancreatic cancer," Dr. Mitchell tells us. This is likely because a sedentary lifestyle leads to obesity, a known risk factor for pancreatic cancer. In addition, a sedentary lifestyle can lead to inflammation, which is also a risk factor for pancreatic cancer. Finally, a sedentary lifestyle can lead to insulin resistance, another known risk factor for pancreatic cancer. While other factors can contribute to the development of pancreatic cancer, a sedentary lifestyle is considered one of the most important. Therefore, it is essential to stay active and avoid sitting for long periods in order to reduce your risk of pancreatic cancer."

Dr. Mitchell says this "doesn't constitute medical advice and by no means are these answers meant to be comprehensive. Rather, it's to encourage discussions about health choices."

Heather Newgen

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Habits Increasing Your Pancreatic Cancer Risk, Say Medical Experts Eat This Not That - Eat This, Not That

Sophie Jackson, 26, might not be here today if she had listened to her doctor. She noticed a large lump on her right breast, so she decided to have it checked out by her general physician. But the provider told her it was likely due to her menstrual cycle and that they would have to wait another four weeks to see if anything had changed before they could do anything.

But the lump turned out to be anything but ordinary. She was diagnosed with invasive ductal carcinoma, an aggressive form of cancer, a short while later.

I cried my eyes out and first asked if I was going to die and second if I was going to lose all my hair, Jackson said. Other than the lump I had no other symptoms whatsoever. It felt completely random, and the diagnosis was such a shock.

Jackson is no stranger to cancer. She works as an oncology nurse as part of the U.K.s National Health Service (NHS). Given her experience with the issue, she decided to get a second opinion and pushed for a referral to a breast cancer clinic.

She said she was disappointed by her GPs initial reaction.

I felt let down. The doctors initially thought it was nothing purely based on age, she explained. I feel frustrated on the guidance out there with the stereotypical lumps to look for such as being hard or non-moveable as mine met all the criteria to be what they classed as nothing.

She sought the advice of a specialist, who diagnosed her with breast cancer after running a few tests. They caught it late, and Jackson knew she was in for a long, arduous road to recovery. Since being diagnosed in November, she has been through ten rounds of radiotherapy and underwent surgery to remove the tumor.

Jackson is now cancer-free thanks to her quick thinking. She recently returned to work at University Hospitals Dorset and said the experience has left her with a better understanding of what her cancer patients are going through.

Unfortunately, doctors told her that the tumor is likely to return within the next two years considering the aggressive nature of her disease.

While she is happy to be back at work, Jackson is also mourning the chance to be a mother because she went through medically induced menopause during treatment. She now takes regular injections to reduce the amount of estrogen in her body. High levels of the female sex hormone can increase the risk of breast cancer tumors growing.

Jackson is now on a mission to spread the word about her experience. She encourages women of all ages to get checked for breast cancer and to seek a referral if they need a second opinion.

If Id left it four weeks like the GP suggested, it may have spread in that time and Id have been looking at an incurable diagnosis.

Breast cancer is the second most prevalent cancer in the U.S., with 288,000 diagnoses a year. It accounts for 30% of all female cancers in the country.

Jackson also admitted that she was frustrated throughout the experience because she already knew how the process works.

When I was diagnosed it was extremely overwhelming usually you drip feed patient information as it is way too much to take on at once. I didnt have that luxury and instead was instantly aware of facing surgery, chemo, losing my hair and becoming infertile at such a young age. I think my job did help in a way as I didnt have the expected anxieties about chemo, she added.

I knew what would happen, I knew the drugs, and I knew and trusted the people giving it to me which saved a lot of worrying. It felt really strange receiving chemotherapy drugs Id given to other patients before, like an out of body experience. I was also in disbelief seeing my name on the chemo bag and having my details checked when it was usually me on the other side.

She also learned more about what it was like for her patients to lose their hair. Jackson eventually lost all the hair on her head and started wearing scarves instead.

Coming back to work has forced Jackson to face her fears of her cancer coming back, but she is doing her part to help others advocate for proper medical care.

Id just love to spread awareness that cancer can affect you at a young age even with no family history, no genetics, no risk factors other than taking the contraceptive pill, she said. Early detection has saved my life so its so important to check monthly and push to get things checked out. You are never wasting anyones time.

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Oncology Nurse Diagnosed with Cancer After Her Physician Dismissed Her Lump as Probably Nothing - Scrubs Magazine

Putting on weight is one of the easiest things to do, especially during the last couple of years when our lives were completely disrupted. The 'Quarantine 15' is real and John Morton, MD, MPH, MHA, medical director of bariatric surgery at Yale New Haven Health System says, "We are definitely seeing weight gain," Dr. Morton says. "You can put on 30 pounds really quicklyyou can do it in three months." That said, it's time to get back into shape and drop the excess weight. Eat This, Not That! Health spoke with Dr. Hector Perez, a board-certified general and bariatric surgeon with Bariatric Journal who shares how much belly fat is too much for men and how to lose it. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Perez explains, "A common way people use to judge if they have too much abdominal fat is to measure their waistline with a tape measure. Men are considered to have too much abdominal fat if they have a waist measurement of more than 40 inches, while women are considered to have too much abdominal fat if they have a waist measurement of more than 35 inches. Having these measurements is generally considered unhealthy and puts you at greater risk for various health conditions.

To get more accurate results, however, you can get a CT, MRI, or DEXA scan to measure your abdominal fat. These are generally considered more accurate methods, but they're also more expensive and not as readily available. Doctors will usually only recommend these tests if they suspect you have a serious health condition related to your abdominal fat."

Dr. Perez tells us, "Carrying too much abdominal fat is generally considered unhealthy because it's associated with a greater risk of developing various health conditions. These include heart disease, stroke, type 2 diabetes, and certain types of cancer. Abdominal fat also produces hormones and substances that can contribute to inflammation, which has been linked to a variety of health problems."

Dr. Perez reminds us, "Fixing your diet is one of the most effective ways to lose abdominal fat. Eating a diet that's high in whole foods, including plenty of fruits, vegetables, and lean protein, and low in processed foods can help you shed pounds all over, including from your belly. Make sure to also limit refined carbs, sugary drinks, and excessive alcohol intake, as these can all contribute to excess abdominal fat.

"A healthy diet alone isn't enough to lose abdominal fat," Dr. Perez emphasizes. "You'll also need to incorporate regular exercise into your routine. Aim for at least 30 minutes of moderate-intensity cardio per day, and include strength training a few days per week as well. These activities help burn calories and can lead to overall weight loss, which will reduce the amount of fat stored in your abdomen."

According to Dr. Perez, "One of the most important but often overlooked aspects of losing abdominal fat is getting enough sleep. Most adults need around 7-8 hours of sleep per night, but many people get far less than that. When you're tired or have low energy levels, you're more likely to make poor food choices and be less active, both of which can contribute to weight gain. So make sure you're getting enough shut-eye each night to help support your weight loss efforts."6254a4d1642c605c54bf1cab17d50f1e

Dr. Perez says, "Experiencing high levels of stress can also lead to weight gain. When you're stressed, your body releases cortisol, a stress hormone that can trigger your appetite. This is why people often turn to food for comfort when they're feeling stressed. Find ways to manage your stress levels through relaxation techniques like yoga or meditation, and make an effort to reduce the amount of stress in your life."

Heather Newgen

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Are You a Man With "Too Much" Abdominal Fat? Here's How to Lose it Eat This Not That - Eat This, Not That

-- Progression-Free Survival Efficacy of Trodelvy Consistent with That Observed in the TROPiCS-02 Intention-to-Treat Population --

-- Results Presented at ESMO 2022 Highlight Trodelvy as a Potential Treatment Option in HR+/HER2-Low and IHC0 Status Metastatic Breast Cancer --

FOSTER CITY, Calif.--(BUSINESS WIRE)--Gilead Sciences, Inc. (Nasdaq: GILD) today announced new data from a post hoc subgroup analysis from the Phase 3 TROPiCS-02 study evaluating Trodelvy (sacituzumab govitecan-hziy) versus comparator chemotherapies (physicians choice of chemotherapy, TPC) in patients with HR+/HER2- metastatic breast cancer who progressed on endocrine-based therapies and at least two chemotherapies. The analysis examined progression-free survival (PFS) in the intention-to-treat population by HER2-immunohistochemistry (IHC) status, and the results demonstrated that Trodelvy improved median PFS vs. TPC in both HER2-low (IHC1+ and IHC2+/ISH-negative) and IHC0 groups.

Summary of results:

HER2-low

IHC0

ITT

Trodelvy arm(n=149)

TPC arm(n=134)

Trodelvy arm(n=101)

TPC arm(n=116)

Trodelvy arm(n=272)

TPC arm(n=271)

Median PFS(months)

6.4

4.2

5.0

3.4

5.5

4.0

Hazard ratio(95% confidenceinterval)p-value

0.58(0.42-0.79)

0.72(0.51-1.00)

0.66(0.53 0.83)p=0.0003

Detailed findings will be presented at a mini-oral session (Abstract #1362) during the European Society for Medical Oncology (ESMO) Congress 2022 in the vry Auditorium, Paris Expo Porte de Versailles, on September 10.

These data demonstrate Trodelvys efficacy across HER2-low and IHC0 status in pre-treated metastatic breast cancer patients in the TROPiCS-02 trial, said Professor Peter Schmid, Professor of Cancer Medicine; Centre Lead, Centre of Experimental Cancer Medicine; Director, Barts Breast Cancer Centre. Once patients have developed resistance to endocrine-based therapies, their prognosis is extremely poor. The results highlight the potential for Trodelvy as a treatment option for people living with pre-treated HR+/HER2- metastatic breast cancer, regardless of their HER2-negative status.

These results show Trodelvy improved progression-free survival regardless of HER2 status in this pre-treated patient population and reinforce the strength of clinical activity in a population where need is highest, said Bill Grossman, MD, PhD, Senior Vice President, Therapeutic Area Head, Gilead Oncology. Trodelvy is already transforming the standard of care in second-line metastatic triple-negative breast cancer, and were excited about its potential in other breast cancers where there is significant need for new treatment options.

In the study, HER2 negativity was defined per American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) criteria as immunohistochemistry (IHC) score of 0, IHC 1+ or IHC 2+ with a negative in-situ hybridization (ISH) test.

Trodelvy has not been approved by any regulatory agency for the treatment of HR+/HER2- metastatic breast cancer. Its safety and efficacy have not been established for this indication. Gilead has submitted a supplemental Biologics License Application (sBLA) to the U.S. Food and Drug Administration (FDA) based on data from TROPiCS-02; these data will also be shared with health authorities outside the U.S.

Sacituzumab govitecan is currently included in the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines)i. This includes a Category 1 recommendation for use in adult patients with second-line metastatic triple-negative breast cancer (defined as those who received at least two prior therapies, with at least one line for metastatic disease). It also has a Category 2A preferred recommendation for investigational use in HR+/HER2- advanced breast cancer after prior treatment including endocrine therapy, a CDK4/6 inhibitor and at least two lines of chemotherapy.

Trodelvy has a Boxed Warning for severe or life-threatening neutropenia and severe diarrhea; please see below for additional Important Safety Information.

About HR+/HER2- Breast Cancer

Hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer is the most common type of breast cancer and accounts for approximately 70% of all new cases, or nearly 400,000 diagnoses worldwide each year. Almost one in three cases of early-stage breast cancer eventually become metastatic, and among patients with HR+/HER2- metastatic disease, the five-year relative survival rate is 30%. As patients with HR+/HER2- metastatic breast cancer become resistant to endocrine-based therapy, their primary treatment option is limited to single-agent chemotherapy. In this setting, it is common to receive multiple lines of chemotherapy regimens over the course of treatment, and the prognosis remains poor.

About the TROPiCS-02 Study

The TROPiCS-02 study is a global, multicenter, open-label, Phase 3 study, randomized 1:1 to evaluate Trodelvy versus physicians choice of chemotherapy (eribulin, capecitabine, gemcitabine, or vinorelbine) in 543 patients with HR+/HER2- metastatic breast cancer who were previously treated with endocrine therapy, CDK4/6 inhibitors and two to four lines of chemotherapy for metastatic disease. The primary endpoint is progression-free survival per Response Evaluation Criteria in Solid Tumors (RECIST 1.1) as assessed by blinded independent central review (BICR) for participants treated with Trodelvy compared to those treated with chemotherapy. Secondary endpoints include overall survival, overall response rate, clinical benefit rate and duration of response, as well as assessment of safety and tolerability and quality of life measures. More information about TROPiCS-02 is available at https://clinicaltrials.gov/ct2/show/NCT03901339.

About Trodelvy

Trodelvy (sacituzumab govitecan-hziy) is a first-in-class Trop-2 directed antibody-drug conjugate. Trop-2 is a cell surface antigen highly expressed in multiple tumor types, including in more than 90% of breast and bladder cancers. Trodelvy is intentionally designed with a proprietary hydrolyzable linker attached to SN-38, a topoisomerase I inhibitor payload. This unique combination delivers potent activity to both Trop-2 expressing cells and the microenvironment.

Trodelvy is approved in more than 35 countries, with multiple additional regulatory reviews underway worldwide, for the treatment of adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (TNBC) who have received two or more prior systemic therapies, at least one of them for metastatic disease. Trodelvy is also approved in the U.S. under the accelerated approval pathway for the treatment of adult patients with locally advanced or metastatic urothelial cancer (UC) who have previously received a platinum-containing chemotherapy and either programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor.

Trodelvy is also being developed for potential investigational use in other TNBC and metastatic UC populations, as well as a range of tumor types where Trop-2 is highly expressed, including hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer, metastatic non-small cell lung cancer (NSCLC), metastatic small cell lung cancer (SCLC), head and neck cancer, and endometrial cancer.

U.S. Indications for Trodelvy

In the United States, Trodelvy is indicated for the treatment of:

U.S. Important Safety Information for Trodelvy

BOXED WARNING: NEUTROPENIA AND DIARRHEA

CONTRAINDICATIONS

WARNINGS AND PRECAUTIONS

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

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

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

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

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

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

ADVERSE REACTIONS

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

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

DRUG INTERACTIONS

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

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

Please see full Prescribing Information , including BOXED WARNING.

About Gilead Sciences

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

Forward-Looking Statements

This press release includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 that are subject to risks, uncertainties and other factors, including Gileads ability to initiate, progress or complete clinical trials within currently anticipated timelines or at all, and the possibility of unfavorable results from ongoing or additional clinical trials, including those involving Trodelvy; uncertainties relating to regulatory applications for Trodelvy and related filing and approval timelines, including with respect to the pending sBLA for Trodelvy, and pending or potential applications for the treatment of metastatic TNBC, mUC, HR+/HER2- breast cancer, NSCLC, SCLC, head and neck cancer, and endometrial cancer, in the currently anticipated timelines or at all; Gileads ability to receive regulatory approvals for such indications in a timely manner or at all, and the risk that any such approvals may be subject to significant limitations on use; the possibility that Gilead may make a strategic decision to discontinue development of Trodelvy for such indications and as a result, Trodelvy may never be commercialized for these indications; and any assumptions underlying any of the foregoing. These and other risks, uncertainties and other factors are described in detail in Gileads Quarterly Report on Form 10-Q for the quarter ended June 30, 2022, as filed with the U.S. Securities and Exchange Commission. These risks, uncertainties and other factors could cause actual results to differ materially from those referred to in the forward-looking statements. All statements other than statements of historical fact are statements that could be deemed forward-looking statements. The reader is cautioned that any such forward-looking statements are not guarantees of future performance and involve risks and uncertainties, and is cautioned not to place undue reliance on these forward-looking statements. All forward-looking statements are based on information currently available to Gilead, and Gilead assumes no obligation and disclaims any intent to update any such forward-looking statements.

U.S. Prescribing Information for Trodelvy including BOXED WARNING, is available at http://www.gilead.com.

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

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

i Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer Version 4.2022. National Comprehensive Cancer Network, Inc. 2022. All rights reserved. Accessed August 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

View source version on businesswire.com: https://www.businesswire.com/news/home/20220902005309/en/

Jacquie Ross, Investorsinvestor_relations@gilead.com

Nathan Kaiser, MediaNathan.kaiser@gilead.com

Source: Gilead Sciences, Inc.

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New TROPiCS-02 Data in HR+/HER2- Metastatic Breast Cancer Patients Demonstrates Progression-Free Survival Benefit of Trodelvy Regardless of Their HER2...

Newswise A new paper inFamily Practice,published by Oxford University Press, indicates that overweight patients are more inclined to disagree with their healthcare providers on advice on weight loss and lifestyle.

The World Health Organization estimates obesity nearly tripled between 1975 and 2016. General practitioners have a key role in medical care targeting weight loss and obesity. The quality of information, mutual comprehension, and agreement between doctors and patients affect a patients health status, compliance, satisfaction, and confidence towards his or her doctor. Previous research has shown patients and doctors often have dissimilar attitudes about weight. Patients tend to attribute excess weight to factors that they cannot control (e.g. genetics, hormones), whereas physicians tend to attribute it to behavioral, and thus controllable, factors (e.g. nutrition, physical activity). While many factors contribute to patients weight and health, these differences in perception of weight could degrade doctor-patient interaction.

This study aimed to analyze whether the interaction between patients and their doctors, as measured by their disagreement on information and advice given during the consultation, varied according to the patients body mass index.

Twenty-seven general practitioners and 585 patients from three regions in France participated in the quantitative phase of the project in September and October of 2007 and answered questionnaires collecting both general practitioners and patients perceptions of information and advice given at the end of the consultation.

Researchers here explored differences concerning the patients and doctors declarations about actions, information, and advice during the same visit, the patients health status, and the perceived quality of their relationship. For example, the questions about weight loss were: Did your doctor advise you to lose weight during the consultation? (Answered by patients) and its mirror Did you advise this patient to lose weight during the consultation? (Answered by doctors). Differences in answers given by doctors and their patients were used to define disagreement.

Agreement between patients and doctors was weak (20 to 40 percent agreement) or moderate (40 to 60 percent agreement) for most of the questions, including questions about actions, information, advice, and patients health status discussed during the doctors appointment. Agreement was very weak (less than 20 percent agreement) for questions about the perceived quality of the patient-doctor relationship.

Researchers also found that there was more doctor-patient disagreement the more overweight the patient was. Disagreement was particularly pronounced for advice given by doctors on weight and lifestyle issues. Compared to patients with a normal BMI, overweight patients were more likely to disagree with their doctors regarding advice given on weight loss, advice given on doing more physical activity, and advice about nutrition.

An exploration of the patient's representations and difficulties related to weight could be offered by the general practitioners as a basis for discussion and appropriate support, said the studys lead author, Latitia Gimenez.

The paper, Interaction between patient and general practitioner according to the patient body weight: a cross-sectional survey, is available at:https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cmac086.

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Overweight patients more likely to disagree with their doctors - Newswise

Blood sugar is a vital part of our overall well-being and when there's an imbalance your health is at risk for serious complications like heart disease, kidney disease and stroke. "Simply put, it's your body's main source of energy. You can't survive without it," Dr. Bayo Curry-Winchell, Urgent Care Medical Director and Physician, Carbon Health and Saint Mary's Hospital tells us. The symptoms of high blood sugar can range from subtle to signs you can't ignore and Dr. Curry-Winchell explains what to look out for and why. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

According to the Cleveland Clinic, "Hyperglycemia, or high blood glucose, occurs when there is too much sugar in the blood. This happens when your body has too little insulin (the hormone that transports glucose into the blood), or if your body can't use insulin properly. The condition is most often linked with diabetes."

Dr. Curry-Winchell explains, "A blood sugar level (glucose) greater than 180, one to two hours after eating is considered too high. A number from 100 to 125 is considered too high if you haven't eaten for at least 8 hours."

According to Dr. Curry-Winchell, "Too much sugar in the bloodstream for an extended amount of time will damage your blood vessels responsible for delivering blood to organs such as your heart and kidney."

Dr. Curry-Winchell tells us, "Not everyone will notice signs of high blood sugar. Some of the symptoms can be subtle such as fatigue or an increase in thirst can develop slowly."

"Extra sugar (glucose) does not mean more energy," Dr. Curry-Winchell emphasizes. "The body is not able to use the excess sugar to fuel what your body needs for extra activity."

"The kidneys are unable to filter excess sugar in your blood and respond by attempting to remove it which increases the amount of time/frequency you urinate and puts you at risk for dehydration," says Dr. Curry-Winchell.

Dr. Curry-Winchell explains, "If you are losing weight (involuntarily), although your appetite has increased or stayed the same. This happens because there isn't enough insulin to respond to excess glucose in the body. To supply your body with energy, the body uses stored fat and muscle."

Dr. Curry-Winchell tells us, "Elevated glucose levels can increase the amount of blood vessels that form behind the eye (retina). The extra vessels are harmful and can lead to a risk of becoming blind."6254a4d1642c605c54bf1cab17d50f1e

"Nerve damage also referred to as neuropathy can occur which can signal numbness or tingling in your fingers, toes, hands, and feet," Dr. Curry-Winchell says.

Heather Newgen

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Warning Signs Your Blood Sugar is "Dangerously High" Eat This Not That - Eat This, Not That

Introduction

Over the last decade, social media has increasingly become a resource for patients seeking information about their health. Studies have shown that the majority of patients are now seeking medical information online,1,2 with patients preferring sites such as Facebook and Twitter.3 These sites have grown to serve as free, attractive, and easy to use apps, with up to 85% of patients using social media to search for health information.4 Physicians and others in the medical field have knowingly increased their presence on these platforms to better educate and disseminate factual medical information, understanding that social media may be the first place that patients turn to for advice and information.57

As with many other fields of medicine, social media research in ophthalmology has primarily focused on sites such as Facebook, Twitter, Instagram and LinkedIn.811 However, these are not the only social media sites that patients are turning to for medical advice. With over 52 million and growing daily active users, Reddit is a popular social media site that patients are frequently turning to for specific medical advice because of its discussion forum type format.12 Reddit has proven to be a source of valuable patient information in other medical fields, such as dermatology, psychiatry, and radiology.1315 Despite its growing popularity, Reddit has yet to be fully explored within the field of ophthalmology.

Reddit offers a unique patient perspective because unlike other social media sites, its users are largely anonymous. This allows for them to make candid posts and comments in the various, individual communities that Reddit hosts on its site, known as subreddits. Within these subreddits, users are given the opportunity to upvote or downvote posts and comments to increase the visibility of information that the community deems useful. The vast majority of ophthalmology information can be found in two main ophthalmology subreddits, r/EyeTriage and r/Ophthalmology. A previous cross-sectional study analyzed the content of posts made in the r/EyeTriage subreddit, giving some insight into the information that patients are seeking within this community.16

The goal for this study is to investigate the other ophthalmology subreddit, r/Ophthalmology, to determine what topics in ophthalmology are of greatest interest to Reddit users and whether ophthalmic care is being recommended to those seeking advice. This information will allow us to better understand the perspectives and discussion of the ophthalmology patient population on Reddit.

This cross-sectional study analyzed posts and comments on the Reddit subreddit r/Ophthalmology to understand eye-related patient concerns. r/Ophthalmology was created on June 29, 2011 with the goal of answering general questions about eye topics by the public.17 As stated by the moderator, u/arcadeflyer, specific patient questions should be redirected to a different subreddit r/EyeTriage.18 Additionally, every post on the subreddit includes an automatic comment by an automoderator that explicitly states that questions from patients about their personal health will be removed. Despite this, many posts on the subreddit continue to be patient questions, providing a wealth of data for analysis. The subreddit is frequented by a wide variety of ophthalmic professionals, including ophthalmologists, optometrists, and ophthalmic technicians. Every user that makes a post is required to identify their background within the text and every user on the subreddit has the opportunity to self-identify their profession, which appear next to their username when they make posts or comments. Posts on the subreddit include advice, links, questions, topics for discussion, personal stories, and educational resources.

The public and anonymous posts and comments on r/Ophthalmology were accessed using the Python Reddit API Wrapper. This allowed the Python software to access the data structures within the Reddit interface and extract the necessary data. There was no interaction with individuals to retrieve this data and this data can be accessed without a Reddit account. Given the public and anonymous nature of this data, Institutional Review Board approval was not needed.19 Posts and comments from March 18, 2018 to November 9, 2020 were analyzed and those that were deleted or removed on or prior to November 9, 2020 were not included in the analysis.

After the extraction of posts and comments, the data was pre-processed to prepare it for analysis (Figure 1). The automoderator comment was removed from each post and excluded from analysis. Following this, all text within post and comments was analyzed for unique references to ophthalmic conditions from the American Academy of Ophthalmologys (AAOs) Eye Health A-Z through a keyword search and the frequency of each reference was evaluated. To isolate posts and comments for references to different types of medical care, the data was parsed for posts and comments that included ophth, opth, opto, eye doctor, professional, physician, primary care, appointment, medicine, medication, insurance, prescribe, or prescription, similar to previous methodology analyzing medical Reddit data.13 The resulting posts and comments were then evaluated to determine if they mentioned or recommended either ophthalmic care or other medical care. Medical care is defined as medical intervention, treatment, or professional evaluation.

Figure 1 Data processing and analysis flowchart.

Posts were considered to be recommending any type of medical care if (1) it was mentioned only within the comments of a post and not within the title or body of the post itself and (2) at least 1 commenter encouraged the original poster or another commenter to seek care. Posts were considered to be mentioning any type of medical care if (1) it was mentioned within the comments of a post or (2) within the title and/or body of the post itself. Posts that were found to both recommend and mention care were categorized as recommending care. Comments were considered to be recommending any type of medical care if the commenter encouraged the original poster or another commenter of the same post to seek care. Comments were considered to be mentioning any type of care if it was mentioned within the comment. Again, the presence of both a recommendation and mention was categorized as a recommendation of care. Posts and comments that referenced both ophthalmic care and other forms of medical care were considered references to ophthalmic care. Post and comments that did none of the above were also noted. Ophthalmic care was defined as references specifically to ophthalmologists, optometrists, and eye doctors. Counts of posts and comments in these various categories were then analyzed.

Statistical analysis was done in Python using built-in statistical packages for frequency and count analysis (Python Software Foundation. Python Language Reference, version 2.7. Available at http://www.python.org).

A total of 919 posts with 5345 non-automoderator comments were posted between March 18, 2018 and November 9, 2020. While posts that ask patient-specific questions were said to have been removed by the automoderator, almost half (403/919) of the posts available on the subreddit were found to be referencing patient questions. Furthermore, two-thirds (612/919) of the posts involved conversation surrounding medical care either within the post, subsequent comments, or both. Of the 5345 comments analyzed, 1196 were found to reference any type of medical care.

Amongst the 919 posts analyzed from r/Ophthalmology, the majority either mention (49%) or recommend (9.5%) ophthalmic care (Figure 2, Table 1). 7.7% of the posts mention other medical care and a negligible amount (0.4%) go as far as to recommend other medical care. Amongst the 5345 comments, the vast majority (78%) made no reference to medical care (Figure 3, Table 1). Of the 1196 comments that referenced any type of care, 66% mentioned ophthalmic care and 11% recommended ophthalmic care (Figure 3). Other forms of medical care were mentioned in 22% of comments and recommended in 1% of comments.

Table 1 Number of References to Medical Care in Posts and Comments

Figure 2 References to medical care in posts.

Figure 3 References to medical care in comments.

Searching within posts for ophthalmic conditions found in the AAOs Eye Health A-Z list demonstrated 312 unique instances of these keywords. This analysis revealed that posters were most commonly discussing flashes and floaters (48/312). Glaucoma (24/312), retinal detachments (21/312), and headaches (21/312) were also commonly brought up by posters. Almost half (61/125) of the ophthalmic conditions within the Eye Health A-Z list were absent from post discussions in this subreddit. A chart of commonly discussed ophthalmic conditions in posts of this subreddit can be found in Figure 4.

Figure 4 Top 20 ophthalmic conditions mentioned in posts.

Similar analysis within the comments of posts led to the discovery of 586 unique references to ophthalmic conditions. The most common condition within the comments, cataracts (71/586), differed from that discussed within posts. However, glaucoma (52/586) and flashes and floaters (45/586) were found to be common between the two analyses. A chart of commonly discussed ophthalmic conditions in comments of this subreddit can be found in Figure 5. The conditions discussed within the comments were also found to be slightly more diverse than those in the posts, with only 54 of the 125 conditions absent from conversation. Fifty-eight of the conditions were found to be discussed in both the posts and the comments.

Figure 5 Top 20 ophthalmic conditions mentioned in comments.

The r/Ophthalmology subreddit is a popular social media platform for patients to seek and share information about eye concerns. Analysis of the interactions show that close to two-thirds of posts discuss medical concerns despite these posts being strongly discouraged and deleted from the subreddit. The persistence of posts seeking medical advice on this platform suggests that there is a need for increased patient education on ophthalmic conditions. Patients were found to discuss a variety of topics within this group, with conversation in posts and comments largely being dominated by discussion surrounding retinal detachments, cataracts, and glaucoma. As these are common ophthalmic concerns of patients seen in-office, this study highlights topics that could benefit from increased patient education.

While it is clear that patients are looking for medical information within this subreddit, these results also demonstrate that 75% of comments did not mention or recommend users to seek any type of medical care. Of the comments that referenced care, only a minority went as far as to recommend some type of medical care. These findings highlight the discrepancy between the number of users seeking medical advice on this platform and how often they are told to see a professional for their concerns. This can partially be attributed to the growing amount of self-diagnosis that patients partake in, given the amount of health information accessible to them, and medical advice they receive from others on the internet. Patients may be hopeful to receive medically accurate information about their concerns online, however a previous study suggests that ophthalmologists make up a minority of the self-identified users that frequent the other ophthalmology subreddit, r/EyeTriage.16 This can result in a greater reliance on the advice of other Reddit users, increasing the risk of misinformation. In addition, many of the posts and comments mentioning ophthalmic care do so in the context of users wondering or unsure if they should seek this type of care. A study analyzing the r/EyeTriage subreddit also found that patients posting about ophthalmic concerns demonstrated anxiety and worry with patients most commonly seeking diagnoses, highlighting the potential vulnerable state that patients may be in when seeking ophthalmic care information online.16 This suggests that there is room for improvement in educating patients about circumstances in which they should seek ophthalmic care. Ophthalmologists can play a key role in improving patient education about a variety of sight-threatening conditions by understanding what ophthalmic information patients are seeking online as a result of this study. This type of education will improve patient outcomes and better educate those who may be giving advice to others online.

When considering what patients are discussing within posts, the increased frequency of flashes and floaters appearing in conversation suggests that patients are turning to this platform to ask others what they should do when experiencing these symptoms. While one of the most common reasons for acute onset flashes and floaters is a posterior vitreous detachment, patients should be aware that they need to be appropriately evaluated in order to rule out a possible retinal detachment.20,21 Patient education strategies aimed to decrease delayed presentation of certain ophthalmic concerns may be useful tactics for ophthalmologists to use in office. One particular acronym, FLASH, can help patients remember the following symptoms for vision-threatening eye emergencies: flashes and floaters, loss of vision, aching pain, second image, help.22 This education can also help address the other commonly brought up topics in posts, glaucoma and headaches. Patients experiencing acute angle closure glaucoma may often presents with headaches and blurry vision,23 both of which are encompassed by the acronym. This can help patients with these concerns know to seek immediate medical attention as opposed to turning to the advice of those on the internet. It is important to note that patients are not exclusively bringing up acute medical concerns in posts. Posts are also made by those seeking more information about chronic conditions they may have such as glaucoma, astigmatism, dry eye, and uveitis. These results can help guide further patient education both on social media and in the office.

Within comments, users of the r/Ophthalmology subreddit are found to be commonly discussing similar topics to those found in posts. This suggests that the comments may be frequently used for other users to give advice on topics brought up in posts. As there is no qualification necessary for a layperson to give medical advice online, it is important that eye professionals are acutely aware of the discussions taking place. The knowledge of the results of this study can help inform ophthalmologists and optometrists on what education they should focus on disseminating. The benefit of this is twofold: (1) Patients are inherently better educated about eye conditions and can more appropriately assess when to seek medical care and (2) if they are giving advice on the internet, they will be less likely to spread misinformation to others. Methods of patient education can be divided into social media resources and non-social media resources. Outside of social media, ophthalmologists can make use of the variety of patient education resources available through the AAO, including pamphlets, videos, and diagrams.24 Many ophthalmologists also have personalized patient education information sheets that can be included in after-visit summaries. These resources are additionally helpful from a patient perspective because they can include links to reputable resources that patients can rely on to further their own education on particular topics. These types of resources tend to be more static, whereas the wide spectrum of social media platforms can give ophthalmologists creative freedom to decide how to disseminate patient education, including text, photo, and video-based material. While engaging in social media can be time-intensive, it is important for physicians to recognize that up to 80% of their patient population is seeking information about their health online.25 Within the field of ophthalmology, social media has been gaining more momentum and the AAO provides guidelines that may help ophthalmologists use social media to market their practices.26 Extending use of social media to educate patients can help ophthalmologists reach those who may otherwise lack other resources to access health information while also helping to build their practice.25

Reddit as a social media platform for health information offers unique advantages and perspectives. Unlike other social media sites, Reddit allows for patients to easily create accounts that give them anonymity. This has been found to facilitate more supportive and instrumental conversation about medical conditions, especially in situations where stigma may be involved.27 The platform creates a space in which patients do not feel like they are broadcasting their concerns or revealing too much personal information to those that they know, as they would on sites such as Twitter and Facebook.2830 The r/Ophthalmology subreddit may possibly attract more ophthalmologist subscribers than that of r/EyeTriage given that the subreddit more adamantly discourages patient-specific questions. Physicians are well aware of the professional consequences of giving specific medical information on the internet.31 The anonymity provided by Reddit and the rules of the r/Ophthalmology subreddit gives ophthalmologists the freedom to interact within the group without feeling obligated to respond to patient questions, making it more likely that they have a greater presence there than in r/EyeTriage. This makes the subreddit an accessible platform for ophthalmologists to disseminate education materials for patients while getting input from other users of various backgrounds, already found to be effective in other fields of medicine.32,33 This type of engagement with patients and others can help increase overall ophthalmic knowledge in the general population.

This study is not free of limitations, both with Reddit itself as a data source and the study methodology. As this study relies on data directly from the r/Ophthalmology subreddit, it is important to consider that this forum is also frequented by others with an interest in ophthalmology, such as medical students, residents, and other eye professionals. With 56% percent of available posts discussing topics outside of medical advice, conversations would be expected to fall outside of mentioning or recommending any type of medical care, serving as a confounder when attempting to determine whether patients are appropriately being recommended to seek care. Additionally, the subreddit rules make it likely that more posts were made discussing patient-specific questions but were deleted prior to data extraction from the site. Further research into the posts and comments in this subreddit since the time of data extraction may prove valuable in better understanding the conversations about ophthalmology on this social media platform. In evaluating the conditions that patients are discussing on r/Ophthalmology, it is possible that conditions outside of those included in the AAOs Eye Health A-Z list were discussed and not captured in these results. A more exhaustive list of ophthalmic symptoms and diseases may yield greater information about topics of conversation. The pre-processing methodology used to identify posts and comments with references to medical care has been previously described, but may have unintentionally excluded a small number of conversations related to patient questions. Future studies analyzing Reddit data may benefit from a more robust natural language processing approach to thoroughly process this complex data source.

In summary, Reddit data, specifically the r/Ophthalmology subreddit, offers unique insight into the conversations that patients are having about their eye health on social media. Patients were found to ask specific questions about their health on the platform, leading to increased self-diagnosis and spread of medical advice from other Reddit users. Within these patient-specific conversations, ophthalmic care was often mentioned, but there is room for increased patient education in this space to better inform patients about both acute and chronic ophthalmic conditions. Ophthalmologists, and others in the vision community, can use the results of this study to tailor patient education towards commonly discussed ophthalmic conditions found in the r/Ophthalmology subreddit. This approach can help improve patient safety while decreasing the spread of misinformation.

There is no funding to report. The abstract of this paper was presented at the Association for Research in Vision and Ophthalmology 2021 as a poster presentation with interim findings. The posters abstract was published in Abstract Issue 2021 in Investigative Ophthalmology & Visual Science: https://iovs.arvojournals.org/article.aspx?articleid=2773677.

The authors report no conflicts of interest in this work.

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2. Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of health information: the impact of the internet and its implications for health care providers: findings from the first health information national trends survey. Arch Intern Med. 2005;165(22):26182624. doi:10.1001/archinte.165.22.2618

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4. Marar SD, Al-Madaney MM, Almousawi FH. Health information on social media. Saudi Med J. 2019;40(12):12941298. doi:10.15537/smj.2019.12.24682

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8. Micieli JA, Tsui E. Ophthalmology on social networking sites: an observational study of Facebook, Twitter, and LinkedIn. Clin Ophthalmol. 2015;9:285290. doi:10.2147/OPTH.S79032

9. Clarke C, Smith E, Khan M, Al-Mohtaseb Z. Social media and ophthalmology: perspectives of patients and ophthalmologists. J Med Syst. 2018;42(12):258. doi:10.1007/s10916-018-1079-2

10. Micieli R, Micieli JA. Twitter as a tool for ophthalmologists. Can J Ophthalmol. 2012;47(5):410413. doi:10.1016/j.jcjo.2012.05.005

11. McGregor F, Somner JEA, Bourne RR, Munn-Giddings C, Shah P, Cross V. Social media use by patients with glaucoma: what can we learn? Ophthalmic Physiol Opt. 2014;34(1):4652. doi:10.1111/opo.12093

12. Patel S. Reddit claims 52 million daily users, revealing a key figure for social-media platforms. Wall Street Journal; December 1, 2020. Available from: https://www.wsj.com/articles/reddit-claims-52-million-daily-users-revealing-a-key-figure-for-social-media-platforms-11606822200. Accessed April 4, 2021.

13. Parks R, Newsom EC, Park JH, Lawrence N. Skincare addiction on reddit: dermatology enthusiasts talk skin. Dermatol Surg. 2020;46(10):13721374. doi:10.1097/DSS.0000000000002060

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15. Munawar K, Prabhu V. Radiology on Reddit: a content analysis and opportunity for radiologist engagement and education. Curr Probl Diagn Radiol. 2021;50(3):362368. doi:10.1067/j.cpradiol.2021.02.001

16. Mahjoub H, Prabhu AV, Sikder S. What are ophthalmology patients asking online? An analysis of the eye triage subreddit. Clin Ophthalmol. 2020;14:35753582. doi:10.2147/OPTH.S279607

17. r/Ophthalmology. Reddit. Available from: https://www.reddit.com/r/Ophthalmology. Accessed March 28, 2021.

18. u/arcadeflyer. Sticky: new Subreddit, r/ eyetriage, for patient questions. r/Ophthalmology; January 27, 2019. Available from: http://www.reddit.com/r/Ophthalmology/comments/ak7i27/sticky_new_subreddit_reyetriage_for_patient/. Accessed March 28, 2021.

19. Guidance on research using social networking sites. Available from: https://research.cofc.edu/administration/documents/policies-documents/IRB_SNSguidance.pdf. Accessed July 8, 2022.

20. Hollands H, Johnson D, Brox AC, Almeida D, Simel DL, Sharma S. Acute-onset floaters and flashes: Is this patient at risk for retinal detachment? JAMA. 2009;302(20):22432249. doi:10.1001/jama.2009.1714

21. Sharma P, Sridhar J, Mehta S. Flashes and Floaters. Prim Care. 2015;42(3):425435. doi:10.1016/j.pop.2015.05.011

22. Jairath N, Commiskey P, Kaplan A, Paulus YM. FLASH: a novel tool to identify vision-threating eye emergencies. Int J Ophthalmic Res. 2020;6(1):336343.

23. Khazaeni B, Khazaeni L. Acute closed angle glaucoma. In: StatPearls. StatPearls Publishing; 2022. Available from:. http://www.ncbi.nlm.nih.gov/books/NBK430857/. Accessed March 13, 2022.

24. Patient education. Available from: https://store.aao.org/patient-education.html. Accessed August 7, 2022.

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26. Use social media to market your practice. American Academy of Ophthalmology; January 1, 2016. Available from: https://www.aao.org/eyenet/article/use-social-media-to-market-your-practice. Accessed August 7, 2022.

27. Choudhury MD, De S. Mental health discourse on reddit: self-disclosure, social support, and anonymity. In: Proceedings of the 8th International Conference on Weblogs and Social Media, ICWSM 2014. Michigan, USA; January 1, 2014:7180.

28. Choudhury M, Gamon M, Counts S, Horvitz E. Predicting depression via social media. 2013.

29. Paul MJ, Dredze M. You are what you tweet: analyzing Twitter for public health. In: Proceedings of the 5th International AAAI Conference on Weblogs and Social Media. Catalonia, Spain; 2011: 8.

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31. Farnan JM, Snyder Sulmasy L, Worster BK, Chaudhry HJ, Rhyne JA, Arora VM. Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the federation of state medical boards. Ann Intern Med. 2013;158(8):620627. doi:10.7326/0003-4819-158-8-201304160-00100

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33. Latack KR, Yuen F, Wang C, Nguyen BT. Online community queries on hormonal male contraception: an analysis of the Reddit Ask Me Anything experience. Contraception. 2021;104(2):159164. doi:10.1016/j.contraception.2021.02.009

Read more from the original source:
Ophthalmology Inquiries on Reddit: What Should Physicians Know? | OPTH - Dove Medical Press

Starting back in high school in 2015, Annie Uyeki was always anxious when she had to leave a class. I wondered, What does my teacher think? she says. Anywhere from two to three times in an 82-minute class period, Uyeki had to step out. Her body demanded it.

Now a lacrosse player at Vassar College, Uyeki was used to infrequent occurrences of excruciating pain that came with irregular and unbearable periods. She started taking birth control pills to help regulate themshe just wanted to feel comfortable in her own body, function as an athlete and compete at the highest level without pain.

But, as she tried to find a birth control method that would prevent pregnancy and help her body cope with relentless cramps and pain, the pill only made her life worse. Maybe this type of pill was a bad fit, she thought. Uyeki switched from one type to another, but her pain didnt change. Her mental health suffered.

Multiple doctors sent a message to Uyeki: [It] might just be your body. You might just be uncomfortable in your body.

Frustrated, she refused to believe it was normal, that it was fine to not get through her day because she was in so much pain.

I feel like birth control almost changed my personality a little bit. I was just so on edge all the time, so irritable. When I told my doctor about this, there seemed to be no real solution, Uyeki says.

Somehow, sometime, it became normal for the insufferable pain, negative side effects and an altered mental state to seamlessly find its way into the athlete lifestyle.

For many collegiate athletes, the birth control pill has brought more harm than good, negatively impacting their bodies and minds. On June 24, the Supreme Court added an additional complicating factor to athletes relationship with the pill. The reversal of Roe v. Wade, the 1973 landmark decision that protected abortion rights in the United States, strips reproductive control further, which naturally may increase the pills popularity. A lack of in-state abortion access may be an athletes sole reason for going on the pill or another form of hormonal birth control (even as advocates say the restrictions on abortions may also lead to restrictions on contraceptives).

With increasing restrictions around reproductive health care, athletes are calling for more conversation and research about the pills health hindrances, some of which have existed long before the overturn of Roe.

Dorothy DiMascio-Donohue, a student at Tufts and member of the nationally ranked womens ultimate Frisbee team, laughed on the phone when explaining how vocal shes been to her teammates about life on the pill.

It feels like a wash of gray has been painted over everything you see and feel, she says. [It is] a little less passionate, a little less colorful, a little worse to endure. And the worst part is that we were told that this is normal. Its almost indescribable how it feels to be on these hormones, but it is noticeable and important. Especially as an athlete, I want to choose a form of birth control that wont make my cramps worse, impeding my performance. I might even want to choose one that will make me feel better.

For DiMascio-Donohue, the relationship between her mental health and athletic performance is the biggest factor. In pursuit of physical control, she lost mental control, with the pill worsening her anxiety and depression. To manage period cramps and take control over pregnancy prevention with a form of birth control she has agency over, she sacrificed her mental and physical wellbeingwhat her athletic performance depends on.

Even as so many athletes and non-athletes alike do reap great benefits from the pill, the side effects are a common conundrum.

Lizzie, who asked Sports Illustrated to identify her by first name only, was aware from a young age that her body was on display. It started with ice skating, before she hit her teen years. She always compared her body to her older sisters; she wanted to be thinner. That thought pattern led to restrictive eating habits, low nutrition and low food consumption, which began to impact her menstrual cycle. Her mother found out that her period stopped and immediately brought her to the doctor. Lizzie left with a birth control prescription to regulate her hormones. She was 15, and there was no conversation about side effects. Months later, she was crushed by anxiety.

I had never experienced anything like this and I never correlated it to birth control, but I do know I started this one thing, then this happened, Lizze says.

Birth controland the side effects that came with itremained part of Lizzies daily timeline. As a Division I college rower, the mental health downfall conflicted with the lifestyle of a collegiate athlete. She gained more weight during her monthly cycle, which added extra stress to regular team weigh-ins. Every mood swing, every period of anxiety or depression, was brought to the next level while rowing in college. Her GPA suffered even when her school-focused anxiety heightened and her depression was at a peak, torpedoing her athletic performance.

A 2018 report shows that the pill is most popular with patients between 20 and 29the prime age for college athletes. When Dr. Alysia Robichau, a sports medicine physician in Conroe, Texas, prescribes the pill, she looks at five criteria: weight, period flow/length, acne, mood swings and reason for going on the pill. Robichau also considers a family history of blood clots, one of the pills more severe possible side effects. There are roughly 150 to 200 types, brands and styles of birth control pills. They each have different combinations of hormones that work for different reasons, and different pills may cause mood or mental health issues. They normally contain estrogen and progesterone, two hormones key in reproductive development that help regulate menstrual cycles. Progesterone-only pills are more commonly given to people who are breastfeeding.

For Sophia Worth, the tiny pill she takes at 10 every night helps manage the onset of endometriosis, which plagues her family lineage. Endometriosis, simply put, is a painful disorder that involves the tissue that lines ones uterus. Symptoms include, but are not limited to, extreme pain in the back, stomach, irregular menstrual cycles and heavy bleeding.

Worth was just 15 when she started taking the pill because symptoms were far too severe to ignore. A rising junior at Missouri as the goalie for the womens soccer team, she found success with the pill, but it has to be taken at the same time every day to work properly. The strict schedule it requires doesnt mix well with the demanding life of a D-I athlete. Road games are a recipe for prescription mishaps; time-zone changes almost ensure a missed dosageeven just one missed pill can cause a hormonal imbalance.

In terms of your athletic performance, when your hormones are out of whack, your mood is messed up, your body feels wack, it messes with your sleep and all of those things are aspects that are always hammered home to us as athletes, Worth says.

The pill helps to avoid physical pain that would trouble her athletic lifestyle, but the solution adds a hormonal imbalance and her body chemistry is nonetheless altered. Weight gain is the most expected side effect, as Robichau explained that doctors estimate users typically gain two to eight pounds on the pill. Uyeki gained roughly 20 pounds. Robichau herself was an elite level gymnast at LSU and went on birth control pills in college, but with strict instructions to not gain weight.

Uyeki remembers when practices would end with a lecture about the importance of staying hydrated or a reminder to maximize sleep. One common issue among the athletes standing around her in the huddle wasnt insomnia or dehydration. It was hormone-related, but that wasnt ever valued; the topic was flat-out ignored.

For decades, information about birth control in relation to athletes was sparse. With women already more likely to tear their ACLs than men, research recently took off to study how oral contraceptive pills factor in. Robichau says most research is not yet conclusive, but a 2021 study from Penn State College of Medicine found that a large percentage of women who sustained ACL tears were taking an estrogen and progesterone birth control pill at the time of injury.

In 2009, researchers from Texas A&M found that oral birth control use impaired muscle gains in young women and was associated with lower hormone levels. The conclusion was followed with a clear statement: There still needs to be more research about the relationship between muscle loss and birth control. Especially in a Roe-overturned world.

In 1988, IUDs were reintroduced to the U.S. market after approval from the FDA. But doctors had always been hesitant to insert them in people who had not given birth previously. The procedural aspect of IUD insertion sparked uncertainty, especially for athletes who could spoil their careers with one mishap.

With IUDs given to only a limited group as a birth control option, the pills popularity increased.

In college athletic communities, it wasnt uncommon for a student to be instructed by a coach or program to go on the pill. High-intensity training meant athletes were at risk of losing their regular period if they didnt get enough fuel to support their training. Red S or Relative Energy Deficiency in Sport, the formal name for when athletes suffer from low bone density, energy deficiency or potentially disordered eating, scared coaches.

In the early 2000s, the vast majority of college programs were run by men, which meant less talk of periods and hormones. To combat Red S, and avoid potential conversations of periods or pregnancy, coaches encouraged their athletes to take the pill. If they werent eating enough, if bones weakened, at least they got their period.

Instead of individualized methods that fit ones body, blanket approaches put the pill in many athletes daily routine, with no warning of side effects or the realization that the pill is not the solution for everyone, or that there are other options.

Victoria Jackson, a pro runner with endorsements from Nike who was a Pac-10 champion at Arizona State, was on the pill like many other endurance athletes in the early 2000s. She didnt go off the pill until she was ready to start a family.

When I went off the pill, it was like the clouds parted, Jackson says. For the last decade and half, I was a little bit sad all the time. I was in a low-level depressive state. I am not an expert but from my personal experience, I realized [the pill] had an effect on my mental health, and that had never been part of the conversation.

In the mid-to-late 2000s, Jackson says research-based coaches began reversing the standard that those before them set and encouraged athletes to go off the pill. A decision with good intentions was made by the wrong people.

You would have coaches involved in the reproductive health and womens health decisions made by athletes, sometimes not in consultation with medical professionals, making those athletes vulnerable, Jackson says.

Jackson, a professor and historian at ASU, is advocating for clear conversations about life off birth control since many athletes have stopped taking the pill.

Other athletes who spoke to SI had similar beneficial results. Lizzie switched off the pill junior year of college to an IUD and says her mental health benefited greatly, as did her athletic performance. DiMascio-Donohue is in a similar place.

I was miserable for so long, she says, now off birth control. This gray filter on life is now removed.

The landscape of college athletes will be different heading into the fallespecially in states with abortion bans. In Missouri, where Worth plays, an added anxiety now lingers.

Thinking about the intimate and sexual details of my life having to be disclosed to my coaching staff in the case that something happened and I were to get pregnant, all these other questions arise, what if they are allowed to say, No, you cant go to another state and do this? she says.

The decision to prevent people from receiving in-state procedures may be the one reason an athlete needs to go on the pill, despite its health risks.

Data gathered by The Washington Post revealed that many elite womens college sports programs are also disproportionately concentrated in states with abortion bans and expected bans or where the future of abortion rights is uncertain.

Given the universal uncertainty but life altering repercussions, Jackson encourages college coaches to develop a plan. Future recruits and parents will have questions, especially in states that ban abortions: where to go, what to do. But medically, the plan should be advised by outside professionals.

Team meetings can no longer focus just on nutrition, and practices cant end with only a reminder to sleep well that night like Uyeki and other athletes have dealt with their entire life. The bodily autonomy athletes once had is now restricted. The pill may be an athletes best bet in a post-Roe landscapeand, students and advocates say, thats far from ideal.

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The Trouble With the Pill - Sports Illustrated

For young students, seeking reproductive health resources available in the area may be difficult to find.

Fosnight Center embraces the uniqueness of each individual in an effort to ensure all feel safe and welcome regardless of intersectional identities, said Casey Duncan, the director of administrative services for the Fosnight Center for sexual health in Asheville.

The director said the Fosnight Center provides inclusive healthcare for all bodies. The center covers gender affirming care, gynecology and urology services, sexual and integrative medicine and physical therapy.

At the Fosnight Center, we recognize the pieces and put them together to create an individualized treatment plan through a multidisciplinary team approach, Duncan said. You will have the opportunity to be evaluated by our medical providers, pelvic health physical therapist and sex therapist in order to look at the whole picture of your health concern.

The director said the sexual health center provides gender inclusive contraceptive care, gender affirming hormone therapies, STI testing and preventative care.

According to the CDC, before the overturning of Roe 65.3% of people born with a uterus were using contraceptives.

We pride ourselves on creating a safe space for all our patients and clients. Duncan said. We believe everyone deserves to love their body.

The Fosnight director said the center is passionate about reproductive freedom and bodily autonomy for all.

We are committed to cultivating an inclusive environment that benefits all our providers, staff, clients, patients and the community, Duncan said.

Duncan said the sexual health center accepts most commerical insurances and has self-pay discounts.

According to Planned Parenthood, after the overturn of Roe v. Wade on June 24, many Planned Parenthood centers were forced to close leavingmany low income young adults struggling to find affordable testing and sexual health clinics.

The staff understand the unique needs and challenges of being a college student, said Jay Cutspec, the director of Health and Counseling at UNC Asheville.

Cutspec said students receive basic reproductive care and services at UNCA comparable to a family physicians office.

We adapt our services to meet the unique needs of college students, Cutspec said. We have a diverse staff from a variety of backgrounds and experiences.

The health and counseling director said they advise students to make the Health and Counseling Center their first step. If they cannot provide specific services or have unmet needs, students will be referred to the most appropriate community provider.

The phone number for the Health and Counseling Center is (828)-251-6520.

We also understand that for many students, this may be the first time that they have to manage their own healthcare, Cutspec said. We try to educate them on how to manage the healthcare system.

Cutspec said the only charge for a visit to the Health and Counseling Center is for possible medication prescription or lab tests received during the visit.

The Menstrual Equity Club on UNCAs campus takes these matters into their own hands providing safer sex supplies, menstrual products and community health resources.

We have had the pleasure of partnering with organizations such as the Western North Carolina Aids Project and Planned Parenthood, said Samantha Mazze, a UNCA student studying psychology and co-president of the equity club.

Through these collaborations we have been able to provide the campus population with free HIV testing and guest speaker community health educators, Mazze said.

Mazze said the club members pride themselves on providing safe spaces for students to discuss reproductive justice, campus community needs and concerns.

The UNCA student said this was their third year being a part of the Menstrual Equity club.

The co-president said in the past year one of the biggest projects the club worked on was providing free menstrual products in all bathrooms on campus.

One of our goals for this next year is to make sure all students on campus have access to these essential supplies regardless of the bathroom they use, said Mazze.

Mazze said another project the club organizes is the packing party, a Halloween goodie bag filled with menstrual products, candies, stickers and more for students. The co-president said with events like packing parties the club donates supplies back to the community.

The UNCA student said the presence of organizations like the menstrual equity club are crucial because voices are not being heard.

We continue to see people of color and the LGBTQ+ community be consistently overlooked by our healthcare and justice systems, said Mazze.

Mazze said after their graduation they want to continue their efforts in reproductive health, and become a sex therapist.

The co-president said students wishing to get involved can follow the clubs instagram page @uncaforme or join the email list [emailprotected].

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UNCA and Asheville clinics priortize inclusive healthcare The Blue Banner - The Blue Banner

A dramatic presentation at the 2022 American Society of Clinical Oncology Annual Meeting changed treatment standards seemingly overnight for women with previously treated metastatic HER2-low breast cancer. However, fundamental questions remain.

A dramatic presentation at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting changed treatment standards seemingly overnight for women with previously treated metastatic HER2-low breast cancer. However, fundamental questions remain. What is HER2-low breast cancer? Are low levels of HER2 meaningful drivers of cancer progression? How can oncologists predict which patients will benefit from treatment with the antibody-drug conjugate (ADC) fam-trastuzumab deruxtecan-nxki (Enhertu)?

Investigators of the phase 3 DESTINY-Breast04 trial (NCT03734029) enrolled previously treated patients with HER2-low metastatic breast cancer, which was defined for the trial as a score of 1+ on immunohistochemical (IHC) analysis or an IHC score of 2+ and negative results on in situ hybridization (ISH). Among the 557 patients who were randomly assigned 2:1 to trastuzumab deruxtecan or physicians choice of single-agent chemotherapy, the median progression-free survival (PFS) was 9.9 months in the trastuzumab deruxtecan group vs 5.1 months in the physicians choice group (HR, 0.50; 95% CI, 0.40-0.63; P < .0001). Overall survival (OS) was 23.4 months with trastuzumab deruxtecan vs 16.8 months with physicians choice (HR, 0.64; 95% CI, 0.40-0.86; P = .003).1

In addition to extending PFS and OS, trastuzumab deruxtecan was also better tolerated than the chemotherapies that physicians selected. Adverse events of grade 3 or higher were observed in 52.6% of the patients who received trastuzumab deruxtecan and 67.4% of those who received physicians choice. Adjudicated, drug-related interstitial lung disease or pneumonitis occurred in 12.1% of the patients who received trastuzumab deruxtecan, and 0.8% of patients died.

News of the results elicited a rare standing ovation at the ASCO meeting, and the FDA subsequently approved the agent for the treatment of patients with HER2-low metastatic disease in August 2022 (Table).2

Establishing definitive parameters for HER2-low disease is still a task set before oncologists and pathologists. Approximately 60% of breast cancers qualify as HER2 low based on the definition in DESTINY-Breast04.3 And although targeted drugs have transformed outcomes for the 15% to 20% of patients with breast cancer with significantly elevated HER2 expression, this was the first time that a drug targeted at HER2 proved beneficial to patients who met this definition of HER2-low breast cancer.4

HER2 is a membrane tyrosine kinase expressed at low levels by many healthy cells that is dramatically overexpressed (40- to 100-fold) by a minority of cancers that can have several million HER2 receptors per cell.5

Existing IHC assays were optimized to distinguish overexpression from normal expression. They have an adequate dynamic range for that purpose but [are] suboptimal to distinguish different HER2 groups among tumors with lower levels of expression. Almost all breast cancers do express some HER2, and an IHC result of 0 is often the result of an artifact caused by formalin fixation rather than truly representing no HER2 protein present. For that reason, current IHC assays are unfit for the purpose of creating a new category of HER2 low, said Antonio C. Wolff, MD, a professor of oncology at Johns Hopkins University and director of breast cancer trials in the Womens Malignancies Program at Johns Hopkins Kimmel Comprehensive Cancer Center in Baltimore, Maryland. Therefore, rather than creating a new category, for now it is better to simply describe the eligibility criteria used for the study to identify patients who could be candidates for this drug.

Testing HER2 expression levels has long been a challenge. In 2007, 9 years after the initial approval of trastuzumab (Herceptin), an expert panel convened by ASCO and the College of American Pathologists (CAP) concluded that both IHC and ISH returned inaccurate results in approximately 20% of cases. They recommended testing standards for HER2 overexpression that, among other improvements, sometimes combined the 2 methods to reduce the error rate.6 Those first ASCO/CAP guidelines were updated in 2013 and again in 2018, but even the most recent guidelines make no mention of HER2-low cancers. They also give no advice for separating cancers with small amounts of HER2 expression from cancers that do not express HER2 at all because, as the authors note, data from [the NSABP-B-47; NCT01275677 trial] confirmed the lack of benefit from adjuvant trastuzumab for patients whose tumors lack gene amplification and are IHC 1+ or 2+. Consequently, HER2 gene amplification assessed by ISH or protein overexpression assessed by IHC remains the primary predictor of responsiveness to HER2-targeted therapies in breast cancer.7

Amplification or overexpression of HER2 has long been known to drive tumor growth and aggressiveness. Before the development of targeted therapies, HER2-positive status was associated with shorter survival.8 The question now, which has been investigated in a pair of recent studies, is whether having low levels of HER2 expression produce different cancer progression and outcomes than having no HER2 at all.

In the first of those studies, findings from which were presented at the 2022 ASCO meeting, investigators mined the National Cancer Database for outcome data on patients with metastatic breast cancer whose cancers scored 0 (HER2 0) or 1+/2+ (HER2 low) on IHC testing. There were no differences between the 6865 HER2-0 patients and the 17,771 HER2-low patients in age, race, year treated, location, income, insurance status, Charlson Deyo comorbidity index score, laterality, T stage, N stage, or use of systemic therapy. There was, however, a difference in hormone receptor status; HER2-low tumors were half as likely to have concomitant hormone receptornegative status. Among hormone receptornegative patients, the 3-year survival rate was 33.8% for HER2-low and 32.2% for HER2-0 patients. Among hormone receptorpositive patients, the survival rate was 60.9% in HER2-low and 55.6% in HER2-0 patients. HER2-low status was associated with longer survival on multivariable regression analysis (HR, 0.91; 95% CI, 0.87-0.95), even with propensity score matching (HR, 0.92; 95% CI, 0.89-0.96). In a subset analysis isolated to hormone receptorpositive cases, HER2 low remained correlated with improved survival (HR, 0.93; 95% CI, 0.89-0.98) with propensity-matched multivariable regression analysis.9

In the second study, whose results were published inJAMA Oncology, investigators compared outcomes of 5235 consecutive patients with nonmetastatic HER2-low or HER2-0 breast cancer who underwent surgery between January 2016 and March 2021 at Dana-Farber Brigham Cancer Center in Boston, Massachusetts. Although the patient populations were different (metastatic vs nonmetastatic cancers), the definitions of HER2 low (IHC score of 1+ or 2+) and HER2 0 (IHC score of 0) were the same as in the previously mentioned study. Also, in that study, hormone receptor expression was significantly more common among HER2-low tumors than HER2-0 tumors (90.6% vs 81.8%;P < .001).

Investigators also found a correlation between the expression of estrogen receptors (ERs) and HER2.Patients with HER2-0 tumors experienced higher pathologic complete response rate (pCR) than patients with HER2-low tumors after neoadjuvant chemotherapy (26.8% vs 16.6%;P = .002). However, after controlling for hormone receptor and ER status, there were no significant differences in pCR, disease-free survival, distant diseasefree survival, or OS between patients with HER2-low and HER2-0 breast cancer.10

We wanted to look at the prognosisfor patients withHER2-lowbreast cancercompared [with]HER2-0breast cancer. We explored data from our institutions largeprospectivedatabase anddiscovered that theydont have a different prognosis, if you correct for the expression of the estrogen receptor, said senior study author Sara M. Tolaney, MD, MPH, chief of the Division of Breast Oncology at Susan F. Smith Center for Womens Cancers at Dana-Farber Cancer Institute. In our mind, if the prognosis of these cancers is not different, it suggests that theyre really not biologically different cancersand low HER2 expressionis likely notan oncogenic driver for that cancer.

Tolaney stressed that while this finding provides new information about tumor behavior, it should do nothing to dampen excitement about trastuzumab deruxtecans apparent effect on HER2-low tumors. Theres no need for an ADC to target an oncogenic driver. If it can reliably bind to the tumor, it can deliver the chemotherapy exactly where it needs to, she said. It is very critical to understand if tumors are HER2-lowpositive, not because its associated with a different prognosis, but rather because its allowing you to utilize a very novel therapythat can dramatically impact patients outcomes.

Of course, given that both studies used IHC to separate patients whose tumors were HER2 low from those whose tumors were HER2 0, some tumors were categorized incorrectly in both studies. Indeed, in data from a new study from Yale Cancer Center in New Haven, Connecticut, investigators concluded that current IHC tests struggle severely to differentiate between IHC 1+ and IHC 0 tumors.

In this study, investigators collected data from a survey conducted by CAP and a Yale-based study of concordance among 18 pathologists reading 170 breast cancer biopsies. The CAP analysis showed that 19% of the cases read by 1400 laboratories generated results with less than 70% agreement between a HER2 score of 0 vs 1+. In the second part of the study, in which 18 pathologists read the same slides from a selected set of breast cancer biopsies using the 4-point scale, there was only 26% agreement among pathologists on scores of 0 and 1+.

Investigators said the disagreement was due to the poor quality of the current IHC test in this critical range that will likely determine which women are eligible for trastuzumab deruxtecan.11

Although the test returns 4 different scores0, 1, 2, or 3it is not actually designed to differentiate 0s from 1s. Its designed to give you a yes/no answer about whether a tumor massively overexpresses HER2 in a way that would make trastuzumab a good treatment, said senior study author David Rimm, MD, PhD. Rimm is the Anthony N. Brady Professor of Pathology and a professor of medicine at Yale University School of Medicine. He also serves as director of Yale Pathology Tissue Services, director of the Yale Cancer Center Tissue Microarray Facility, and director of the Physician Scientist Training Program in Pathology Research. Weve always known this, but the results of this study indicate that the biggest factor in determining whether a result is interpreted as a 0 or a 1+ is chance, and that will likely lead to the mismanagement of many patients in terms of who gets treated with trastuzumab deruxtecan.

Is it possible to develop a test that more accurately distinguishes tumors with low HER2 expression from those with no HER2 expression (Figure12)? Weve already developed one, Rimm said, adding that diagnostic companies are also developing higher sensitivity tests because of the large unmet need. Of course, youd need to validate any test thats developed, but that can be done in a reasonable time frame.

The IHC tests inability to differentiate between low and nonexistent levels of HER2 expression also creates a potential problem with the DESTINY-Breast04 results. To be eligible for the study, patients needed to have a tumor that tested HER2 IHC 1+ or IHC 2+ without gene amplification. Patients with IHC 0 were not eligible for the study, and it is quite plausible that this antibody-drug conjugate would be active in them too, but this must be confirmed, Wolff said.Some evidence exists about the effect of trastuzumab deruxtecan in patients whose tumors receive IHC scores of 0 from the phase 2 DAISY trial (NCT04132960), which reported results during the European Society for Medical Oncology Breast Cancer Congress 2022 and the 2021 San Antonio Breast Cancer Symposium.

Investigators in DAISY assigned 186 patients with metastatic breast cancer to 1 of 3 cohorts based on HER2 IHC expression: IHC 3+ or IHC 2+/ISH+ (cohort 1; n = 68); IHC 2+/ISH- or IHC 1+ (cohort 2; n = 72); and IHC 0+ (cohort 3; n = 37). All patients received 5.4 mg/kg trastuzumab deruxtecan intravenously on day 1 of 21-day cycles.

Best objective response (BOR) favored cohort 1 (71.0%; 95% CI, 58.3%-81.0%) over cohort 2 (37.5%; 95% CI, 26.4%-50.0%) and cohort 3 (30.0%; 95% CI, 16.0%47.0%). Investigators also found that those in cohort 1 had the longest median PFS at 11.1 months compared with 6.7 months in cohort 2 and 4.2 months in cohort 3.13,14 These results indicate that trastuzumab deruxtecan is more effective in patients with IHC scores of 1+ than it is in patients with IHC scores of 0, but it says nothing about the relative effectiveness of trastuzumab deruxtecan vs other treatments in patients with IHC scores of 0. It is therefore possible that many such patients would receive some benefit.

I predict that a lot of savvy oncologists will, upon having a patients IHC test come back 0, advise that patient to send the sample to be read at a different lab, knowing theres a strong chance it will be upgraded to a 1 and they will qualify for this treatment, Rimm said. Patients will want to try this medication. Those results were spectacular.

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Metastatic Breast Cancer Enters a New Era of HER2 Classification - OncLive

When discussing fitness, a major focus is often on the number of calories you eat and burn during exercise, especially when it comes to weight loss or weight gain. But did you know you're still burning calories even at rest? Even though exercising is important and has many health benefits, it only makes up a small percentageof the calories you burn throughout the day. In fact, most of the calories you burn go toward involuntary activities and everyday tasks like cooking and cleaning.

There are many factors that determine how many calories you burn at rest versus during a workout, so we spoke to experts to get a clearer explanation. Read on to find out how many calories you burn daily and why it's helpful to know these details.

As you can imagine, the number of calories burned varies per person. Your total daily energy expenditure is the number of calories you burn in a day, including exercise. In order to get this figure, you first need to find out a few other calculations.

One of these key figures is your basal metabolic rate, which is the minimum number of calories your body needs to burn to maintain basic functions such as heart rate, breathing and digestion. "The number of calories your body burns while you're at rest is determined by your BMR," saidDr. Brittany Robles, an OB-GYN physician and a National Academy of Sports Medicine certified personal trainer. Things that affect your BMR include your age, weight, muscle mass and activity level. Your BMR accounts for about 60 to 75% of your daily energy expenditure.

A helpful way to determine an estimate of what your BMR is, is by using the popular Harris-Benedict Equation. This formula takes into account your weight, height, age and gender.

BMR calculations based on men and women:

Men: BMR = 66.5 + (13.75 * weight in kilograms) + (5.003 * height in centimeters) - (6.75 * age)

Women: BMR = 655.1 + (9.563 * weight in kg) + (1.850 * height in cm) - (4.676 * age)

Knowing your BMR can be helpful if one of your goals is to lose weight, but Robles says to keep in mind that this method is only an estimate. "The most accurate way to measure your BMR is through indirect calorimetry, which involves measuring your oxygen consumption and carbon dioxide production," she said. Generally, it's not necessary to go this far to measure your BMR since it's expensive, mainly used in research settings and isn't practical for everyday use.

Once you have an estimate of your BMR, you can use it to find your TDEE. To figure this out, you need to multiply the BMR and your activity factor. There are different types of formulas you can find online, but the Harris-Benedict Equation is the most popular and uses a rubric for activity factors that range from sedentary, moderate to strenuous. The rubric used is: 1.2 (for sedentary), 1.5 (for moderate) and 1.7 (for strenuous) and 1.9 (for very active individuals).

Your body also burns calories through activities such as fidgeting, walking or doing other everyday tasks.

Besides BMR, your resting metabolic rate, the thermic effect of food, non-exercise activity thermogenesis and exercise-related activity thermogenesis also play an important role.

RMR: RMR and BMR tend to be used interchangeably because both make up the basis for how many calories you burn when you're not exercising. The difference is your RMR looks at the number of calories you burn when you're at rest, including regular activities like eating, while BMR only looks at the number of calories you burn for vital functions like breathing. To find out your RMR, you use the same BMR formula to get a result.

TEF: The thermic effect of food is the number of calories your body burns in order to digest and absorb food. The TEF accounts for 10% of your daily energy expenditure. To find this number, calculate: BMR X 0.1= TEF.

NEAT: Non-exercise activity thermogenesis is the number of calories your body burns through activities that are not exercise, such as fidgeting, walking or doing other everyday tasks. It makes up about 15% of a sedentary person's total daily energy expenditureand up to 50% or more for highly active people. Your occupation heavily influences your NEAT. Hence, why a construction worker or someone who works on their feet all day will have a higher NEAT number than someone who works at a desk all day.

In order to find out your NEAT number, you first need to know your total daily energy expenditure figure. Once you determine the figure that fits your lifestyle best, you'll be able to get your NEAT number.

The formula used to calculate NEAT is: TDEE - (BMR + TEF) = NEAT

EAT: Finally, EAT refers to intentional exercise and accounts for an estimated 15 to 30%of your total energy expenditure. Therefore exercise doesn't make up for much of your overall calories burned daily.

"All of these factors play a role in how many calories you burn in a day," said Robles. "RMR and BMR make up the basis for how many calories you burn at rest, and TEF and NEAT add to this total by representing the number of calories you burn through activity."

Individuals with higher muscle mass tend to burn more calories at rest than those with less.

Now that you know about the different ways our bodies burn calories, it's important to understand how your lifestyle habits can influence this too. Matt Scarfo, a National Academy of Sports Medicine certified personal trainer, told CNET, "People with larger bodies burn more calories than those with smaller bodies because they need to keep their blood flowing, their muscles oxygenated and their cells operating." Additionally, if your body composition changes, the number of calories you burn at rest will change.

"Individuals with higher muscle mass tend to burn more calories at rest than those with less, since muscles require a lot of energy," explained Scarfo. Hormone cycles can also affect your energy needs, which is why some women get hungry during the high hormone phase of their cycle, leading up to their period.

Then there are the changes that come with aging. "As you age you will often lose muscle mass, which leads to a slower metabolism," saidRachel Macpherson, an American Council on Exercise certified personal trainer and certified nutrition specialist. "Menopause and reduced testosterone can cause metabolic slow down as you age too," she added.

Therefore if you're trying to lose weight, gain weight or maintain your weight, knowing an estimate on how many calories you burn regularly can give you a better guideline on how many calories you should be intaking a day. "If you want to lose weight, you can decrease your calorie intake from your total daily energy expenditure, but only a small one so as not to slow your metabolism too much," explained Macpherson. Likewise, if you want to gain muscle or weight, you will need to eat more than you burn.

It's important to remember that most of these calculations that determine how many calories you burn while exercising or at rest are simply estimates. They can help serve as a guide to help you better understand the different ways your body burns calories, but they're not definitive. If you're looking to lose weight, gain weight or simply maintain your weight, it's best to receive advice from a certified dietitian nutritionist.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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How Your Body Burns Calories At Rest, During Workouts and More - CNET

Read on to know more about what an expert has to say about menopausal hormone therapy and its side effects.

Photo : iStock

Dr Gandhali Deorukhkar, Gynecologist at Wockhardt Hospital, spoke about HRT and its possible negative effects.

Points to consider prior to initiating MHT include checking the indications and contraindications of MHT, which requires history recording, physical examinations, and other tests. Because the symptoms of menopause are varied, customized tests should be conducted for each risk factor based on the basic examination conducted according to the life cycle and family history of a woman, the expert added.

The basic examination, which is a general examination conducted according to the life cycle, should identify lifestyles such as smoking and drinking habits; mental diseases such as depression; and with family history for diseases such as Alzheimer's disease, osteoporosis, diabetes, endometrial cancer, breast cancer, liver disease, thyroid disease, cardiovascular disease, and venous thromboembolism via history taking.

In addition, the basic examination should include a physical examination for height, weight, and blood pressure as well as the pelvis, breast, and thyroid. Blood tests include tests for liver function, kidney function, anemia, and fasting blood sugar as well as lipid examination, followed by mammography, bone mineral density (BMD) test, pelvic ultrasound and Pap smear screening. In the case of premature ovarian insufficiency (POI), MHT can be used at least until the mean age of menopause regardless of symptoms.

Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.

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Menopausal hormone therapy: Gynaecologist answers FAQs you need to know - Times Now

Endo belly is when the abdomen becomes severely bloated and painful. It happens in people with endometriosis, a condition that causes pelvic pain and heavy menstrual periods.Treatments are available to lessen the symptoms, and people can also use home remedies to relieve pain and discomfort.

This article explains what endo belly is and how to get relief from the symptoms.

Endo belly is a complication of endometriosis, a condition that occurs when tissue similar to the lining of the uterus (endometrium) starts to grow in areas outside of the uterus. Endometriosis affects more than 11% of women ages 1544 years and is most common among those in their 30s and 40s.

Endo belly refers to severe bloating in the abdomen that accompanies pain similar to the pain of labor. The abdomen becomes painfully distended so much so that clothes no longer fit, and the body shape may suggest pregnancy. Sometimes, diarrhea or constipation can occur alongside abdominal bloating.

Endo belly occurs due to the growths that occur outside of the uterus. Although these growths are not cancerous, they still cause swelling and pain. If the growths occur on the intestines, they can cause stomach and digestive problems. There is no way to prevent endo belly if you have endometriosis, but it is possible to manage the condition with medications and at-home care.

The most common complaint with endo belly is severe abdominal bloating. Bloating happens when the abdomen fills with air or gas. An older study showed that 96% of women with endometriosis experienced abdominal bloating compared with just 64% of women who did not have the condition.

Other symptoms of endo belly include:

Endo belly occurs when endometrial-like tissue builds up and causes inflammation in the abdomen. If this tissue covers or blocks the ovaries or fallopian tubes, cysts can form due to trapped blood in the ovaries.

Scar tissue and adhesions can also form, causing the internal organs to bind together, which can cause pain.

Bacterial overgrowth on the small intestines and fibroids can occur, causing issues with digestion, such as constipation or gas.

You should consult a doctor about endo belly if you are in severe pain or if the bloating is so bad that your clothes no longer fit.

The doctor may prescribe pain medication or recommend other treatments to treat endo belly symptoms.

It is also best to seek medical advice if you have severe nausea, constipation, diarrhea, or pain with bowel movements.

Doctors diagnose endo belly by looking at your overall symptoms and health history. The cause of endometriosis is still unknown, but experts believe that it results from problems with:

The doctor will assess your abdomen and listen for the presence of bowel sounds with a stethoscope. They will be able to hear whether your gastrointestinal system is too active or not active enough. They will also tap on your belly to listen for the areas where there is excessive gas or air.

Doctors usually treat endo belly and endometriosis with hormonal birth control. This can be in the form of a pill, shot, or intrauterine device (IUD).

If you are trying to get pregnant, your doctor may prescribe you a gonadotropin-releasing hormone (GnRH) agonist. This medication stops the body from making the hormones responsible for the growths associated with endometriosis.

In severe cases in which hormonal birth control is not controlling the symptoms of endo belly, doctors may suggest surgical treatment. During the procedure, the surgeon will be able to locate and remove areas of endometrial-like tissue. After surgery, you will start again on hormonal birth control unless you are trying to get pregnant.

For pain management, your doctor may recommend over-the-counter pain medication, such as ibuprofen (Motrin) or naproxen (Aleve). Some people also have success with complementary and alternative therapies, such as acupuncture, chiropractic care, herbs, and supplements.

There are many at-home remedies you can do to help with the symptoms of endo belly. These include:

The complications of endo belly include digestive problems such as severe nausea, constipation, and diarrhea. If you are unable to keep food or fluids down due to these symptoms, you should notify a doctor.

Painful bowel movements can also occur at certain points during the menstrual cycle. This may be due to adhesions that form on the intestines.

Another complication of endo belly is chronic pelvic pain. You may experience severe pain with each menstrual cycle, along with heavy bleeding. If you experience chronic pain from endo belly or endometriosis, seeing a pain management doctor who specializes in seeing individuals with this condition may help.

Below are the answers to some common questions about endo belly.

How long do endo belly episodes last?

Endo belly can last for a few hours, days, or even weeks, depending on the severity of the symptoms. You should notify a doctor if endo belly symptoms last more than a few days.

Does endo belly after hysterectomy occur?

Generally, endo belly symptoms subside after a hysterectomy. As your body stops making estrogen, the endometriosis growths start to shrink. However, some people may still experience endo belly if they are receiving hormonal estrogen replacement therapy.

How do I get rid of endo belly?

You can treat endo belly by talking with a doctor about hormonal birth control, which is usually the first-line treatment for people with endometriosis. You can also try at-home remedies such as heat, dietary changes, yoga and meditation, acupuncture, herbs, and supplements.

Endo belly is a symptom of endometriosis in which the abdomen becomes severely bloated and distended. It occurs due to endometrial growths that occur in the pelvis and intestines. Endo belly is painful and can last for a few hours, days, or, in severe cases, weeks.

The first line of treatment is usually hormonal birth control pills, which help control the growths. In severe cases, doctors may recommend surgery to remove the growths.

You can help manage endo belly by making dietary changes, using heat on your abdomen, and trying complementary and alternative therapies, such as acupuncture, herbs, and supplements.

Read more:
Endo Belly: What It Is, Symptoms, Causes, and Treatment - Healthgrades

Working as a disaster relief volunteer made this 2022 Healthline Stronger Scholarship winner determined to improve health inequity for refugees around the world.

The outdoors have inspired Immanuel Bissell for as long as he can remember. He grew up in Los Angeles, California, where the San Gabriel Mountains set a glorious background for the cityscape.

His enthusiasm for nature nudged him to pursue earth science in university but it wasnt the only reason he chose that field.

He was also working with the American Red Cross as a disaster relief volunteer, and the experience showed him firsthand how climate change affects some communities far worse than others.

The work was a stark introduction to the complexity of disaster response efforts and a visceral reminder that environmental change disproportionately affects under-resourced communities, says the 21-year-old, who is entering his junior year at Yale University this fall.

Addressing these disparities requires, among other things, a solid understanding of earth science hence why Bissell chose that major. He plans to enter medical school after college. The eventual goal? To address the health inequities refugees experience with climate change.

We asked Bissell about his studies, goals, and obstacles. Heres what he had to say.

Studying earth science is the academic extension of the passion Ive felt toward the outdoors for as long as I can remember.

Exploring nature has long dictated my path. Back home in Los Angeles, the San Gabriel Mountains inspired me to help with trail restoration projects on the weekends when I was in high school. I also went to Tennessee over my gap year to climb sandstone rock walls.

All of that has fed into my interest in earth science, but I also chose to study it for the human impact. Every drought, heat wave, or tsunami that takes a toll on human lives feels significant to me.

Caring for others as an emergency medical technician (EMT), tutor, and family member have been extremely fulfilling experiences for me. This field would allow me to continue helping others while feeding my passion for the outdoors.

I took a leave of absence over the 20202021 school year to work on three projects.

In the aftermath of Hurricane Laura and the Oregon wildfires, I worked as a disaster responder with the American Red Cross, connecting clients with resources like financial aid, housing, and meal stipends.

I also worked in two research labs through Yale. In the earth and planetary sciences department, I helped develop computer models of orographic precipitation. This type of rain forms when moist air is lifted over mountains. Its an important source of water for many people around the world.

The other research lab I worked on was through the Yale Institute for Global Health. Our team reviewed how climate change may impact migration within and out of Afghanistan over the next 50 years. We also explored how this could affect public health in the region.

After college, I plan to attend medical school, possibly in an MD or PhD program, and continue working on these problems in both clinical and research settings. I hope to focus my work on how climate change will affect the health of refugee populations around the world.

Academia and medical research can be very narrow in their scopes. We largely talk about the causes and treatment of diseases as if they only occur in one population, which usually means white males from well-resourced backgrounds.

But the playing field is not level for everyone. For example, research on children in Southern California showed that kids who live near busy roads face a higher risk of asthma. It also found that living in neighborhoods with high levels of pollution leads to measurable lung damage.

These facts show that we cannot address health inequities without talking about environmental justice.

Treating symptoms of a given disease doesnt address the root cause. Breaking this mold in both clinical and research settings will be one of the most critical challenges for my field in the future.

Reenvisioning healthcare means breaking down barriers between disciplines, such as medicine, earth science, or politics. We need to take an interdisciplinary approach and expand our view of what it means to care for a person.

Growing up in Los Angeles, I saw firsthand the difficulties of sustaining a big city in the face of environmental change.

I saw the effects of relentless heat and smoke-filled skies on my community each summer. We regularly worried about what another decades-long drought might mean for everyone in the city, but especially people who are homeless.

While volunteering with the American Red Cross, I saw how the effects of environmental change disproportionately burden those who live with the challenges of poverty. Though environmental change worsened their struggles, many of their challenges are rooted in structural inequities.

These experiences have taught me that trying to address the connection between climate change and health is not only important, but an obligation. I hope to rectify these inequalities through a career in medicine, in a way only healthcare can.

I am sorry for what youve had to endure. Your experience is something no one should have to go through. Feeling overwhelmed by the challenges youve already faced or by the looming impact of climate change is completely understandable, but its not your fault.

Remember how resilient you are. You, your family, and your friends have withstood innumerable difficulties in the past. Youve grown from these difficulties, and you can weather this, too.

Also, remember that youre not alone. Talk about your experience with others. Dont look away. To confront the climate crisis, we must find ways to forge ahead collectively.

Read more here:
Helping Under-Resourced Communities Affected by the Climate Crisis - Healthline

Our 60s can be filled with many great and healthy years, but it takes discipline and effort to live a quality life. We can help determine the length of our lifespan by cutting out bad habits and practicing positive choices and Eat This, Not That! Health spoke with experts who reveal their tips for living a long healthy life. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Jacob Hascalovici MD, PhD, Clearing Chief Medical Officer tells us, "Bodies and minds are often so tough and resilient. There is only so much they can take though, so it becomes increasingly important to take care of them as we age. Though "being healthy" is often portrayed as a set of 'Don'ts," practicing good health is often a matter of swapping more supportive, vibrant habits for ones that may be dragging you down. If any of the habits below are true for you and you're heading into your 60s and beyond, think about how you could taper off that habit and put another, healthier one in its place."

Dr. Hascalovici says, "Smoking may be your chosen way to relax or just a deeply ingrained habitit's also deadly. It increases the risks of many chronic conditions and can make it harder for you to heal from any injuries, which only gets harder to deal with as you get older. As soon as you stop or slow down smoking, the body starts recuperating. What could you do to relax instead?"

Dr. Hascalovici explains, "Sitting kills! It can lead to more problems with your heart health, to lost muscle mass, to weaker bones, to weight gain, and to mood disorders. Though it feels as though it should be relaxing, sitting around or being sedentary actually hurts us a lot. It deprives us of natural mood-lifting hormones and weakens our bodies. The answer is to move more. How might that look for you?"

Dr. Hascalovici explains, "Among all the poor food decisions it's possible to make, sugar is pretty high on the list. It's compelling, attractive, and, sadly, nutritionally empty. With time, sugar can lead to poor moods, to diabetes, and to poor health overall. A little bit goes a long way (and should be enjoyedbut only in moderation!) Sugary sodas, many alcoholic beverages, and even some juices should be avoided. What could you drink instead?"

Barbara Bergin, M.D. Retired Board Certified Orthopedic Surgeon says, "Deep Squats are something someone over 60 should avoid. As we age, the meniscus and surface cartilages in our knees begin to wear out and weaken. They cannot withstand the kinds of pressures they could tolerate when we were young. Squatting puts tremendous pressure on the knee, and often can be responsible for tearing the meniscus and shearing articular cartilage right off the surface of our knees. This can lead to the beginning of arthritis. The exercise industry is currently invested in people doing all sorts of squats, to the benefit oforthopedic surgeons. After 60, try something else: walking, straight leg raises, swimming, cycling."6254a4d1642c605c54bf1cab17d50f1e

Heather Newgen

Excerpt from:
After 60, Never Do These Things, Say Physicians Eat This Not That - Eat This, Not That

When it comes to our overall health, there's countless things that can go wrong at a moment's notice and sometimes there are undeniable warning signals like chest pain, but oftentimes subtle signs are overlooked. While they may seem like it's not a big deal, it could be a sign of something bigger that needs medical attention. So how do you know when it's a serious health issue? When should you see a doctor? Eat This, Not That! Health spoke with Dr. Tomi Mitchell, a Board-Certified Family Physician with Holistic Wellness Strategies who shares symptoms that shouldn't be ignored and why. As always please speak with your physician for medical advice.Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Mitchell shares, "I have seen thousands of patients with severe symptoms, and when they present with certain symptoms, I am highly concerned. Physicians are programmed to quickly assess the situation and ask supporting questions to find possible causes. I believe honesty is the best policy, and when patients have very concerning symptoms, I let them know in advance that I am concerned. With anything, I hope for the best and prepare for the worse, and I let the patient know.

In my experience as a medical professional, I have found that it is essential to be honest with patients right from the start. When patients come to me with symptoms of concern, I explain everything in detail and let them know what we need to do to address the issue. This approach helps put patients at ease and makes them more likely to keep their appointments. Also, this allows them time to create your support network and put certain things in their life in order. By being upfront and honest about the situation, we can work together to ensure that the problem is dealt with promptly and effectively.

If you go to the doctor with a new or concerning symptom, likely, your doctor will immediately set you up with a series of diagnostic tests(labs, x-rays, CT scans, etc.) and urgent referrals to other specialties. This can be overwhelming, but it is essential to remember that the sooner a diagnosis is made, the sooner treatment can begin. So if you are in this situation, try to stay calm and follow your doctor's instructions. It may be a lot to handle all at once, but with the help of professionals, you will get through it. If you present with any of the following symptoms, you must consult your doctor as soon as possible.

Your body is a fantastic machine constantly working to keep you healthy. However, sometimes things can go wrong, and it's essential to be aware of the signs that something is seriously wrong. This isn't an exhaustive list. However, it includes some of the more common symptoms associated with severe medical conditions. Here are five signs to watch out for."

Dr. Mitchell tells us, "Sudden pain is often a sign that something is wrong with the body. It can be a sign of injury, infection, or disease. Pain signals the body to alert the brain that something is wrong and needs to be fixed. Without pain, we would not be able to survive. It motivates us to take action to protect ourselves from further harm. Sudden pain can also signify something more serious, such as a heart attack or stroke. If you experience sudden pain, it is essential to seek medical attention immediately. The delay could result in permanent damage or even death. While some sudden pain causes are not severe, it is always best to avoid caution and have a doctor check it out."

Dr. Mitchell says, "Shortness of breath is a common symptom of many different medical conditions. It can be caused by something as simple as anxiety or exertion, or it can signify a more serious problem, such as a heart condition. In general, shortness of breath accompanied by other symptoms, such as chest pain or dizziness, is more likely to indicate a serious problem. For example, if you experience shortness of breath regularly, or if it occurs suddenly and without explanation, it is essential to see a doctor as soon as possible. With prompt treatment, many underlying causes of shortness of breath can be effectively managed."6254a4d1642c605c54bf1cab17d50f1e

According to Dr. Mitchell, "Bleeding is a sign that something is wrong with you when it occurs at an abnormal time or in an abnormal amount. Your body has many mechanisms to prevent bleeding; when these mechanisms are not working correctly, you may experience bleeding. Many factors can contribute to abnormal bleeding, including blood disorders, hormonal imbalances, medications, and injuries. If you experience abnormal bleeding, it is essential to see a healthcare provider to determine and treat the cause appropriately. Occasionally, irregular bleeding may signify a serious condition requiring immediate medical attention. Therefore, if you experience any unusual bleeding, it is essential to seek medical attention immediately.

While some bleeding is normal, certain signs can be cause for concern. Please note that this list is not exhaustive, so make sure you discuss it with your doctor for medical advice. If you experience any of the following, it is essential to seek medical attention:

* bright red blood in your stool

* black or tarry-looking stool

* bloody vomit or vomit that looks like coffee grounds

* coughing up or spitting up blood

* rectal bleeding

* severe abdominal pain

* unexpected and prolonged bleeding from cuts or wounds

* heavy menstrual bleeding in women with a history of heavy periods

* vaginal bleeding in women who are menopausal

* bleeding during pregnancy"

"A change in bowel habit, defined as a difference from an individual's typical pattern of three or more bowel movements per week, can signify something serious going on," Dr. Mitchell states. "The most common cause of a change in bowel habit is an infection, such as food poisoning or a stomach virus. However, other reasons include changes in diet or medications, stress, and some medical conditions. If an infection is the cause, symptoms typically resolve within a week. However, if the cause is unknown or persistent, it's essential to see a doctor as soon as possible. Blood in the stool, severe abdominal pain, and weight loss are all potential red flags that warrant further investigation. Bowel problems can be uncomfortable and embarrassing, but your doctor has likely heard it all before. Don't delay seeking help if you're concerned about a change in your bowel habits."

Dr. Mitchell explains, "Losing weight can be good if you're trying to improve your health. But sometimes, weight loss happens without changing diet or exercise habits. If this happens to you, it could signify a serious health condition. Cancer is one possible cause of unexplained weight loss. Cancer cells use up a lot of energy, leading to weight loss. Other signs of cancer include fatigue, pain, and changes in appetite. See your doctor if you experience any of these symptoms as soon as possible. With early detection and treatment, many diseases can be managed effectively. So don't wait to see a doctor if you're experiencing unexplained weight loss.

Remember, these are just five possible signs that something may be wrong if you have any concerns about your health, it's always best to see your doctor."

Dr. Mitchell says this "doesn't constitute medical advice and by no means are these answers meant to be comprehensive. Rather, it's to encourage discussions about health choices."

Read more:
Signs Your Symptoms are Something Serious, Warn Physicians Eat This Not That - Eat This, Not That

High blood sugar (hyperglycemia) is closely associated with type 2 diabetes, and can lead to serious health conditions if left untreated. "Diabetes is a condition expected to gradually progress over time," says Vidya Aluri, MD. "If type 2 diabetes goes untreated, the high blood sugar can affect various cells and organs in the body. Complications include kidney damage, often leading to dialysis, eye damage, which could result in blindness, or an increased risk for heart disease or stroke. Unfortunately, the effects of high blood sugars are not limited to this." Here are five ways to lower blood sugar, fast. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Eating a healthy, balanced diet and avoiding ultra processed junk food and sugary drinks is a non-negotiable for lowering blood sugar quickly. "If you have diabetes, a healthy eating plan for you is not that different from a healthy eating plan for people without diabetes," advises Harvard Health. "The American Diabetes Association (ADA) echoes the dietary guidelines recommended for the general public that is, a diet centered on fruits, vegetables, whole grains, legumes (peas and beans), and low-fat dairy products. For most people with diabetes, carbohydrates should account for about 45% to 55% of the total calories you eat each day. Choose your carbohydrates wisely ideally, from vegetables, whole grains, and fruits. Avoid highly refined carbohydrates such as white bread, pasta, and rice, as well as candy, sugary soft drinks, and sweets. Refined carbohydrates tend to cause sharp spikes in blood sugar, and can boost blood triglyceride levels."

Intermittent fasting has been shown to be effective in lowering blood sugar and fighting insulin resistance, researchers say. "There is evidence to suggest that the circadian rhythm fasting approach, where meals are restricted to an eight to 10-hour period of the daytime, is effective," says metabolic expert Dr. Deborah Wexler, Director of the Massachusetts General Hospital Diabetes Center and associate professor at Harvard Medical School. Who recommends people "use an eating approach that works for them and is sustainable to them."

Regular exercise is not only good for your overall health, it can help lower blood sugarespecially before meals. "Brief, intense interval exercise bouts undertaken immediately before breakfast, lunch and dinner had a greater impact on post-meal and subsequent 24 h glucose concentrations than did a single bout of moderate, continuous exercise undertaken before an evening meal," says Dr. Monique Francois. "The practical implications of our findings are that, for individuals who are insulin resistant and who experience marked post-meal increases in blood glucose, both the timing and the intensity of exercise should be considered for optimizing glucose control."

Losing excess fat is one of the most effective methods of lowering blood sugar. "Individuals diagnosed at an early stage with type 2 diabetes (known as prediabetes) often see resolution of elevated blood sugars with diet and weight loss," says Dr. Aluri. "We can also prescribe oral medications to keep blood sugars in a healthy range. There are various injectable medications as well, not just insulin, which work on hormones tied to insulin secretion and appetite. We work with people with diabetes as a team, including the physician, diabetes educators and nutritionists all with the patient at the center."

A diet high in fiber has been shown to help prevent insulin resistance and lower blood sugar, experts say. "The results of our study suggest that an intake of approximately one tablespoon of viscous fiber per day, either taken as a fiber concentrate in a form of a supplement added to regular food and beverages, such as psyllium, konjac or guar gums, or by consuming foods that are a rich source of viscous fiber (beta-glucan) such as oats, would result in a significant reduction in hemoglobin A1c (HbA1c) and other diabetes control markers," says Vladimir Vuksan, PhD.6254a4d1642c605c54bf1cab17d50f1e

Ferozan Mast

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Doctors Say This is the Fastest Way to Lower Your Blood Sugar Eat This Not That - Eat This, Not That

High cholesterol is a serious health concern that affects over 94 million adults in the United States, according to the Centers for Disease Control and Prevention.While many don't realize they're at risk because high cholesterol often doesn't show symptoms, major complications like heart disease, stroke and diabetes can happen if left untreated. Eat This, Not That! Health spoke with Dr. Tomi Mitchell, a Board-Certified Family Physician with Holistic Wellness Strategies who shares how harmful high cholesterol is to your overall health. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Mitchell explains, "Cholesterol is a type of fat found in our bodies. It's essential for many functions, including cell growth, hormone production, and digestion. However, too much cholesterol can lead to serious health problems like heart disease and stroke.

So, where does cholesterol come from? Our bodies produce some cholesterol independently, but we also get it from our food. Animal products, such as meat, poultry, and dairy, are exceptionally high in cholesterol. In addition, plant-based foods, such as fruits and vegetables, contain very little cholesterol.

When it comes to our bodies, cholesterol is found in the blood. It's carried by particles called lipoproteins. Low-density lipoprotein (LDL) cholesterol is often called "bad" cholesterol because it can build up on the walls of your arteries and increase your risk of heart disease. High-density lipoprotein (HDL) cholesterol is often called "good" cholesterol because it helps remove LDL cholesterol from your arteries.

Having too much LDL cholesterol in your blood is one of the main risk factors for heart disease. That's why it's essential to eat a healthy diet and exercise regularly to help keep your LDL levels under control. For example, if you have a family history of heart disease or other risk factors for heart disease, your doctor may also recommend medications to help lower your LDL levels."

Dr. Mitchell tells us, "Cholesterol is necessary to properly function many essential body processes, including producing hormones and the digestion of fats. However, too much cholesterol can lead to health problems such as heart disease and stroke. Cholesterol is found in the body: LDL cholesterol and HDL cholesterol. LDL cholesterol is often referred to as "bad" cholesterol because it contributes to plaque buildup in the arteries. HDL cholesterol is often referred to as "good" because it helps remove LDL cholesterol from the streets. The best way to keep your cholesterol levels under control is to eat a healthy diet and exercise regularly. High cholesterol is more than just a number on a lab report. It can seriously impact your health, increasing your risk for heart disease, stroke, and other severe conditions. Here are five ways high cholesterol can affect your health."6254a4d1642c605c54bf1cab17d50f1e

According to Dr. Mitchell, "High cholesterol can cause atherosclerosis, a condition in which plaque builds up on the walls of your arteries, making them narrow and hard. This can lead to chest pain, heart attack, or stroke. Just as too much sugar can lead to cavities, too much cholesterol in the blood can develop plaques in your arteries. Over time, these plaques can harden and narrow your arteries, restricting blood flow to your heart and increasing your risk of heart disease. In addition to heart disease, high cholesterol can increase your risk of stroke, kidney disease, and memory loss. High cholesterol can still damage your health even if you don't have any symptoms. That's why it's essential to check your cholesterol regularly and take steps to keep it under control. By making healthy lifestyle choices and working with your doctor, you can help keep your cholesterol healthy and reduce your risk of severe health problems."

Dr. Mitchell says, "high cholesterol can cause fatty deposits to form in your arteries, making them less flexible and more likely to become blocked. High cholesterol doesn't just clog your arteries. When too much of the waxy substance is in your blood, it can build up on the walls of your arteries (atherosclerosis) and make it hard for enough blood to flow through. That could lead to a heart attack or stroke. The fatty deposits can also affect circulation elsewhere in your body. In atherosclerosis, plaques narrow arteries and reduce blood flow. Over time, the reduced blood flow can cause problems such as:

Coronary artery disease: Plaque buildup narrows the coronary arteries and reduces blood flow to your heart muscle. This can lead to chest pain (angina), shortness of breath, heart attack, and possibly heart failure.

Carotid artery disease: Plaque buildup in carotid arteries decreases blood flow to your brain and increases your risk of stroke.

Peripheral artery disease: Plaque buildup narrows peripheral arteries those in your legs, arms, and stomach which decreases blood flow to these extremities. This can cause pain when you walk (claudication). Unfortunately, too little blood flowing to these areas can heal wounds slowly and make you more susceptible to infections.

Aortic aneurysms: This is a bulge in the aorta wall caused by plaque buildup that weakens artery walls. Aortic aneurysms are often undetected until they rupture, causing internal bleeding that sometimes proves fatal.

Kidney damage: Plaque buildup in renal arteries limits blood flow to your kidneys, which may cause kidney failure." While Satou was going over this, her patient was sweating bullets, not knowing if he was going to live or die with his high cholesterol levels."

High cholesterol can make blood flow through your arteries difficult, leading to high blood pressure," says Dr. Mitchell. "High cholesterol is a problem because it can cause blockages in your arteries. Your arteries are the blood vessels that carry blood from your heart to the rest of your body. When you have high cholesterol, there is a buildup of plaque on the walls of your arteries. This plaque narrows the diameter of the arteries and makes it more difficult for blood to flow through them. Over time, this can lead to high blood pressure, a condition in which the force of the blood against the artery walls is too high. High blood pressure can damage the arteries and lead to heart disease, stroke, and other serious health problems. Therefore, it is essential to keep your cholesterol levels under control to prevent these problems from occurring."

Dr. Mitchell tells us, "High cholesterol can increase your risk of developing blood clots, which can block an artery and lead to a heart attack or stroke. Cholesterol is a fatty substance that is found in your blood. Your body needs some cholesterol to make hormones and other substances, but too much cholesterol can lead to health problems. Atherosclerosis makes it more difficult for blood to flow through your arteries. Blood clots can occur anywhere in the body, but they are most likely to form in an artery with high cholesterol and can cause plaque buildup in your arteries. Plaque is made up of cholesterol, fat, calcium, and other substances found in the blood. Over time, plaque can harden and narrow your arteries. This condition is called atherosclerosis. Arteries become blocked, which can cause a heart attack or stroke. A blood clot is a mass damaged by plaque buildup. A blood clot forms in an artery already narrowed by plaque; it can block blood flow and cause a heart attack or stroke. High cholesterol increases your risk of developing atherosclerosis and forming blood clots. Therefore, controlling your cholesterol levels is essential to reducing your heart disease and stroke risk."

Dr. Mitchell shares, "High cholesterol can damage the lining of your arteries, making them more susceptible to inflammation and injury. Inflammation is the body's natural response to injury or infection. It helps to protect us from harm by fighting off invaders and promoting healing. However, inflammation can also lead to several severe health problems when it becomes chronic. One of the most significant risk factors for chronic inflammation is high cholesterol. When cholesterol levels are too high, it causes a buildup of plaque in the arteries. This plaque narrows the arteries, making them more susceptible to inflammation and injury. Over time, inflammation can damage the lining of the arteries, leading to a condition known as atherosclerosis. Atherosclerosis increases the risk for cardiovascular problems, including heart attack and stroke. If you have high cholesterol, it's essential to take steps to lower it and reduce your risk of developing these serious health problems."

Dr. Mitchell says this "doesn't constitute medical advice and by no means are these answers meant to be comprehensive. Rather, it's to encourage discussions about health choices."

Read this article:
This is What High Cholesterol Does to Your Body Eat This Not That - Eat This, Not That

SACRAMENTO Senator Scott Wieners (D-San Francisco) Senate Bill 923, the TGI Inclusive Care Act passed the Assembly by a vote of 60-11. It now heads to the Senate for final sign-off before going to the Governors desk.

This first-in-the-nation legislation will help create a more inclusive and culturally competent healthcare system for TGI (transgender, gender diverse, and intersex) people in California by requiring:

We need to provide culturally competent healthcare for trans people, saidSenator Wiener. That is the bare minimum when it comes to supporting TGI patients health and wellness. No one should have to go to the doctor only to be misgendered or have their identity undermined in other ways. California needs to be a bulwark against the anti-trans laws and sentiment growing in states like Texas. SB 923 is a first-in-the-nation bill that will set the tone for TGI-inclusive care across the country.

That physician Continuing Medical Education (CME) include evidence-based culturally competent curriculum to help physicians provide inclusive care for TGI people

That the Health and Human Services Agency issue enforceable quality standards for treating TGI patients and recommend curriculum working collaboratively with Departments and TGI-serving organizations

That health insurance companies provide TGI cultural competency training for their staff and delegated entities who are in direct contact with patients

That health insurance companies, in their network directories, include a list of in-network providers who offer gender-affirming services, so that TGI people know where to go for specialized care

That the relevant oversight agencies track and monitor complaints relating to TGI-inclusive care and publicly post findings in their annual reports or website

SB 923 comes at a time when LGBTQ people and particularly transgender children are under attack across the country by right-wing state leaders. Many of those attacks seek to criminalize gender-affirming care. In February, Texas Governor Greg Abbott issued an executive order making it illegal for parents to allow their trans kids to receive gender-affirming care. These parents could have their children taken away and be sent to prison simply for allowing their children to be who they are and receive this necessary care. Abbott called gender-affirming care child abuse. Alabama just enacted a law imposing ten-year state prison sentences on parents and physicians who allow or provide gender-affirming care to their children. In Florida, Governor Ron DeSantis signed the Dont Say Gay law, banning discussions about gender identity and sexual orientation from public school classrooms.

While LGBTQ kids are under attack in Texas, Alabama, Florida, Arizona, and other states, SB 923 shows a different path forward one in which quality gender-affirming care is provided for anyone who needs it, with providers going above and beyond to treat TGI patients with the respect and care they deserve.

Healthcare discrimination and a lack of access to culturally competent care is a major problem that many TGI people regularly face. The National Center for Transgender Equality reports that one-third of all transgender individuals who saw a healthcare professional in 2014 had at least one negative experience related to being transgender, with even higher rates for people of color and people with disabilities. These negative experiences include being refused treatment, verbally harassed, physically or sexually assaulted, or having to teach the provider about transgender people in order to receive appropriate care.

This is especially problematic given that TGI people, compared with the general population, suffer from more chronic health conditions. TGI people experience higher rates of health problems related to HIV/AIDS, substance use, mental illness, and sexual and physical violence, as well as a higher prevalence and earlier onset of disabilities that can also lead to long-term health issues. Sadly, 23% of transgender individuals reported that fear of discrimination caused them to postpone or not receive necessary medical care.

Moreover, while all health plans are required to cover gender-affirming care, it can be difficult for TGI patients to actually find providers who routinely offer this care. This is a major impediment to TGI people accessing the care they need.

Every person deserves to receive quality, compassionate health care from understanding, informed, and respectful providers providers who dont make assumptions about their gender or sexuality, and who honor their bodily autonomy. TGI people already face so many obstacles outside of the healthcare system, including higher rates of violence, workplace discrimination, ostracization from families and religious communities, and housing discrimination. Going to the doctor should not mean facing additional discrimination or unnecessary hardship.

TGI people should have access to positive healthcare experiences. This includes seeing providers who are able to give them the care they need in a non-judgmental and supportive environment, and being able to search for providers who provide gender-affirming services (gender-affirming services include but are not limited to: chest reconstruction, mastectomy, facial feminization surgery, hysterectomy, voice masculinization or feminization, hormone therapy related to gender dysphoria or intersex conditions, gender-affirming gynecological care, or voice therapy related to gender dysphoria or intersex conditions). Gender-affirming care is critically important health care, and anyone who needs it should be able to find and access it.

The TGI-Inclusive Care Act will help create a healthcare system that meets the needs of TGI people, and provide a more positive patient experience.

SB 923 is sponsored by the California LGBTQ Health and Human Services Network, Equality California, National Health Law Program, Trans Community Project, TransFamily Support Services, and Western Center on Law & Poverty.It is co-authored by Assemblymembers Sabrina Cervantes (D-Corona), Evan Low (D-San Jose), Alex Lee (D-Fremont), and Cristina Garcia (D-Bell Gardens).

Follow this link:
Senator Wiener's 1st-in-Nation Transgender-Inclusive Health Care Act Passes Assembly - Senator Scott Wiener

When people go plant-based, it's often not the idea ofgiving up meat that proves difficult. It's cheese. There's a reason for that.In a study on food and addiction, Yale researchers found thatcheese triggers the same neuroreceptors for pleasure that drugs do since cheese contains casein, a dairy protein that during digestion releases casomorphine, which plays directly on the brain's dopamine receptors. So if you think you're addicted to cheese, you probably are. Like most addictions, this one isn't healthy.

If you have ever tried to give up anything addictive, whether it's cigarettes, caffeine, or alcohol, you know that there is usually a painful period of withdrawal followed by a sense of improved health and even natural euphoria. The same is true ofwhat happens when you give upburrata, brie, Jarlsberg, or parmesan. First, it's hard, then you feel so much better. Here's why.

While a handful of studies have come out to say that dairy is not inflammatory, at least some of those have been funded by milk producers. In "fact-checking"the research and its funding,Dr. Neal Barnard, founder of the Physicians Committee for Responsible Medicine (PCRM), has found that even a serving a day of dairy is not good for you and that the proteins in dairy are inflammatory, especially if you areamong the nearly 70 percent of the world's population that has some levelof lactose malabsorption.

When you stop eating dairy, Barnard asserts, inflammation drops on a cellular level, allowing long-sore joints and swollen body parts to deflate and feel relieved. You may lose your under-eye bags, your skin is likely to clear up and the pain in your joints or muscles will subside. You may also find your face and belly become less bloated, all of which is a healthy reactionafter getting rid of an allergen.

Experts estimate that 68 percent of the world's population suffers from some level of lactose malabsorption,a milder degree of lactose intolerance. The best way to figure out if you are in that group is to cut out dairy, especially cheese, and see how you feel after a week or two.

Lactose malabsorption is more common incertain parts of the world, such as Africa and Asia, where the majority of the population have some level of lactose malabsorption.In northern Europe, many people carry agenethat allows them to digest lactose after infancy but babies can have a very hard time with cow's milk, and some are sensitive if the lactating mother is eating dairy and cow proteins are in her body.

In the U.S., less than 40 percent of the population has lactose intolerance. Lactose malabsorption is not full-blown lactose intolerance and can cause symptoms that are mild or moderate, but many of those with lactose malabsorption also have lactose intolerance.

Other than inflammation, whichis driven up by eating cheese and goes downwhen you give up dairy, you may also find that your hormonal balanceshifts for the better when you give up dairy, especially cheese. That's because cheese contains traces of hormones like estrogen and growth hormone, both passed from the lactating cow's milk to humans, according to Dr. Barnard.

Barnard, who wrote a bookcalled Your Body In Balance: The New Science of Food, Hormones, and Health,has explored the ways thatthe traces of estrogen in dairy and cheese can impacthumans and especially women who have struggled with hormonal problems that affect their periods, fertility, and their endocrine system (as is the case with PCOS).

In his book, Barnard tellsstories of patients who have given up dairy and had their symptoms abateand hormonal health restored.While Barnard is notasserting that dairy causes PCOS or that giving up grilled cheese and pizza can cure all menstrual woes, if you look at the overall impact of cheese on the body, less appears to be better, he says.

Back in 2019 Barnard and dozens of other doctors joined together with PCRM to recommend that the FDA require warning labels on cheese,to caution consumers that eating this food raises their risk of breast cancer.

"Dairy products contain traces of estrogens from cows, and as milk is converted to cheese, the estrogens are more concentrated," according to PCRM. "While they are only traces, they appear to be biologically active in humans, increasing breast cancer mortality."

Dairy cows in the US areroutinely injected with Bovine Growth Hormone to increase their production of milk, which is allowed by the FDA, but this also may increase the levels of Insulin Growth Factor-1that gets passed to humans. IGF-1 promotes cell growth, including cancer cells, according to research published in the UK.

Milk, cheese, yogurt, and anything made from these ingredients can contain varying levels of IGF-1, which regulators at the FDA claim is safe for human consumption. Organic milk does not contain these growth hormones, and neither does non-dairy milk and cheese.

Cows are injected with hormones to keep them lactating for longer and to produce more milk every month. So modern-day milk has more hormones in it than the dairy your grandparents drankfrom their local old-fashioned dairy farms of a century ago.

The FDA explains that this is completely fine. An article on the government agency's sitecalled,"Steroid Hormone Implants Used for Growth in Food-Producing Animals" asserts that since the 1950s, theFDAhas approved a number of steroid hormone drugs for use in beef cattle and sheep, includingnatural estrogen, progesterone, testosterone, and their synthetic versions.

Since dairy producers started giving cows massive amounts of growth hormones in the early 1990s, consumers have speculated that these trace amounts that get passed to children could have health impacts such as early puberty, antibiotic-resistant infections, and a higherrisk of cancer. Studies now find that it's likely that obesity is a contributing factor to early puberty, but in a study on IGF-1 and cancer, there was a link.

In the UK, a group of researchers found that IGF-1 was linked to the growth of second primary cancers. That means if you are a cancer survivor, IGF appears to find those cells and help them grow.

To quote the study: "IGF-1 is known to promote cancer development by inhibiting apoptosis and stimulating cell proliferation. Epidemiological studies have reported a positive association between circulatingIGF-1 levels and various primary cancers, such as breast, colorectal, and prostate cancer," but they set out to figure out how IGF helps secondary cancers grow. They found that this hormone helps convert normal cells into cancer cells.

Yet theFDA assertsthat food or dairy from animals who are given growth hormone is fine, and that "studies have shown that the food from the treated animals is safe for people to eat and that the drugs do not harm the treated animal or the environment."

If you are eager to avoid growth hormones in your morning coffee or cereal, choose almond, soy, or oat milk instead.

The public's perception is that soy, which contains plant estrogen, or phytoestrogens, could raise the risk of breast cancer, but in fact, women who eat more soy have less incidence of cancer, studies have found. That's becausephytoestrogens mimic estrogen in a good way and essentially pump the brakes on the body's estrogen uptake.

In large studies of Asian populations in which the women eat a lot of soy, the evidence is strong that the more soy you eat,the lower your overall risk of breast cancer. Soy appears tohave a protective effectin keeping estrogen production in check.

Read More:Does Soy Cause Breast Cancer? Here's What An Expert Says

In a 2021 study that followed nearly 53,000 women for 8 years, tracking daily consumption of milk, a serving a day (or more) was associated withanelevated risk of breast cancer. Consuming as little as one-quarter to one-third cup of dairy milk per day was associated with an increased risk of breast cancer of 30 percent, lead researcher Gary E. Fraser, Ph.D., of Loma Linda University explained. Soy had the opposite effect, the study found.

By drinking up to one cup [of dairy] per day, the associated risk went up to 50 percent, and for those drinking two to three cups per day, the risk increased further to 70 to 80 percent. Most cheese is made from dairy, so while the study was about milk, cheese would be considered dairy food and the results would correlate to cheese.

Read More:Study: One Daily Serving of Dairy Linked to Higher Risk of Cancer

Men who consume dairy are also at elevated risk for cancer. Dr. Shireen Kassam, Ph.D., founding director ofPlant-Based Health Professionals UKwantsmen toknow that there is also an association between dairy and prostate cancer risk, according to scientific studies.

"Acombined analysisof 32 observational studies found that for every 400 grams of dairy consumed daily (justover 1 1/2 cups)correlated with a 7 percent increased risk of developing prostate cancer, and this risk applied to both milk and cheese, she says.

In another review of studiesonplant-based foodsand cancer risk, researchers found that the consumption of plant-based foods reduced the risk of prostate cancer.

Read More:Dairy Increases Risk of Prostate Cancer. What to Eat to Lower It

Cheese is high in saturated fat, linked to an increased risk of heart disease. In the UK, researchers have recommended that people eat no more than a matchbook size sliver a day, and even that may be too much for someone battlinghigh blood pressure, a symptom and a risk factor forcardiovascular disease, according to heart doctors.

Saturated fat has been linked to high cholesterol, blockages that make heart attack and stroke more likely, and calcium deposits that can be fatal if blood flow to the brain, heart, or lungs is hindered. Dr. Joel Kahn, a plant-based cardiologist, says the less sat fat you eat the better.

A study inThe Cochrane Reviewdemonstrated that reducing dietary saturated fat intake lowered the risk of combined cardiovascular events by 21 percent, andthe greater the reduction in saturated fat, the greater the drop in the risk ofcardiovascular events.

This was true both for peoplewho hadno prior history of heart events,and those who had a history of heart disease, Dr. Kahn added. In fact, the reduction in satfat was evenmorepowerful for those who did have known heart disease.

Read More:The Fat Wars Are Over and Sat Fat is a Killer, Says Dr. Joel Kahn

A plant-based diet can lower your risk of heart disease since saturated fat is only found in animal fat and some tropical oils such as palm oil and coconut oil. TheAmerican Heart Associationstates that decades of sound science has proven [saturated fat] can raise your bad cholesterol and puts you at higher risk for heart disease.

The ADA recommends keeping daily saturated fat intake to 5 percent of your daily calories. That means if you eat 2,000 calories a day, no more than 100 of those should come from animal fat, which essentially means going plant-based.

In Dr. Barnard's book

It can take up to 21 days for alltraces of dairy protein to leave your system, according to experts at La Leche League, which helps women who have babies that are intolerant to cow's milk. (Human milk contains lactose but not dairy protein, so it is in a form that babies can tolerate.)

To see the full results of giving up cheese and dairy, you need to give upmilk, cheese, yogurt, and all forms of cow's milk for three full weeks.

But thepositive effects of giving up cheese and dairy will start to be felt much earlier, as soon as just a few days.Still, if you want to know whether dairy is causing your joint pain or inflammation, allow it to fullyleave your system and have zero dairy products for 21 ways and wait until the three weeks are up to evaluate the results.

Will you miss cheese? Does a former smoker. miss cigarettes? Yes, you will miss cheese. But less and less as the days go by and it loosens its grip on you.

Cheese is linked to inflammation in most people, and contains hormones such as growth hormone and traces of estrogen, known to increase the risk of cancer. It takes 21 days for all traces of dairy to leave your system but you can see the benefits when you give up dairy. Just a few changes are that your hormones get back into balance and you'll live free ofjoint pain and bloating.

For the best cheese alternatives, visit The Beet's review of vegan cheese slices and non-dairyvegan cheese shreds.

Continue reading here:
Here's What Happens to Your Body When You Stop Eating Dairy - The Beet

John Otwell was driven by desperation five years ago to search online for a non-pharmaceutical treatment for multiple sclerosis (MS). Thats when he stumbled onto a social media page about the Coimbra protocol.

He read testimonies including one by a young man who was playing piano after being unable to even lift his head, and another by a woman who woke up blind on her 40th birthday but was now back at work and walking four miles a day. She shared an MRI brain scan that showed she had no signs of having had the disease.

Otwells multiple sclerosis (MS) only continued to decline after his diagnosis, even with medication. He ended up in a wheelchair and in mental and physical misery. The neurologist says to you there is no cure. The best hope for you is slow progression, Otwell said. Its a terrible, terrible disease.

His neurologist had told him medicine might slow progression by 40 percent. Yet his physical and emotional health were instead rapidly declining, and the side effects of pharmaceuticals were as wretched as the disease. In April 2017, he started the Coimbra protocolhigh dosing of vitamin Dwith nothing to lose.

Vitamin D is a hormone that is produced in the skin when its exposed to sunlight. Vitamin D is also found in lesser amounts in food. Higher vitamin D levels lower the risk of developing multiple sclerosis, and boosting vitamin D also appears to be beneficial for curbing disease relapsesand even putting symptoms into remission. The Coimbra protocol is based on one of the highest prolonged doses of vitamin D.

Within 41 days of starting the protocol, I wanted to go outside and scream, It works. It works. Oh my God, it works, Otwell said. When I got well, I knew I had my lifes calling. I thought, Everybodys going to listen to me.

It hasnt been easy, though. Hes been mocked and called into question because he isnt a physician.

Otwell is frustrated because some MS patients demand published studies of the protocol. There isnt one, though theres plenty of evidence and published research on vitamin D preventing MS and relapses of the disease.

People will say the meanest things, he said. Theyll repeat the same things their doctors have told them. I say, Thats not true. Research it yourself.

Nevertheless, he isnt deterred from shaking the pharmaceutical industry by the core and spreading the word on the Coimbra protocol. He started a YouTube channel and Facebook group to publish interviews with doctors who are using it to treat their patients, as well as people who are experiencing dramatic symptom reversals.

No, I dont have on a white coat that says Dr. Otwell, he said. One reason [the Coimbra protocol] is going to take off is, Big Pharma is filling us with drugs, and were not getting better. My job is to go up against them.

Dr. Ccero Coimbra, a neurologist and professor at the Federal University of So Paulo in Brazil, refined the protocol after using vitamin D10,000 international units (IU) per dayon patients with Parkinsons disease starting in 2001. He was particularly interested in vitamin D because the hormone is known to stimulate the production of regenerative substances in the brain.

A dose of about 10,000 IU per day is safe to use without medical supervision. This is the amount made by the body when exposed to about 20 to 30 minutes of midday sun.

Using medical literature on the effects of vitamin D on the immune system, Coimbra began treating MS patients with higher amounts of the hormone, which came to be known as the Coimbra protocol. His approach is based on a therapeutic dose of 40,000 to 300,000 IU per day, regular lab tests, medically supervised care, and support supplements that vary by patient.

He was especially interested in MS because its the most common neurological disease. A 2019 study in the journal Neurology estimated that there were more than 900,000 adults living with MS in the United Statesmore than twice the number reported in a 1975 national study.

On his website, Coimbra states: When we started with vitamin D and found out that it was effective, we made a life choice. We left academia behindthis thing of drugs here, drugs there, launches of drugs, testing of new drugs, allegedly satisfactory successes. We put it all aside and thought only of the interest of the patient who was there, at our office, in that moment It has been very gratifying.

As Otwell points out, patients like him dont care about the studies when the disease is raging.

When you hit that wheelchair, you dont give a rip about anybodys study, he said. You just want to get better.

He has been told to be grateful because MS isnt a death sentence. As far as Otwell is concerned, that makes it worse.

Its a suffering sentence. You can lay in a nursing home for 10 years immobilized, he said. Its a terrible disease, and it slowly robs you of physical abilities, mental abilities. Its a slow torture.

Otwell, a 57-year-old former antiques dealer, had many symptoms for 15 years before his diagnosis, including an impinged nerve that resulted in hand surgery yet returned a couple years later.

It wasnt until he staggered into an emergency department in St. Louis with stroke-like symptoms that he got an MRI and a diagnosis.

His first thought was that he could work through his MS if that was the worst it would get. Even his wife commented that he looked happy after finally knowing there was, in fact, a reason for all his symptoms and doctor visits.

Unfortunately, Otwells disease became worse. Within a year and a half of his diagnosis and on a common MS medication, Copaxone, he was in a wheelchair. The side effects of the drug, administered three times a week by a shot in his stomach, made him feel like he was constantly fighting influenza. At times, he thought hed rather die than continue to suffer.

Involuntary movements happened frequently for Otwell, who struggled emotionally as the disease destroyed his body and he realized there was nothing he could do about it. The hardest part for him was the memory loss, because hed had such a great memory before.

My mind was so bad. Your brain moves slow, Otwell said. I would set my credit card on my lap, look at four numbers, pick up the phone to punch it in and could only remember two of four numbers.

He was also constantly stuttering, coughing, choking, twitching, and spasming. His skin was itchy, he was intolerant of heat, and he had severe brain fog.

Otwell spoke bluntly about the symptoms that robbed him of his dignity, like defecating and urinating on himself and scratching his scalp so much that blood dripped down his face. These are not uncommon MS symptoms.

Others include dysesthesia (a squeezing sensation around the torso), fatigue, numbness, tingling, stiffness or spasms in the leg muscles, weakness, vision problems, vertigo, significant pain, and emotional changes, according to the National Multiple Sclerosis Society. Also common are sexual problems and depression.

One criterion for diagnosing MS is to exclude other potential diagnoses. Physicians must also find evidence of damage in at least two areas of the central nervous system, which is composed of the brain, spinal cord, and optic nerves. Evidence must exist that the damage occurred at different times.

Otwell has been using the Coimbra protocol for five years, and nearly all of his symptoms have disappeared.

To get anything back is a victory, he said. Different things came back over months and years, but within 2.5 years everything came back except my ability to walk. My left leg is paralyzed. Fifteen years of misdiagnosis will do that to you.

Coimbra protocol patients are reporting a faster return to normal for those who begin vitamin D earlier in their disease course. Some damage to the central nervous system may be irreversible.

I feel great. I feel better than I did 20 years ago, Otwell said. I cant wait for my eyes to open up every day and share my story.

The Coimbra protocol seems to be just as effective at lowering and ceasing symptoms of other progressive autoimmune diseases. This is because the dysregulated immune system is brought into balance by vitamin D, believed to have a role in T lymphocyte cell production. T cells are produced in response to fighting disease and pathogens.

Coimbra discovered, for instance, that vitiligo lesions diminished in a patient using the protocol for Parkinsons disease. And the relationship between vitamin D deficiency and MS is well-established in scientific, peer-reviewed studies.

Coimbra supervised a study in 2013 on the effect of prolonged high-dose vitamin D supplementation with nine psoriasis and 19 vitiligo patients. They received 35,000 IU daily for six months with a low-calcium diet and high hydration. The condition of patients significantly improved during treatment, with no negative side effects.

In 2011, a study conducted with 209 patients of systemic lupus erythematosus by the Ohio State University Medical Center found that the majority of patients included in the study had vitamin D deficiency. The authors found the more vitamin D in the blood, the lower the lupus disease activity, and vice versa.

As for MS and vitamin D, studies continue to accumulate revealing even higher doses can be safely administered with beneficial results. A study presented at the 2009 annual meeting of the American Academy of Neurology found that high doses of vitamin D dramatically cut the relapse rate in people with MS. Patients in the high-dose groupgiven between 14,000 and 40,000 IU dailyhad lower relapse rates, and their T cell activity dropped significantly, when compared to the group that took lower doses.

The Coimbra protocol website indicates effectiveness for common autoimmune diseases such as rheumatoid arthritis, lupus, psoriasis, Crohns disease, and others.

Coimbra protocol patients live all over the world. A map on CoimbraProtocol.com indicates that physicians overseeing the treatment protocol are located in North and South America, Asia, the Middle East, Europe, and Africathough the total numbers are low.

Patients use social media sites to refer newbies to doctors. Otwell and others are helping to spread the word and hoping to inspire more doctors to accept Coimbra protocol patients.

Ana Claudia Domene, author of Multiple Sclerosis and (Lots of) Vitamin D, details her eight-year experience on the Coimbra protocol.

Year after year, the imaging tests confirm that I have made the best possible decision, she writes in the book. Many lesions simply disappeared, others are still there, like scars, but theres been no progression of the disease. Absolutely no progression at all! This fact in itself is already cause for celebration, and my most profound gratitude to this doctor who has dedicated his life to his patients.

Otwell suspects there are about 100,000 patients being treated with the protocol. There are about 70 physicians in South America and more than 50 in Europe, but only 10 in North Americasomething that frustrates him.

We know that vitamin D heals people. To purposefully withhold it would be malpractice, he said. Ive seen MRIs that are miraculous.

Otwell is motivated by patients to keep posting interviews and speaking out. Too many people with MS believe they may never see their childrens dance recitals or sporting events. He calls his YouTube and Facebook sites MS, There Is Hope!

Theres too many mothers or fathers out there sitting in a chair thinking, My life is over. They already lost their job. Their husband or wife doesnt want anything to do with them, Otwell said.

Otwell longs to deliver hope, but he isnt dispensing medical advice. He reads a disclaimer before every interview he does.

Its vital that Coimbra protocol patients work with a doctor. Underlying conditions may affect whether or how they are treated. Each case is unique. Otwell takes one pill four times a day that includes the correct dosage of vitamin D, and other supplements designed for him personally.

He must drink 2 1/2 liters of water daily, because one of the side effects of high doses of vitamin D is lowered calcium levels, which could cause osteoporosis or kidney stones. He has a blood draw for lab tests every 90 days.

And while hes a big advocate for sunshine, Otwell pointed out that the challenges for people diagnosed with MS include sensitivity to heat, as well as contradictory guidelines.

The recommended daily allowance in the United States is surprisingly no more than 600 to 800 IU and only 2,000 IU by the Vitamin D Council, which warns against high doses of vitamin D, claiming it to be toxic.

Depending on where you live, all you need to get 10,000 to 15,000 IU of vitamin D is to swim outside for about 10 to 15 minutes two or three times a weekwithout sunscreen, according to Overcoming MS, which has a ultraviolet light calculator on its website for determining the amount of sunlight you need based on where you live.

I encourage people to get out in the sun as much as they can, Otwell said. It feels good, and its good for you.

See the article here:
A Simple Protocol Is Stopping the Progression of MS - The Epoch Times

Novartis will spin-off its generics division Sandoz, which includes a portfolio of eight biosimilar products.

In 2018, Novartis granted its generic and biosimilar medicine division Sandoz more autonomy while claiming to be completely committed to the business. Since then, analysts and investors have been hedging their bets as to when the inevitable spin-off would therefore occur. Following a strategic review last year, the Swiss firm has now cemented a separation plan to be completed by the second half of 2023.

Our strategic review examined all options for Sandoz and concluded that a 100% spin-off is in the best interest of shareholders, said Joerg Reinhardt, chair of the Board of Directors of Novartis.

A spin-off would allow our shareholders to benefit from the potential future successes of a more focused Novartis and a standalone Sandoz, and would offer differentiated and clear investment theses for the individual businesses.

Novartis will now dedicate itself to innovative medicines, including its antibody and cell and gene therapy portfolio. It will, however, lose a robust portfolio and pipeline of biosimilars a modality focused on lower-cost biologics it was instrumental in bringing to the fore in both Europe and the US.

In 2006, the firm achieved approval of Omnitrope (biosimilar recombinant human growth hormone [rhGH]) in Europe, and nine years later became the first commercial biosimilar developer to bring a biosimilar to the US Zarxio, a version of Amgens Neupogen (filgrastim).

Beyond these two, the firm has won approval for six other biosimilars across various regions: Erelzi (etanercept), Binocrit (epoetin alfa), Ziextenzo (pegfilgrastim), Rixathon (rituximab), Hyrimoz (adalimumab), and Zessley (Infliximab).

Furthermore, the firm has been instrumental in advocating for such medicines, through industry, physician, and payor programs such as the recently launched Act4Biosimilars roadmap that hopes to increase global adoption of biosimilar medicines by at least 30% in 30+ countries by 2030.

For Novartis, the separation of Sandoz would further support our strategy of building a focused innovative medicines company, with depth in five core therapeutic areas, and strength in technology platforms, said Vas Narasimhan, CEO of Novartis.

In addition, both companies would be able to focus on maximizing value creation for their shareholders by prioritizing capital and resource allocation, employing separate capital structure policies, and increasing management focus on their respective business needs.

Read more here:
Novartis waves bye to biosimilars with Sandoz split - BioProcess Insider - BioProcess Insider

The ban is based on a 173-year-old law, but a lawsuit has challenged it on the grounds it violates a 1985 law permitting abortions before a fetus is viable outside the womb. Other abortion-related news comes from Texas, Indiana, and North Carolina.

AP:GOP Asks Judge To Toss Lawsuit Challenging Abortion BanRepublicans who control the state Legislature asked a judge Tuesday to dismiss Democratic Attorney General Josh Kauls lawsuit challenging Wisconsins 173-year-old abortion ban. Kaul filed the lawsuit in June after the U.S. Supreme Court overturned Roe vs. Wade, the landmark decision that essentially legalized abortion across the country. The ruling gave states the authority to regulate abortion on their own, putting Wisconsins ban back into play. The ban prohibits abortions in every instance except to save the mothers life. (8/23)

In other abortion news from Texas

The Texas Tribune:Abortion Funds Sue To Help Pregnant Texans Get Abortions Outside The StateReproductive rights groups on Tuesday filed a federal class-action lawsuit to head off possible prosecution from Texas officials for helping Texans gain access to legal abortions in other states. (Harper, 8/23)

Dallas Morning News:Under Texas New Abortion Ban, How Will Dallas-Fort Worth DAs Treat Cases?North Texas prosecutors are divided over how to apply a new law that criminalizes abortion, setting the stage for a patchwork of enforcement that varies by county. While Dallas County District Attorney John Creuzot vowed not to bring charges under the abortion ban, prosecutors in neighboring Denton and Tarrant Counties said they will handle the cases like any other felony. Collin County did not respond to requests for comment. (Morris, 8/23)

From Indiana and North Carolina

Indianapolis Star:Indiana Abortion Law: Foster Care, Adoption Services Left In LurchGov. Eric Holcomb signed legislation on Aug. 5 that earmarks about $75 million for pregnant women and children programs in tandem with the state's new abortion restrictions,but child advocates such as Missler say it's just not enough money to solve a major need in the state. (Fradette, 8/24)

AP:Top NC Senator Prefers Abortion Limits After 1st TrimesterNorth Carolinas most powerful state senator said Tuesday he would prefer to have approved restrictions on abortion after roughly the first three months of pregnancy. Senate leader Phil Berger, speaking before convening another round of no-vote General Assembly sessions this week, also said he would support exceptions to any prohibition following the first trimester, such as in situations of rape and incest or when the mothers life is in danger. (Robertson, 8/23)

In other news about reproductive rights and sex education

Bloomberg:Black Women Are Hardest Hit By Abortion Restrictions Sweeping The Deep SouthAcross the country Black patients have an abortion rate roughly four times that of their White peers,in part due tolower use of contraceptionthat leads to higher rates of unintended pregnancies.In the states that have moved quickly to enact restrictions, Black women make up a far larger proportion of abortion seekers than in places where abortion remains legal.(Johnson and Butler, 8/23)

The 19th:Weakening Title X Would Hurt Contraception Access And Gender-Affirming CareJulieAnn Fitzy couldnt ask her doctor for help. She wasnt out yet to her family, many of whom went to the same primary care practice as she did. What if they found out? And besides, her physician wouldnt know where to find someone who offered hormone therapy. (Luthra, 8/22)

The Washington Post:After Roe, Teens Are Teaching Themselves Sex Ed, Because The Adults WontSome teens are part of a burgeoning movement of high-schoolers nationwide who, after Roes fall, are stepping up to demand more comprehensive lessons on reproduction, contraception and abortion and who, if the adults refuse, are teaching each other instead. (Natanson, 8/23)

View post:
Republicans Try To Get Suit Opposing Wisconsin Abortion Ban Thrown Out - Kaiser Health News

By State Rep. Paul Schemel

Gov. Tom Wolf recently grandstanded while signing an executive order he says will protect Pennsylvania residents from the boogeyman of conversion therapy.

Conversion therapy is loosely defined as a medical or psychological treatment intended to help a person with same-sex attraction realign to a heterosexual orientation. Although conversion therapy is frequently associated with long-discredited practices such as electric shock or food depravation, these techniques were abandoned in the 1970s.

Rafael Alvarez Febo, director of the Pennsylvania Commission on LGBTQ affairs, speaks at a press conference regarding Gov. Tom Wolf's executive order discouraging conversion therapy on Aug. 16, 2022.

Conversion therapy can also refer to a method of psychotherapy called talk therapy, where an individual explores feelings and emotions with a therapist in search of realigning with a heterosexual orientation. There are several academic studies demonstrating the general ineffectiveness of conversion therapy as a treatment for homosexuality, which is why this form of therapy is nearly non-existent today.

Gov. Wolfs executive order resurrects the old saw of conversion therapy and significantly broadens its definition to include protections for all manner of other identities, including children experiencing gender dysphoria, a condition more commonly called transgenderism. Under the governors order, children who assert they are transgender must be affirmed in their new gender identity, a treatment method known as the Dutch Protocol or affirmation therapy.

Affirmation therapy begins with accepting and supporting a childs new identity and, in most cases, leads to the child being prescribed drugs to block their natural puberty followed by cross-sex hormones, which give them some permanent outward characteristics of their non-biological gender. These are powerful drugs being prescribed off label with little long-term research to ensure safety. Understandably, many parents have reservations concerning affirmation therapy.

Gov. Wolf would have us believe that affirmation therapy is so universally accepted by medical and mental health professionals that any physician, psychologist, or counselor who uses traditional therapeutic approaches for treating gender dysphoric children is a purveyor of conversion therapy and junk science and thus must be stopped using the full force of the government. However, the world of gender science is not nearly as settled as the governor maintains.

In 2020, I held a series of hearings of the House Subcommittee on Healthcare. Those hearings were designed to inform the General Assembly of the debate within the medical and psychological community concerning the appropriate course of treatment for gender dysphoric children. The subcommittee received testimony from four physicians with significant experience in this field.

Two of the testifiers, both psychiatrists, supported affirmation therapy, whereas the other two, a psychiatrist and a pediatric endocrinologist, did not. In addition to hearing testimony from experts, the subcommittee also reviewed hundreds of pages of data, peer-reviewed journal articles and studies conducted by government agencies in several nations.

What the subcommittees work revealed is that the field of science surrounding affirmation therapy is far from settled. Although many major medical associations and journals promote affirmation therapy, scientists and researchers with evidence challenging this approach report being marginalized, blocked from presenting their research or denied the opportunity to publish their work. In a world that typically welcomes critical input, the dissenting voices of scientists and doctors who are not on board with the latest trend are being silenced.

The governors order extends the same barrier to dissent over healthcare professionals here in Pennsylvania.

Gov. Wolf doubles down on affirmation therapy, referring to it as medically necessary and directing state agencies to investigate providers and insurance companies not toeing the affirmation therapy line. The governors order prevents state resources from being used for any treatment method deemed by the governor to be conversion therapy, which he makes clear is any treatment that does not accept a childs assertion that they are transgender. That may be the opinion of the governor, but it leaves no room for traditional treatment approaches such as watchful waiting and psychotherapy, both of which are well researched and commonly used by professionals in the field.

What does this mean in practical terms? The governors gag order significantly limits the options available to parents by threatening the very professionals on which families with troubled children rely for help. Although some families embrace affirmation therapy for their children, others do not. Now, parents seeking options will find none in Pennsylvania.

This executive order is another example of Gov. Wolfs autocratic brand of governing, repeating the same, I know whats best for you approach rejected by voters in the 2020 referendum checking his emergency powers.

The sad effects of the governors most recent initiative will only become apparent when todays children mature into adults and find themselves permanently scarred and lifelong clients of the drug companies that supply their hormones. By then, Gov. Wolf will be enjoying retirement while families bereft of options today pick up the pieces of their childrens broken lives.

Rep. Paul Schemel represents the 90th Legislative District in the Pennsylvania House of Representatives. He is Chairman of the House Health Committees Subcommittee on Healthcare.

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Gov. Wolfs order denies families reasonable options to help children exploring their sexual identity | Opini - PennLive

Mothers Depression Does Not Worsen Childrens Behavior Symptoms, Study Finds

About 50% of all mothers of children with autism spectrum disorder (ASD) had elevated levels of depressive symptoms over 18 months, while rates were much lower (6% to 13.6%) for mothers with neurotypical children in the same period, UCSF researchers report in a new study published August 26 inFamily Process.

In addition, while past studies suggest having a parent with depression increases the risk that children will have mental health and behavior problems, this study found something different.

We found mothers higher symptoms of depression did NOT predict increases in childrens behavior problems over time, including among families with a child with autism who experience a lot of stress, saidDanielle Roubinov, PhD, UCSF assistant professor in the Department of Psychiatry and Behavioral Sciences, and first author of the study. That was surprising and good news.

Being the parent of a child with special needs is inherently challenging every day, notedElissa Epel, PhD, UCSF professor in the Department of Psychiatry and Behavioral Science, and senior author of the study. It is a prototypical example of chronic stress, which is why we have been focusing on caregiving moms in our studies that examine effects of stress on health.

We already know from this sample that mothers with more depression tend to have signs of faster biological aging, such as lower levels of the anti-aging hormoneklothoandolder immune cells, on average, added Epel. Here, we wanted to understand the impact of their depression on their child, and vice versa.

A One-Way Street

The researchers found that child behavior problems predicted higher levels of maternal depression down the road, regardless of ASD status. They didnt see the inverse effect, however; prior maternal depression didnt predict child behavior problems later.

The finding that maternal depression does not lead to worsened child symptoms is especially important for mothers of children with ASD to help alleviate guilt many mothers feel about their childrens diagnosis and behavior problems, said Roubinov. We hope these findings will reassure mothers that its both common to struggle with some depression in this high-stress situation of chronic caregiving, and that their depression likely isnt making their childs behavioral issues worse.

Self-blame and guilt among parents of ASD children is common andpredicts worsening depression and lower life satisfactionover time, the teams past research shows.

In the current study, the researchers repeatedly measured maternal depression and childrens behavior problems in 86 mother-child dyads across 18 months. Half of the mothers had children with ASD and half had neurotypical children. The age range of children in the study was two to 16 years old, though the majority (75%) of the children were elementary age or younger.

Maternal depression was measured using the Inventory of Depressive Symptoms, a self-report scale completed by mothers. Child behavior was measured through maternal report on the Childs Challenging Behavior Scale, which focuses on externalizing behaviors such as tantrums, aggression and defiance. The researchers said future studies should also look at associations between maternal depression and childrens internalizing symptoms (e.g., withdrawal, anxiety, emotional reactivity).

Few studies on maternal depression, child behavior in ASD context

Bidirectional associations between maternal depression and child behavior problems have been reported in prior research. However, few studies have examined these relationships in families with autism.

Families with autism tend to experience more marital conflict, lower relationship satisfaction, and many other challenges, said Roubinov.

A stressful family environment may spill over onto family members and could change the ways mothers and children relate to each other, she said. We wanted to see whether the link between maternal and child mental health was different in the context of a high-stress family system, such as when a child has autism.

Although the study acknowledged that families with a child with ASD experience high levels of stress, the authors were cautious to note that stress is not their only defining characteristic.

Many mothers of children with autism also report high levels of emotional closeness and positive interactions with their children, Roubinov said. These are important experiences that supportive programs can build upon.

Following the study, the researchers offered mindfulness classes to all parents to help manage parenting stress. The parents were grateful to share common challenges and learn inner strategies to cope, Epel said. Many studies have shown that mindfulness training can help with parenting stress, and we also found our parents showed improved mental health.

It is important to experience and notice positive emotions and joy, despite having a more challenging life situation, said Epel.

Given the effects of chronic stress on health and mood, caregiving parents need extraordinary emotional support in addition to the special services for their child, she said. Its as vital to provide support for parents mental health as it is for childrens mental health.

Physicians should be on the lookout for parental distress and ready to offer resources for parents, especially for parents of special needs children, she said. In the Bay Area, support groups can be found atthe National Alliance on Mental Illnesss California chapter,Support for Families of Children with Disabilities, and through some health insurers.

Co-authors:Brian Don, PhD, and Robin Blades, BS, both from UCSFs Department of Psychiatry and Behavioral Sciences.

Funding:The study was supported by the National Institute of Mental Health (grant K23MH113709); the National Institute on Aging (grants R01AG030424 and R24AG048024);Althea Foundation; Chapman Family Foundation; and John and Marcia Goldman Foundation.

Disclosures:Please refer to the study.

About UCSF:The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.UCSF Health, which serves as UCSF's primary academic medical center,includestop-ranked specialty hospitalsand other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno.Learn more athttps://ucsf.edu, or see ourFact Sheet.

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Half of moms of kids with autism have high depressive symptoms - EurekAlert