Archive for the ‘Hormone Clinic’ Category

Women who experience early menopause may be more likely to face an early onset of progressive multiple sclerosis (MS). That is the finding of a Mayo Clinic study recently published in Brain Communications.

Researchers also discovered that the fewer pregnancies a woman had, the more likely an earlier onset of progressive MS. These results highlight the key role sex hormones may play for women with MS.

It is already well-known that multiple sclerosis affects men and women differently. Women are two to three times more likely to be diagnosed with MS, an autoimmune disease in which the body's immune system attacks the protective sheath that covers nerve cells in the brain and spinal cord. Researchers previously had discovered that women are more likely to developing the relapsing-remitting phase of multiple sclerosis at an earlier age than men, and women have more frequent relapses than men. Meanwhile, men's symptoms tend to worsen faster than women, causing them to enter the progressive phase of the disease more quickly.

Delaying the onset of the progressive phase of MS is important in helping prevent or limit severe disability in the future. That is one of the reasons Mayo Clinic researchers wanted to understand the role women's reproductive histories could play in delaying the onset of progressive MS, says Dr. Burcu Zeydan, a Mayo Clinic researcher and the study's lead author.

The study compared the cases of 137 postmenopausal women with MS seen at Mayo Clinic to 396 postmenopausal women without MS. To identify participants without MS, the researchers relied on the Rochester Epidemiology Project, a unique medical records linkage system, to gather the necessary patient data. They found that women who underwent menopause before 46 were more likely to experience an early onset of progressive MS. Meanwhile, pregnancies appeared to have a positive effect when it came to delaying progressive MS.

"There seems to be an association between the number of pregnancies and the onset of progressive MS," Zeydan says. "The higher the number of pregnancies, the later the progressive MS onset."

That is good news for women with MS who may have avoided pregnancy due to concerns about negatively affecting the disease's progression. Indeed, it is the opposite.

Regarding their findings on the association between menopause and progression, Zeydan cautions that more research is needed to truly understand the potential benefits of perimenopausal hormone therapy. But for patients with MS who are already mulling hormone therapy, this study is worth considering.

"Our findings would be another reason to encourage patients to use hormone therapy," Zeydan says.

Continued here:
Earlier menopause, fewer pregnancies linked to early onset of progressive MS - West Central Tribune

Are you sick and tired of feeling sick and tired? Are you gaining weight without any major diet changes, feeling sluggish, depressed, constipated, weak and aching muscles, dry skin and cant get the heat into you no matter how warm the weather is?

If the answer is yes then it might be worth visiting your GP to get your thyroid checked as you may be suffering from an underactive thyroid know as hypothyroidism.

Hypothyroidism is a condition in which the body doesnt make enough of the thyroid hormone thyroxine. Thyroid hormones help control growth, cell repair, and metabolism.

As a result, people with hypothyroidism may experience the symptoms above, among many others. However many of the symptoms can easily be confused for other conditions and as the symptoms generally appear slowly, sometimes over many years, you may just think your symptoms are a result of growing older.

If hypothyroidism is left untreated more serious symptoms may start to appear, such as a change in voice (hoarseness) a slow heart rate, anaemia and hearing loss to name a few.

Diet and nutrition alone wont cure hypothyroidism and medication alone may not restore your health and energy fully. However, a combination of the right nutrients and medication can help restore thyroid function and minimise your symptoms.

What exactly is hypothyroidism?

The thyroid gland is a small, butterfly-shaped gland that sits near the base of your neck and it makes and stores thyroid hormones that affect nearly every cell in your body.

When thyroid levels are low the thyroid gland receives a signal from the pituitary gland, called thyroid-stimulating hormone (TSH), it then releases thyroid hormones into the bloodstream.

Occasionally, the thyroid gland doesnt release thyroid hormones, even when there is plenty of TSH. This is called primary hypothyroidism and the most common type.

When the pituitary gland is not working properly, the thyroid gland does not receive enough thyroid stimulating hormone in order to make hormones. This is called secondary hypothyroidism.

The thyroid gland may be very small but thyroid hormones are very important. They help control growth, cell repair, and metabolism, this is the process by which your body converts what you eat into energy.

Your metabolism affects your body temperature and at what rate you burn calories. Thats why people with hypothyroidism often feel cold and tired and may gain weight easily and find it hard to lose weight no matter how hard they try.

How does hypothyroidism affect your metabolism?

The thyroid hormone helps control the speed of your metabolism. The faster your metabolism, the more calories your body burns at rest. So as people with hypothyroidism make less thyroid hormone, the result of this is they have a slower metabolism and burn fewer calories at rest.

Having a slow metabolism comes with several health risks. Low levels of thyroid producing hormones, such as T3 and T4, can change the way the body processes fat.

This can lead to high cholesterol and clogging of the arteries, both of which can potentially lead to serious heart related problems.

If you find it difficult to maintain your weight with hypothyroidism, try doing moderate or high intensity cardio.

Which nutrients are important for thyroid health?

Several nutrients are important for optimal thyroid health.

Iodine

Iodine is an essential mineral thats needed to make thyroid hormones. Therefore, people with iodine deficiency might be at risk of hypothyroidism. consider adding iodized salt to your meals or eating more iodine rich foods like seaweed, fish, dairy, and eggs.

Selenium

Selenium helps activate thyroid hormones so they can be used by the body. This essential mineral also has antioxidant benefits, which means it may protect the thyroid gland from damage by molecules called free radicals. Adding selenium rich foods to your diet is a great way to boost your selenium levels. This includes Brazil nuts, tuna, sardines, eggs, and legumes.

Zinc

Like selenium, zinc helps the body activate thyroid hormones. It has been shown that zinc may help the body regulate TSH, the hormone that tells the thyroid gland to release thyroid hormones. Although zinc deficiencies are rare, if you have hypothyroidism, you should aim to eat more zinc rich foods like oysters and other shellfish, beef, and chicken.

Foods to avoid

Foods that contain goitrogens should be eaten in moderation and ideally cooked first.

You should also avoid eating highly processed foods, as they usually contain a lot of calories, sugar and trans-fats. This can be a problem if you have hypothyroidism, as you may gain weight easily and a diet high in processed foods may lead to fatigue.

Here is a list of foods you can eat in moderation. These foods contain goitrogens or are known irritants if consumed in large amounts.

* soy-based foods:tofu, tempeh edamame beans, soy milk, etc.

* cruciferous vegetables:broccoli, kale, spinach, cabbage, etc.

* certain fruits:peaches, pears, and strawberries

* beverages:coffee, green tea, and alcohol these beverages may irritate your thyroid gland

Foods to eat

There are plenty of food options for people with hypothyroidism, including:

* eggs:whole eggs are best, as much of their iodine and selenium are found in the yolk, while the whites are full of protein

* meat:all meats, including lamb, beef, chicken, etc.

* fish:all seafood, including salmon, tuna, halibut, etc.

* vegetables:all vegetables cruciferous vegetables are fine to eat in moderate amounts, especially when cooked

* fruits:all other fruits, including berries, bananas, tomatoes, etc.

* gluten-free grains and seeds:rice, buckwheat, quinoa, chia seeds, and flax seeds

* dairy:all dairy products,

* beverages:water and other non-caffeinated beverages

People with hypothyroidism should aim to eat a balanced diet based around vegetables, fruits, and lean meats.

If you think you have symptoms of an underactive thyroid, your first port of call would be to make an appointment with your GP to have a thyroid blood test done.

If you have an underactive thyroid and need support around dietary changes, why not schedule in an appointment with The Nutri Coach! There is no time like the present My clinic is back open and I am taking bookings for new and existing clients, so just pop me a message if you would like to schedule an appointment. contact details below.

Debbie Devane from The Nutri Coach is a qualified Nutritional Therapist and health & lifestyle coach, Debbie runs her clinic from the Glenard Clinic in Mountmellick and also offers one to one and group online consultations. Debbie is also Nutritionist to the Offaly GAA senior footballers.

For more information or to make an appointment email Debbie at

info@thenutricoach.ie

Ph: 086-1720055

Facebook: The Nutri Coach @debbiedevanethenutricoach

Instagram: the_nutricoach

For more information go to http://www.thenutricoach.ie

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Healthy Living: Are you sick and tired of feeling sick and tired? - Leinster Leader

I think for sheer exuberance the best day of my life was my last on Everest, she wrote in Conundrum. The mountain had been climbed, and I had already begun my race down the glacier toward Katmandu, leaving the expedition to pack its gear behind me.

She continued: I heard from the radio that my news had reached London providentially on the eve of Queen Elizabeths coronation. I felt as though I had been crowned myself. For a Britain that was fast losing its empire, the conquest of Everest was greeted with nationalistic euphoria.

As a correspondent with The Times and later with The Guardian, Ms. Morris wrote about wars, famines and earthquakes and reported on the trial in Israel of Adolph Eichmann, the Nazi war criminal who was convicted and executed for his leading role in the extermination of millions of Jews.

She also covered the trial in Moscow of Francis Gary Powers, the United States spy plane pilot who was shot down over the Soviet Union. She traveled to Havana to interview Che Guevara, the revolutionary leader, who was described in Conundrum as sharp as a cat, and to Moscow again to meet with the British intelligence defector Guy Burgess, who was swollen with drink and self-reproach.

It was in the early 1960s that Ms. Morris met with a prominent New York endocrinologist, Dr. Harry Benjamin, an early researcher on transgender people.

He advised her on a slow process of transition that began with heavy doses of female hormones some 12,000 pills from 1964 to 1972, according to the writers own calculations. Ms. Morris wrote, I was about to change my form and apparency my status, too, perhaps my place among my peers, my attitudes no doubt, the reactions I would evoke, my reputation, my manner of life, my prospects, my emotions, possibly my abilities.

From the very beginning of her marriage, Ms. Morris had confided her feelings about her gender identity to her wife, Elizabeth Tuckniss, the daughter of a tea planter.

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Jan Morris, Celebrated Writer of Place and History, Is Dead at 94 - The New York Times

The abortion pill is a simple way to end a pregnancy up to 11 weeks after the first day of your last period.

You can usually carry out part of the procedure at home, which can be more comfortable for some people.

But that can lead to anxiety about whether the pill has worked.

Although a follow-up appointment is the best way to get reassurance, there are a number of signs to look out for that point to abortion pill success.

Most people experience cramping and bleeding within a few hours of taking the second pill, misoprostol.

This is a good indicator that the abortion pill has worked.

Bleeding, or the passing of large blood clots, shows that the fetal tissue is exiting the body. Cramping helps the uterus return to its usual state.

Your healthcare provider will also schedule a follow-up appointment a couple of weeks later to check that the abortion pill worked.

The abortion pill comes in two separate doses. The process usually takes 1 to 2 days to complete.

You may experience symptoms for a few weeks after taking both pills.

Youll first have an appointment with a nurse or doctor who will ask about your medical history and explain how the process works.

If you havent had a recent ultrasound, they will perform one to see how far along the pregnancy is.

At this appointment, the healthcare staff will give you the first pill, mifepristone. In many cases, they will ask you to take it there and then.

The second pill, misoprostol, can be taken between 24 and 48 hours after the first one.

You may be given an oral dose or a slowly dissolving tablet thats placed in your vagina, under your tongue, or between your teeth and cheek.

Some people return to their healthcare provider to take misoprostol, while others take it at home.

Within 1 to 4 hours of taking the second pill, your body should begin to cramp and bleed.

Its common to pass the pregnancy within 4 hours, but it can take a few days for some people.

You may also experience lighter bleeding and cramping for a few weeks afterward.

A follow-up appointment with your healthcare provider usually takes place around 2 weeks after taking the pills.

A medical abortion uses two medications in the form of a pill to end a pregnancy.

Mifepristone is the first pill.

It blocks an important pregnancy hormone called progesterone. This results in the breakdown of the uterine lining and stopping the growth of the embryo.

The body soon realizes that the pregnancy cant continue, so the second medication, misoprostol, helps the body push out the embryo through the vagina.

The body does this by causing the uterus to contract, which leads to a similar level of cramping and bleeding as a miscarriage.

The abortion pill is highly effective, but its effectiveness does decrease the further along the pregnancy is.

For example, the medication works for 94 to 98 percent of people who are 8 weeks pregnant or less.

This reduces to 91 to 93 percent effectiveness for those who are between 9 and 10 weeks pregnant.

A 2011 research review found no evidence of a difference between the effectiveness of medical abortions and surgical procedures.

And, according to the University of California, San Francisco, only around 3 to 5 percent of people need a surgical abortion after a medical one.

But certain factors can change effectiveness.

An abortion pill wont work if you have an ectopic pregnancy or dont take both medications correctly.

Similarly, you shouldnt have a medical abortion if you have an IUD or certain medical conditions, like a bleeding disorder.

Healthcare staff will check all of the above and provide clear instructions before giving you any abortion medication.

Many liken the feeling of a medical abortion to an early miscarriage.

After taking the second pill, youll likely experience abdominal cramps and heavy bleeding for a few hours.

Depending how far along the pregnancy is, you may pass larger tissues that are brown or red in color, and may be able to see the white pregnancy sac.

Misoprostol can also cause:

Look after yourself by staying in a comfortable place, whether thats your own home or the home of family or friends.

If you can, take a couple of days off work so you can rest.

Lying down with a hot-water bottle on your abdomen can help relieve any pain. Some find sitting on the toilet to be a more comfortable position.

Youll also need highly absorbent menstrual pads for the bleeding.

If you need pain medication, avoid aspirin, as it can worsen bleeding. Instead, take ibuprofen (Advil, Motrin). It may help to take pain medication around 30 minutes before the misoprostol.

If you feel that something isnt right especially if youre soaking two or more pads an hour for a few hours or have a fever that lasts longer than a day seek medical advice.

Hospitals and clinics dont need to know youve taken the abortion pill if you feel unsafe telling them. Your symptoms mimic a natural miscarriage, so staff wont be able to tell the difference.

As soon as your abortion is complete, your symptoms should begin to reduce.

Bleeding may be lighter, while cramping may not feel so severe. Other side effects like fever or nausea should also disappear.

It may take a couple of days for you to get back into your normal routine, as the process can make you tired.

Its normal to experience lighter bleeding for a few weeks after taking the abortion pill, so dont worry if youre still spotting after your follow-up appointment.

Before the appointment, try to keep track of how much youre bleeding. Be sure to tell your healthcare provider any concerns you have.

Around 4 to 6 weeks after your abortion, your period should return.

Be aware that your body can start to ovulate around 3 weeks after taking the medication, meaning you can become pregnant once again.

Your follow-up appointment may take place over the phone or in person, depending on your and your providers preference.

Its important to attend this so your healthcare provider can check that your body is healing properly. Theyll also look for any signs of infection.

Your healthcare provider will ask you about the process, including:

Your healthcare provider may also physically check the cervix and uterus, perform lab tests to check for the pregnancy hormone, and perform an ultrasound to determine whether the abortion pill worked.

If you opted for a phone appointment, youll often be given a pregnancy test to take at home.

Avoid taking an at-home test too soon after an abortion, as the pregnancy hormone may still linger in your body. Its best to wait 4 weeks to avoid a false-positive result.

Although the abortion pill is effective in the vast majority of cases, theres a small chance that it may not work.

Your healthcare provider will be able to determine this at your follow-up appointment.

If youre still pregnant, your healthcare provider will discuss other abortion options.

You may be able to take another dose of the abortion pill, or you may need a surgical abortion instead.

If youre having trouble finding a clinic in your state or want more information about the abortion process, the following organizations can help:

Remember that its perfectly normal to experience a wide range of emotions after an abortion.

If you need to speak to someone about how youre feeling, consider a post-abortion counselor.

All-Options and Exhale offer various forms of free support, including over-the-phone counseling and a confidential text line.

Lauren Sharkey is a U.K.-based journalist and author specializing in womens issues. When she isnt trying to discover a way to banish migraine, she can be found uncovering the answers to your lurking health questions. She has also written a book profiling young female activists across the globe and is currently building a community of such resisters. Catch her on Twitter.

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How to Know If the Abortion Pill Worked and What to Do Next - Healthline

DEIR AL-BALAH, Gaza Strip, Palestine I always encourage the women I know to do a self-examination and regular screenings, Intisar, 55, told UNFPA. She is a breast cancer survivor from Deir al-Balah in the Gaza Strip, and her outspokenness about the topic is a rarity in her community.

The incidence of breast cancer has been increasing in Palestine in recent years partly due to growing awareness and detection, but also because of lifestyle and dietary habits related to poverty. It is the most prevalent cancer among Palestinian women, accounting for 32 per cent of cancer diagnoses in the West Bank and 18 per cent of those in the Gaza Strip.

Breast cancer is most treatable when detected early. Unfortunately, more than 60 per cent of breast cancer cases in Palestine are found at a late stage, reducing the chance of survival.

Women with breast cancer also face serious stigma.

In Palestine, it is widely understood that vulnerability to breast cancer can be hereditary. As a result, some women avoid getting screened because they fear a breast cancer diagnosis could affect their daughters marriage prospects. Women with breast cancer have also faced gender-based violence and abandonment. A recent UNFPA study showed that breast cancer stigma is a major cause of delayed detection and treatment.

Advocates for breast cancer awareness speak to women at the Islamic University in Gaza. Image courtesy of Culture and Free Thought Association

Intisar was fortunate to have the support of her family when she received her breast cancer diagnosis in 2016. But the social stigma left her feeling depressed and isolated.

UNFPA works with the Ministry of Health to improve detection and treatment efforts, and coordinates a breast cancer working group.

Working with Augusta Victoria Hospital and the Palestinian Medical Relief Society, and with funding from the Government of Japan, UNFPA has deployed a mobile breast cancer screening clinic to marginalized communities in the West Bank.

UNFPA also works closely with the Culture and Free Thought Association (CFTA) and the Campaign for the Children of Palestine to support breast cancer patients in Gaza. After Intisar received chemotherapy, she started to visit the CFTA for services.

There, she received a wig, dignity kits with hygiene products, hormone therapy, vitamins, medication and financial assistance. The association also helped her receive a mastectomy operation and prostheses. CFTA also provided psychosocial support, recreational activities and group outings.

I met women who became my real friends, Intisar recalled.

These services, as well as community awareness sessions, are supported by UNFPA with funding from the Government of Japan. Awareness is essential, experts say.

The aim is to increase awareness on the importance of early diagnosis for breast cancer for both women and men, said Firyal Thabet, director of the Women Health Centre at CFTA.

We do this by online campaigns, radio coverage, and by involving mosques, hair salons and taxi companies. Now we see more and more women and men coming to our centre for screening.

CFTA holds a recreation day for women at Al-Gouna Resort. Image courtesy of Culture and Free Thought Association.

Swift access to treatment services is also crucial. A recent evaluation of UNFPAs projects on breast cancer found that, among the projects clients, the average time from diagnosis to initiation of treatment fell from 6 months to 7 days between 2016 and 2018.

Still, some treatment options remain out of reach.

Intisar needed to receive radiotherapy, but no such services were available in Gaza. CFTA helped her obtain a permit from the Israeli authorities to receive treatment at Augusta Victoria Hospital in East Jerusalem, but her permit application was rejected five times before she was finally granted permission.

In 2018, almost 40 per cent of Israeli permit applications for Palestinian patients to exit the Gaza Strip to receive treatment in the West Bank or Jerusalem were rejected or delayed. About a quarter of these applications were for cancer care.

Today, Intisar is a leading advocate for early detection and a peer supporter at CFTA. She also counsels women and girls about the topic in her community. Breast cancer is a start of a new life and not the end of your life, she tells them. Do not give up.

She is also refusing to give up.

A year ago, doctors found a small cancerous tumour on her lung. She is again undergoing chemotherapy.

I am hopeful that I will recover again, she said, with the help of God and those around me.

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For one breast cancer survivor in Gaza Strip, a journey of hardship and hope - UNFPA News

Tossing and turning between the sheets could be the cause of your excessive gas.

Image Credit: KrisCole/iStock/GettyImages

There are a few foods you know are going to give you gas. That's why, before you sit down to a loaded bean chili or try that recipe for cabbage rolls (because, hey, it's a pandemic, so why not), you make sure you don't have anywhere to be.

"Flatulence is normal," says Monica Borkar, MD, a gastroenterologist with NorthShore University HealthSystem in Glenview, Illinois. In fact, you (and everyone else) probably do it around 20 times a day, notes the Cleveland Clinic.

Your diet is a big culprit in creating gas. As you eat, you swallow air, and bacteria in the gut break down food, a process that also leads to flatulence. But did you know there are other things going on in your life that you'd probably never connect to a troubling case of tooting that could do it, too?

Here are seven sneaky causes of excessive gas and what you can do about them.

The stress of the pandemic, your job, caring for kids during e-learning (and the list goes on) could be weighing on your mind and your digestive system. Your gut and brain are in constant communication, and when you're lacking ways to offload stress, your digestion can pay the price, Dr. Borkar says.

Stress may also inadvertently cause you to make less-healthy choices. "We may drink more coffee, eat more sweets, smoke, consume alcohol or chew more gum," Dr. Borkar says. "All of those factors may lead to even more flatulence."

Your fart-free plan: If you're in a time of high stress, it's even more critical to take care of yourself (even if that feels like your last priority). Dr. Borkar recommends focusing on eating a well-balanced diet, which will not only limit your consumption of the culprits above, but will also help keep you regular in the bathroom. "Staying regular often leads to less bloating and gas," she says.

Drink plenty of water and eat fiber-rich foods like fruits, vegetables and whole grains.

2. Youre Taking in a Lot of Air When You Eat

Eating quickly or mindlessly may mean you're gulping more air than normal when you eat, per the Mayo Clinic.

Your fart-free plan: Slow down at meals and snacks. Eat without distractions like the TV or your phone, take small bites and chew thoroughly.

Each time you take a puff, you swallow more air, according to Harvard Health Publishing.

Your fart-free plan: Count this as a bonus benefit of quitting for good.

4. Youre Getting Your Period

Experiencing GI issues during PMS is common. "Fluctuations in the hormones estrogen and progesterone can cause these symptoms," Dr. Borkar says.

Your fart-free plan: Exercising, drinking water and eating a diet low in sodium and with fewer processed foods can help ease PMS, she says.

5. Youre Not Sleeping Well

Whether its due to stress, busyness or too many new shows on Netflix, cutting shut-eye short may be behind your farts.

"Since lack of sleep simulates a stressful situation, our bodies release a stress hormone called cortisol, which can cause bloating and flatulence," Dr. Borkar says.

Your fart-free plan: The National Sleep Foundation recommends adults get seven to nine hours of sleep per night. If you're not getting that many hours in before your alarm goes off, try moving your bedtime earlier by 15-minute increments each night (and stay consistent with when you tuck in, even on the weekends).

6. Its Your Medication

Both over-the-counter and prescription medications, as well as supplements, can cause gas. One common example is NSAIDs (like ibuprofen and aspirin), which you might take to relieve headaches, reduce muscle pain or ease PMS. These might cause gas and bloating as well as diarrhea or constipation, according to the Cleveland Clinic.

Metformin, a common prescription drug to treat diabetes, is linked to flatulence, too, per an April 2017 review in Diabetes, Obesity and Metabolism.

And iron supplements that treat anemia have been found to double the risk of GI side effects, including flatulence, according to February 2015 research in PLOS One.

Your fart-free plan: Take NSAIDs with food or along with an antacid, advises the Cleveland Clinic. If you're on a prescription medication, talk to your doctor about switching, as there may be certain formulations that are better suited for your system (it's important not to stop taking a prescription med without first talking to your doc).

7. You Have a Digestive Condition

There are several conditions that count abdominal discomfort, bloating and gas as symptoms, Dr. Borkar says, including constipation and inflammatory bowel disease (IBD) as well as bacterial or viral infections.

Your fart-free plan: Farting is normal, but if you feel like it's over the top and is accompanied by other symptoms (such as abdominal pain or changes in bowel habits), talk to your doctor.

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7 Causes of Excessive Gas That Aren't Food - LIVESTRONG.COM

The idea of repurposingexisting medicines as a fast approach to containing COVID-19 is still popular, even as vaccines and antibodies designed to combat the disease are starting to gain steam. Scientists at the Cleveland Clinic are among those examining existing compounds as possible treatments for the coronavirus, and now they're suggesting that the popular over-the-counter sleep aid melatonin may be a possible option in treating the disease.

The researchers used an artificial intelligence tool to analyze data from 26,779 individuals in the Cleveland Clinics COVID-19 registry, of whom 8,274 tested positive for SARS-CoV-2, the novel coronavirus that causes COVID-19.

They found that people who were taking melatonin were 28% less likely to test positive for SARS-CoV-2, after adjusting for factors such as age, sex and underlying diseases, according to results published in the journal PLOS Biology.

The melatonin effect was more pronounced in African Americans, with a reduction of 52%. In White Americans, the number was 23%.

Melatonin is a hormone released by the body that regulates the sleep-wake cycle. As a dietary supplement, its commonly used to help manage insomnia andjet lag.

Besides melatonin, the Cleveland Clinic team also found that the beta-blocker carvedilol, sold under the brand Coreg for high blood pressure and other heart diseases, was associated with a 26% reduction in a persons chance of testing positive for SARS-CoV-2.

RELATED:Melatonin? Stem cells? Researchers step up with unconventional approaches to COVID-19

Some members of the same Cleveland Clinic team previously pinpointed melatonin among a group of drugs they suggested might work for COVID. They showed that melatonin and mercaptopurine might work as a good combo for COVID. Those findings came from a pharmacology-based platform that used a technique called network proximity analysis. It was based on the idea that some proteins involved in other diseases might hold proximity to a virus interaction with the host.

The researchersapplied the same method in the current study to shed a light on clinical manifestations and pathologies common between COVID-19 and 64 other diseases. Closer proximity would mean a higher likelihood of pathological associations between the diseases.

They found that proteins involved in respiratory distress syndrome and sepsis were highly connected with SARS-CoV-2. That wasnt a surprise given that the two disorders can also cause death in patients with severe COVID-19.

This signals to us that a drug already approved to treat these respiratory conditions may have some utility in also treating COVID-19 by acting on those shared biological targets, Feixiong Cheng, Ph.D., the studys senior author, said in a statement.

Overall, they identified close network proximity to SARS-CoV-2 proteins from inflammatory bowel disease, attention deficit hyperactivity disorder, as well as pulmonary diseases such as COPD. Using a computational model, they identified 34 drugs that were significantly proximal to two or more SARS-CoV-2 host protein sets.

RELATED:COVID-19: Bio researchers race to repurpose everything from antiviral to anticancer discoveries

A team at Columbia University has also linked melatonin with increased likelihood of clinical improvement among critically ill COVID-19 patients on intubation or mechanical ventilation.

The sleep-promoting supplement was also reportedly used by President Donald Trump during his COVID-19 infection, though its not clear if he was taking it specifically to treat the disease or as part of his daily nutrition routine.

Despite melatonin emerging as a top pick from the Cleveland Clinic registry, Cheng cautioned that larger, randomized control trials would be needed before the supplement could be widely adopted in the treatment of COVID-19.

Cheng added that AI-based approaches to analyzing COVID-19 patient registries should be embraced in the effort to find effective treatments for the disease.Recent studies suggest that COVID-19 is a systematic disease impacting multiple cell types, tissues and organs, so knowledge of the complex interplays between the virus and other diseases is key to understanding COVID-19-related complications and identifying repurposable drugs, Cheng said. Our study provides a powerful, integrative network medicine strategy to predict disease manifestations associated with COVID-19 and facilitate the search for an effective treatment.

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Cleveland Clinic team draws a link between COVID-19 protection and the sleep aid melatonin - FierceBiotech

SEATTLE A federal judge in Seattle has awarded $10 million to the family of a severely disabled child who was born after a community clinic nurse inadvertently gave the mother a flu shot instead of a birth-control injection.

The Seattle Times reported that US District Judge Robert Lasnik last week awarded the child $7.5 million for her medical, educational and other expenses, on top of $2.5 million in damages for her parents.

After a trial earlier this year, Lasnik found that the mother, Yeseni Pacheco, did not want to become pregnant and would not have become pregnant in 2011 if the nurse at the Neighborcare Health clinic had given her the correct shot.

The federal government is responsible for the damages because the clinic, which serves low-income and uninsured patients, is federally funded.

The familys lawyers, Mike Maxwell and Steve Alvarez, described the case in court documents as a wrongful pregnancy and wrongful life case. They said the case was a hard-fought battle and sharply criticized the government for refusing to accept responsibility at the outset.

Luis and Yesenia Pacheco are pleased that theyre closer to receiving the funds needed for their daughters extraordinary medical care and training, they wrote in a statement. It was a long hard road for the family.

Emily Langlie, a spokeswoman for the US Attorneys Office in Seattle, which defended the lawsuit, said some of the delays were necessary to ensure medical experts could accurately measure the extent of the childs disabilities.

Pacheco, an El Salvadoran refugee who moved to the US when she was 16, had gone to the clinic for a quarterly injection of Depo-Provera, a hormone used for birth control.

A nurse at the clinic who had been administering walk-in flu shots all day apparently did not check Pachecos chart and gave Pacheco the flu vaccine instead, the court found.

Pacheco didnt discover the mistake until she called to make her next appointment, more than two months later. By then, she was pregnant.

The child is now 8 years old and in third grade at an Everett-area school, north of Seattle.

According to court documents, she suffers from a birth defect known as bilateral perisylvian polymicrogyria (PMG), which has resulted in cognitive delays, slowed speech and language skills, epilepsy, vision problems and other complications.

She has an IQ of 70, according to the familys attorneys. Maxwell said that she will live a normal life span, and will require some level of care and assistance for her entire life.

Justice Department lawyers are asking that some of the award be placed in a reversionary trust that would return to the government if the girl does not need it.

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Judge awards $10M to family in 'wrongful life' case - West Haven Observer

While people are glad to have access to technology like Zoom and Facetime to stay connected with friends and family, this does not fully meet the need for social interaction that human beings need to thrive, said Dr. Emily Sander, psychologist at Mayo Clinic Health System in Red Wing. The reality of human connection is that aspects of communication that build trust and connection, such as touch and eye contact, cannot be accomplished via video technology.

Online meetings she has observed during the pandemic involve more uncomfortable silence as well as less social chatter, less laughing than pre-pandemic in-person meetings. She said this might be caused by failing to activate our mirror neurons, which are brain cells that allow us to reflect the facial expressions, body language, and emotions of others.

Emily Sander, psychologist at Mayo Clinic Health System in Red Wing. Submitted photo

When humans are together, these mirror neurons activate automatically, giving us a wealth of data that fosters communication, connection, and learning, Sander said. When we are not able to be physically present with others, we are left without much of this data, and the quality of the interaction is diminished.

Jessica Wiskow, school counselor at Ellsworth High School, said extended online meetings and classes have caused Zoom fatigue in some of the teachers.

So much of our communication comes from nonverbal cues, and when in groups where people are only focusing on the main speaker many nonverbal cues are missed, Wiskow said. I think its hard to feel engaged and supported when half of the message is lost in translation.

She said the strength of human relationships is critical in education. Teachers and staff at Ellsworth High School have been working

Jessica Wiskow, counselor at Ellsworth High School in Ellsworth. Submitted photo

I feel this paid off last spring when we were shut down, she said. We were able to cash in some of the relationship equity we built with the students to engage them during a very scary time.

Another concern about screen time is the drug-like effect it can have on the brain, because screen-based activities trigger the release of dopamine, which Sander said is often called the happy hormone.

These activities impact the reward system in the brain in a way that is similar to addictive substances or addictive behaviors, like gambling, Sander said. This was an issue in households across the world long before COVID-19, but the limitations of the pandemic have made finding alternatives to screentime far more difficult for many individuals and families.

For students, distance learning has created problems with appropriate study spaces, anxiety, parental support, and learning styles.

If there is one thing that this pandemic has confirmed for me is that every individual child and adolescent learns differently, Sander said. The primary motivator that makes many students excited to go to school each day is simply not the same in a distance-learning format, and that is getting to spend time with friends.

Sitting for hours in front of a screen is not healthy for anyone, Sander said, and she encourages families to set up screen free times and model healthy boundaries in using devices. Breaking sessions of screen time up with other activities, especially those that involve some movement like sports, yoga, games or family walks can provide relief from added screen time.

Movement supplies oxygen to the brain, promotes the creation of new brain cells, and helps those brain cells make connections, Sander explained. Movement also increases energy, reduces stress, and soothes the mind and bodily tension.

With many families involved in remote work as well as distance learning, it may be harder to keep to some standard routines like getting enough sleep.

I firmly believe that every household should have a tech curfew where screens are put away at least 30 minutes prior to bedtime each night, Sander said.

Sander said some adults who feel limited using technology might experience more distress when they attempt to communicate and struggle with the technology.

While there are many challenges related to the increase in screen time in all of our lives, every challenge we face in life is an opportunity for growth, Sander said. As we learn to navigate this very new world of heavy screen use in schools, the workplace, and home, I encourage individuals and families to examine their individual needs and to learn to advocate for those needs whenever possible.

As COVID cases continue to increase, no one knows how long our current situation will last, how long the additional screen time will be our lifestyle. Because mobile devices and tablets are relatively new, Sander said our understanding of the impact of screen time on the human brain is also new and is increasing.

While some of the effects may be negative, she recognizes one thing that gives her hope.

Humans are capable of resilience, she said. We can dig in and be resilient for a while, then we see a bit of a crash. People have to regroup and let themselves experience the grief that comes along with all of the changes that we are seeing, then pick ourselves up and continue. My suspicion is that is what we are going to see over time.

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Screen time increases with pandemic adjustments - RiverTowns

Since the FDA approved the abortion pill mifepristone in 2000, self-managed at-home abortions in the US have become increasingly common.

According to the Guttmacher Institute, 39% of all abortions in 2017 were carried out with the abortion pill, also known as medication abortion, compared to 29% in 2014.

With many states still lacking widespread abortion clinic access and the imminent challenging of Roe v. Wade which says pregnant women have the right to abortions without excessive government intervention self-managed abortions with the pills mifepristone and misoprostol are likely to become especially sought-after, Carole Joffe, sociologist and co-author of "Obstacle Course: The Everyday Struggle to Get an Abortion in America,"told Insider.

Here's everything you need to know about medication abortion.

Two pills, mifepristone and misoprostol, are used together to complete a self-managed abortion, Yale University gynecologist Dr. Mary Jane Minkin told Insider.

After a healthcare provider explains other abortion options and completes lab tests to ensure you're a good candidate for medication abortion, you'll be given mifepristone and misoprostol, directions on how to use the pills, and a number to call if you need assistance during or after the abortion.

At home, you'll first take the mifepristone, which blocks the production progesterone, a hormone needed to sustain a pregnancy. Right after or up to two days later, depending on your doctor's instructions, you'll take misoprostol, a drug that causes the uterus to contract and pushes the embryo or fetus out of your body.

"You will be experiencing, in a sense, a miscarriage," Minkin said.

Misoprostol normally causes cramping and bleeding one to four hours after a patient takes it, according to Planned Parenthood.

Sometimes a self-managed abortion is only done with mifepristone, but research has shown that using both drugs in tandem leads to better outcomes because it prevents the potential need for surgery to remove the fetus.

Afterwards, you'll have a follow-up appointment with a doctor to make sure the abortion is complete.

A person can do a self-managed abortion up to 11 weeks after the first day of their menstrual cycle, Minkin said.

After that, you'd have to explore other options. People with IUDs, bleeding disorders, a suspected ectopic pregnancy, or who are allergic to the pills can't get medication abortions, according to the Mayo Clinic.

The effectiveness of the abortion pill changes depending on close you get to the 11-week cutoff.

For example, the pill is effective between 94% and 98% effective for people who are less than eight weeks pregnant. But for people who are nine to 10 weeks pregnant, the pill is effective 91% to 93% of the time, the Planned Parenthood website says.

Sometimes doctors will prescribe an extra dose of medicine for patients who are closer to the 11-week threshold, which can increase effectiveness, according to Planned Parenthood.

To get the drugs you need for a self-medicated abortion, you'll need to see a gynecologist who's trained and licensed to give you the pills. Most gynecologists have this ability, Minkin said, and you can call and ask ahead of time if you're unsure.

If you can't access a gynecologist in your area, you can order the pill online.

Carafem, a reproductive healthcare provider in Maryland, Georgia, Tennessee, Washington DC, and Illinois, offers both in-person and telemedicine medicated abortion services.

People who want the pill in these states but don't live in driving distance of a brick-and-mortar provider can set up an encrypted video meeting with a physician and then they'll be sent the pills in the mail, according to chief operating officer Melissa Grant.

Grant said Carafem in-person clinics are located in close proximity to states that don't have easy abortion access. Over the summer, Carafem found 30% of their clients drove more than 100 miles to get to their clinics in Washington DC, Nashville, Chicago, and Atlanta, Grant said.

Minkin said medicated abortion is typically less expensive than in-clinic, but cost varies based on your location and insurance coverage.

According to Planned Parenthood, the pill can cost up to $1,000 without insurance.

If you have Medicaid and need an abortion due to rape, incest, or life endangerment due to carrying a pregnancy, all states cover the cost of the pill, according to the Kaiser Family Foundation.

Due to a piece of legislation called The Hyde Amendment, 16 other states use their own funds to cover abortions, including the pill, for reasons outside of the three previously mentioned if you have Medicaid.

Though rare, there are complications that can occur after a self-managed abortion, including excessive bleeding, blood clots, and infection.

If you have any of these symptoms, contact your healthcare provider right away and go to the hospital.

Read more here:
Everything you need to know about the abortion pill, according to a gynecologist - Insider - INSIDER

Karen Russell, MD, Tallahassee Memorial HealthCare Published 12:36 p.m. ET Nov. 16, 2020

Karen Russell, the medical director for cancer research, talks about the importance of research and clinical trials.

Dr. Karen Russell, a cancer and hematology specialist at Tallahassee Memorial HealthCare, speaks with a breast cancer patient at the chemotherapy infusion and exam area of the Cancer Center of the hospital.(Photo: Joe Rondone/Democrat)

While this year has brought a new normal for us all, we found cancer was somewhat hidden in the shadows as the world focused on the COVID-19 pandemic. Nevertheless, cancer unfortunately continued to be disruptive and deadly, especially breast cancer.

Today, breast cancer remains the No. 1cancer in incidence for women and men combined in the United States (not including non-melanoma skin cancers). Through improved access to prevention and better treatment options, it is no longer the highest in mortality as death rates have dropped 40 percent for women between 1989 and 2017.

Yet this year alone an estimated 42,000+ deaths are predicted in the United States (American Cancer Society), which is still too many. With these daunting statistics in mind, we get to work to find a cure.

Every advancement in breast cancer care and prevention has been the result of a clinical trial and the patients who have participated in these trials. Paving the way for progress, clinical trials are how we improve healthcare and ultimately, save lives.

At Tallahassee Memorial HealthCare, we are proud to offer an international network of clinical trials for cancer patients in the Big Bend. Clinical trials are an important piece of the complete care offered at TMH, as they provide the opportunity for patients to receive new and cutting-edge treatments.

Currently, we have six clinical trials active specifically for breast cancer patients. These trials are a mix of large, often government or public sector funded, cooperative group trials among many cancer centers around the world, alternately, those directly run by pharmaceutical companies testing new drugs or new timing/indication for drugs that have worked well.

Four current studies are in the area of aggressive estrogen positive or triple negative breast cancer, using added chemotherapy or immunotherapy before or after surgery in hopes for prevention of recurrence and increased cure.

BWEL is an ongoing cooperative trial led by the Dana Farber Cancer Institute. This study is an intervention of weight loss and fitness counseling after treatment of early breast cancer, where there has been suggestive data that healthy weight and exercise can decrease cancer recurrence. We continue to see robust enrollment to this trial and are encouraged by the patient experience.

We are also part of an anonymous cancer registry trial that compiles data on side effects and quality of life for our patients to improve holistic care. This clinical trial is available to all cancer types.

Finally, we continue to follow patients in an ongoing phase three trial already reporting positive results, using the new drug abemaciclib with hormone blocking therapy after standard treatment. Patients with estrogen expressing breast cancers receiving the new drug have lower recurrence rates (less cancer coming back) in the time studied to date.

In the next few months, we are excited to expand this portfolio with additional trials of novel drugs that continue to offer life-changing results for our patients. Specifically, we will soon be contributing to the COVID-19 Cancer Consortium (CCC-19) led by Vanderbilt University, to further understand how cancer patients have experienced COVID at various stages of their therapy.

Unfortunately, only about three percent of U.S. adult patients with cancer enroll in clinical trials, largely because there is a lack of access for patients to clinical research in many communities. At the very heart of improving cancer care, there must be a local cancer clinic providing accessibility to the people who need it most, and TMH is proud to be the leader in comprehensive cancer care providing access to our region.

We thank you for your continued support for the cancer services and patients at Tallahassee Memorial Cancer Center. For more information on clinical trials, visit TMH.ORG/Cancer.

Dr. Karen Russell(Photo: Tallahassee Memorial HealthCare)

Karen Russell, MD, medical oncologist at Tallahassee Memorial HealthCare

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Cure for cancer is research: Clinical trials pave the way at TMH - Tallahassee Democrat

DEIR AL-BALAH, Gaza Strip, Palestine I always encourage the women I know to do a self-examination and regular screenings, Intisar, 55, told UNFPA. She is a breast cancer survivor from Deir al-Balah in the Gaza Strip, and her outspokenness about the topic is a rarity in her community.

The incidence of breast cancer has been increasing in Palestine in recent years partly due to growing awareness and detection, but also because of lifestyle and dietary habits related to poverty. It is the most prevalent cancer among Palestinian women, accounting for 32 per cent of cancer diagnoses in the West Bank and 18 per cent of those in the Gaza Strip.

Breast cancer is most treatable when detected early. Unfortunately, more than 60 per cent of breast cancer cases in Palestine are found at a late stage, reducing the chance of survival.

Women with breast cancer also face serious stigma.

In Palestine, it is widely understood that vulnerability to breast cancer can be hereditary. As a result, some women avoid getting screened because they fear a breast cancer diagnosis could affect their daughters marriage prospects. Women with breast cancer have also faced gender-based violence and abandonment. A recent UNFPA study showed that breast cancer stigma is a major cause of delayed detection and treatment.

Intisar was fortunate to have the support of her family when she received her breast cancer diagnosis in 2016. But the social stigma left her feeling depressed and isolated.

UNFPA works with the Ministry of Health to improve detection and treatment efforts, and coordinates a breast cancer working group.

Working with Augusta Victoria Hospital and the Palestinian Medical Relief Society, and with funding from the Government of Japan, UNFPA has deployed a mobile breast cancer screening clinic to marginalized communities in the West Bank.

UNFPA also works closely with the Culture and Free Thought Association (CFTA) and the Campaign for the Children of Palestine to support breast cancer patients in Gaza. After Intisar received chemotherapy, she started to visit the CFTA for services.

There, she received a wig, dignity kits with hygiene products, hormone therapy, vitamins, medication and financial assistance. The association also helped her receive a mastectomy operation and prostheses. CFTA also provided psychosocial support, recreational activities and group outings.

I met women who became my real friends, Intisar recalled.

These services, as well as community awareness sessions, are supported by UNFPA with funding from the Government of Japan. Awareness is essential, experts say.

The aim is to increase awareness on the importance of early diagnosis for breast cancer for both women and men, said Firyal Thabet, director of the Women Health Centre at CFTA.

We do this by online campaigns, radio coverage, and by involving mosques, hair salons and taxi companies. Now we see more and more women and men coming to our centre for screening.

Swift access to treatment services is also crucial. A recent evaluation of UNFPAs projects on breast cancer found that, among the projects clients, the average time from diagnosis to initiation of treatment fell from 6 months to 7 days between 2016 and 2018.

Still, some treatment options remain out of reach.

Intisar needed to receive radiotherapy, but no such services were available in Gaza. CFTA helped her obtain a permit from the Israeli authorities to receive treatment at Augusta Victoria Hospital in East Jerusalem, but her permit application was rejected five times before she was finally granted permission.

In 2018, almost 40 per cent of Israeli permit applications for Palestinian patients to exit the Gaza Strip to receive treatment in the West Bank or Jerusalem were rejected or delayed. About a quarter of these applications were for cancer care.

Today, Intisar is a leading advocate for early detection and a peer supporter at CFTA. She also counsels women and girls about the topic in her community. Breast cancer is a start of a new life and not the end of your life, she tells them. Do not give up.

She is also refusing to give up.

A year ago, doctors found a small cancerous tumour on her lung. She is again undergoing chemotherapy.

I am hopeful that I will recover again, she said, with the help of God and those around me.

Continue reading here:
For one breast cancer survivor in Gaza Strip, a journey of hardship and hope - occupied Palestinian territory - ReliefWeb

Crom Rehabilitation puts your physical therapy goals first while striving to keep you safe.

Here in the U.S. and around the globe, were struggling to get used to the new normal, at least for the time being. Really, none of us have ever been through anything like this! Itll be wonderful when COVID is under control but until then, we must all do our part to keep others safe.

Crom Rehabilitation is built on the principle of putting you and your physical therapy goals first but we also need to keep you safe and do as much as we possibly can to avoid spreading this terrible virus while youre visiting our center! When you come into the Crom Rehabilitation Houston clinic, your time and resources will be respected as our professional staff works to create a rehabilitative program that is tailored to meet your needs and help you effectively achieve your therapeutic goals. Together with our team of experienced therapists, we will work towards helping you reach your maximum rehabilitative potential and return to your previous lifestyle without pain or disability.

Our profession has gained some regulatory momentum.Heres some food for thought: our profession has fought hard to get to the level of autonomy and recognition we have garnered this far. The fact that physical therapy has been recognized at the federal level as essential work is monumental. We now have an opportunity to shine and truly show that we have the skills, education, and fortitude to be considered primary care providers for neuromusculoskeletal issues. What better use of our skillset than to assist in this time of crisis in order to reduce the volume of musculoskeletal pain patients in emergency rooms and urgent care? We are trained in use of personal protective equipment (PPE); we understand the science behind viral transmission and can help educate our patients-and their families-on proper handwashing, sanitization, and other ways to mitigate infection.

When we first started hearing about COVID-19 (coronavirus) in the media, it seemed like the chances of a global pandemic-while possible-were more hypothetical than anything. After all, we have seen other health concerns rise and recede-but this part of the world, we have experienced little social impact. And now, here we are almost overnight, it seems we have found ourselves in the middle of a global crisis. And while solutions are in flight, it will probably be some time before things fully return to normal-whatever the new normal may be.

Embrace social distancing.According to the CDC, this entire year is going to remain challenging and as much as many of us are tired of the masks, lockdowns etc its very important that we all do our part! In addition to carrying over sanitization best practices from your home to the Crom clinic, you should also follow similar social distancing guidelines. By nature, physical therapy has some unique challenges when it comes to maintaining a healthy distance between patients and providers. However, here are a few best practices that will reduce the risk of unnecessary contact:

Taking Care of Our PatientsConsidering all the business and financial uncertainty, it is vital that physical therapy practice owners do not forget our overarching mission as healthcare providers: ensuring the health and wellbeing of outpatients. Our patients are our most valuable asset, and many of them fall into the high risk category, which means they are even more scared. Plus, they are hearing all kinds of information, statistics and hypotheticals from people who may, or many are not trusted sources. As their physical therapist, you play the role of care provider, educator, and-now more than ever-a guiding light in the storm ahead.

Taking Care of YourselfThe most important part of this entire crisis is you! This may seem oversimplified, but your first line of defense starts at home. I suspect this wont be news to any of you, but keeping your home environment clean is the key to ensuring you and your family remain healthy as well as slowing the spread of illness, so:

And of course, consume plenty of fresh fruits and vegetables. Chances are that your local grocery store is fully stocked with both at the moment.

There has also been a lot of discussion regarding social distancing, or physical distancing, as the World Health Organization now refers to it, which you should practice at all times. Stick to critical gatherings only and limit them to 10 people or fewer. When you have to leave your home, keep about six feet of distance between you and other people.

Of course, taking care of yourself goes beyond cleanliness and proximity, which is why aggressive hand washing and sanitizing isnt the only thing you should be doing for yourself.

Practice self-careOne of the things that makes this health crisis so unique is that it is not isolated to a single continent or hemisphere-it is everywhere. As a result, the entire world is feeling the effects-both physically and mentally. In moments of stress-and when we experience feelings of helplessness-our brains become flooded with cortisol (the stress hormone) which has been proven to impair brain function, decision-making abilities, and rationalization. For that reason, it is not uncommon for people to turn to unhealthy coping mechanisms. But, as Im sure you know, unhealthy habits can weaken the bodys immunity and when were stressed, our immunity is already less than optimal.

For that reason, it is important to be kind to yourself: go for a walk; meditate; do a quick yoga routine; play with your dog. There are companies that offer extended free trials in light of this crisis (guided meditation apps). And if you find yourself with extra time on your hands, pick up a hobby you wouldnt otherwise have time for: learn an instrument; make a new recipe with the kids; put a dent in your reading list. Devoting time to self-care and wellness is crucial to keeping your mind happy, which will make your body happy, too. These self-care reminders have been extremely helpful to many as they are juggling working, home-schooling children and all the other extra stress that has come along with this pandemic.

Crm Rehabilitation734 North Loop, Houston, TX 77009281-729-5130

For more information, visit cromrehab.com

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What Happens to A Physical Therapy Clinic during COVID-19? - outsmartmagazine.com

Decades of research has shown that singing individually and in groups is good for you on many levels.

Here, according to science, are 10 key benefits of raising your voice in song.

Singing appears to be a stress-reliever. A 2017 study measured the amount of cortisol, the stress hormone, in participants saliva before and after they sang.

Researchers in that study found that the amount of cortisol was lower after singing, an indication that people felt more relaxed after theyd belted out a tune.

They also found singing reduces stress levels whether the participants were singing in a group or by themselves.

Theres a small catch, though: Cortisol only goes down if youre singing in a place that doesnt make you anxious. A similar 2015 study tested salivary cortisol levels after a singing performance, finding that cortisol levels went up in this scenario.

Theres some evidence that singing may boost your immune system and help you fight off illnesses.

A 2004 study compared the effects of singing with the effects of simply listening to music. In two separate sessions, research subjects either sang or listened to music.

Those who sang showed higher levels of immunoglobulin A, an antibody your body secretes to help you fend off infections. Listening to music (without singing along) reduced stress hormones but didnt stimulate the bodys immune system.

When you sing in a group, whether its a large choir or a smaller group, the act of collective singing causes your body to release endorphins. This hormone can help promote positive feelings, and even change your perception of pain.

A 2012 study found that singing, drumming, and dancing in a group triggers the release of hormones that raise your pain tolerance in ways that just listening to music doesnt.

Researchers note that the feelings of social connection, rather than the music itself, seems to be behind the boost in pain tolerance.

Regular singing may change the way you breathe, even when youre not singing. Researchers in a 2008 study interviewed the spouses of choir members, along with the spouses of people who dont sing.

The researchers found that significantly fewer choir members snored. This led them to recommend regular singing as a potential treatment for snoring.

Studies have also shown that people who play wind instruments also snore less than the general population.

These findings have prompted some experts to suggest that singing and playing wind instruments might be helpful for people with obstructive sleep apnea (OSA).

Because singing involves deep breathing and the controlled use of muscles in the respiratory system, it may be beneficial for certain lung and breathing conditions.

Studies have shown that the breathing techniques used with singing may offer benefits for people with the following conditions:

While singing doesnt treat or cure any of these conditions, you may benefit from gaining strength in your respiratory muscles.

Singing also increases the amount of oxygen in your blood, research shows. In addition to the pulmonary benefits, singers also experience improved mood and a greater sense of social connection.

When you sing together with others, youre likely to feel the same kind of camaraderie and bonding that players on sports teams experience.

In one 2014 study involving 11,258 schoolchildren, researchers found that children in a singing and musical engagement program developed a strong sense of community and social inclusion.

In a 2016 study involving 375 adult participants, researchers found that people who sang together in a group reported a higher sense of wellbeing and meaningful connection than people who sang solo.

One of the neurochemicals released when people feel bonded together is oxytocin, also known as the love hormone.

Spontaneous, improvised singing causes your body to release this feel-good hormone, which may help give you a heightened sense of connectedness and inclusion.

People with Alzheimers disease and other types of dementia experience a gradual loss of memory. Studies have shown that people with these conditions were able to recall song lyrics more easily than other words.

In one singing study by the Alzheimers Foundation, participants said it was nice to be able to remember something.

However, the singers found they remembered more than just the lyrics. For some, singing familiar songs suddenly brought back life memories theyd forgotten, too.

Researchers found that singing songs learned at a younger age caused a spontaneous return of autobiographical details for many people.

Singing in a group doesnt just help you with physical pain; it may also help with the emotional pain you feel after youve lost someone you love.

In a 2019 study conducted among people dealing with grief, researchers found that for those who sang in a choir, depression symptoms didnt get worse over time and their sense of wellbeing remained stable.

In fact, the choir singers felt a gradual improvement in their self-esteem during and after the 12-week study. Those in the control group who didnt participate in the singing intervention didnt report this benefit.

Researchers concluded that group singing may be a good option for people who need additional support during a time of grief.

A 2018 study done in the United Kingdom evaluated 20 people in a singing program known as The Sing Your Heart Out project. The participants included people with mental health conditions, as well as the general public.

Researchers found that the participants reported improvements in their mental health, mood, sense of well-being, and feeling of belonging as a result of these singing workshops.

Decades ago, scientists began researching the effects of singing among people who have a hard time with speech due to a neurological condition.

To date, researchers have found that singing improves the speaking ability for people with:

Singing stimulates multiple areas of the brain at the same time. This may enable people with an impairment in one part of the brain to communicate using other areas of their brain.

Singing can also prolong the sounds in each word, which may make it easier to pronounce them.

Singing also makes it easier to incorporate hand-tapping, a method that can help people maintain speaking rhythms that are otherwise challenging.

Because SARS-CoV-2, the coronavirus that causes COVID-19, is known to spread through respiratory particles, public health officials have cautioned against events where people sing collectively.

Researchers are currently advising organizers to keep rehearsals short, small, and ideally, remote. Larger, longer events are likely to be problematic for now.

Using masks, outdoor venues, and physical distancing may help, but are not a guarantee that the virus causing COVID-19 wont spread when people meet to sing in person.

Research on this relatively new phenomenon is being continually updated.

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Benefits of Singing: 10 Ways Singing Boosts Your Health - Healthline

When Supreme Court justice Ruth Bader Ginsburg died in September, many began to lament the potential undoing of a host of human rights milestones. High among them was the federal decision on abortion access.

In 1973, via the landmark Roe v. Wade decision, the Supreme Court ruled that a woman's right to choose an abortion is protected by the Constitution. Earlier this year, in an amicus brief, more than 200 Republican Congress members urged the Supreme Court to reconsider Roe v. Wade. Anti-abortion activists have been setting up legal cases in states such as Louisiana and Mississippi in an effort to have them heard by the Supreme Court. Meanwhile, Illinois lawmakers have promised the state will continue to provide this necessary medical procedure, regardless of any potential decisions that would undo the precedent set by Roe v. Wade.

Before Ginsburg's death, Brigid Leahy, director of public policy for Planned Parenthood of Illinois, and others were already hard at work solidifying protections. "We have been seeing a steady drumbeat of attacks on access to reproductive health care, and attacks on abortion access in particular. These are state-level attacks and they are part of a national strategy to cut off access to abortion," said Leahy.

As part of an effort to combat those attacks, in 2019 Illinois passed the Reproductive Health Act. The point was to ensure any federal decision would not undermine the ability for people to access abortions in Illinois. Now "access to reproductive health care is a fundamental right under Illinois law," Leahy said. The measure affirmed that the state should handle reproductive procedures the same as all other forms of health care. It also required private medical insurance providers that cover maternal health costs to also cover abortion. The state had decided in 2017 abortion would be covered by Medicaid.

The road to care

According to the Illinois Department of Public Health, the number of nonresidents coming to the state for abortions has risen in recent years. Between 2014 and 2018, the percentage grew by more than 90%, up to 5,669 cases in 2018.

Hope Clinic for Women, in Granite City, is near the state's border with Missouri where there is a single abortion clinic left. Hope Clinic is one of the oldest clinics of its kind in the country, founded in 1974. Many early practitioners there were motivated by the desire to prevent the deaths of women, who had limited options for safe abortion before Roe v. Wade, said Alison Dreith, the clinic's current deputy director.

Missouri is one of the states that has passed sweeping restrictions in recent years. As more states make it harder for people to access care, Hope Clinic has provided an increasing number of abortions, Dreith said. In 2017 and the decade prior, the clinic was seeing about 3,000 patients a year, she said. In 2019, the same year the Reproductive Health Act passed, that number was above 5,000. Dreith said the increase was due to the "proactive legislation in Illinois" as well as "restrictive laws also being passed in our neighboring state."

Photo by Julie Lynn

Activists dressed as handmaids observed an Illinois House human services committee meeting in May of 2019 as the Reproductive Health Act was under consideration. The Handmaids Tale is a book by Margaret Atwood, published in 1985, about a dystopian, patriarchal society where fertile women are enslaved as breeders. The book follows the womens attempts to gain their independence. The novel was made into a popular television series on Hulu, with the first episode released in 2017. Handmaid outfits have become common for those demonstrating in support of reproductive health care in recent years.

Along with the increase of clients has come an increase of opposition. "We've seen an insurgence of new protesters coming to our clinic" and the Trump administration has seemingly emboldened them, said Dreith. She said the protesters have physically blocked clients from getting into the clinic. This form of antagonism, while on the rise, is not new. In 1982 a Hope Clinic doctor and his wife were kidnapped by members of an extremist group called the "Army of God."

Dreith said about 65% of patients come from out of state, largely from Missouri. Last year, The New Yorker wrote about Illinois as an "abortion-rights haven." As the article states, it was long before Ginsburg's death that advocates began the fight to codify abortion rights through additional avenues. "Staff from Planned Parenthood offices across the country were holding a strategy session in Chicago on June 27, 2018, when Supreme Court Justice Anthony Kennedy announced his retirement, clearing the way for Trump to appoint Kavanaugh," the article read. One of those people was Brigid Leahy, who told the magazine, "We started looking state by state and asking, where do we need to shore things up." The goal was to ensure "Illinois was as strong on reproductive rights as we could possibly make it," she had said.

Before Roe v. Wade

Abortion is literally ancient history, with evidence of the practice dating back into the pre-modern era. Miscarriages are quite common. One in eight pregnancies end with one, according to some statistics. Some women need an abortion to assist their miscarriage, a medical intervention for a natural process. Regardless of the reason, without legal and safe abortion, women have taken matters into their own hands, using risky self-induced methods or patronizing unregulated and unsanitary providers. "Almost every abortion death and disability could be prevented through sexuality education, use of effective contraception, provision of safe, legal induced abortion and timely care for complications," according to the World Health Organization.

It took an evolution of thought for LuAnn Atkins to see abortion as a human rights issue. Five decades ago, she was one of the first students at Sangamon State University (SSU) now University of Illinois Springfield. Married with two children, she had moved to Springfield in 1966. While at SSU, she earned a degree in "justice and the social order." During that time she was introduced to the women's liberation movement.

Previously, Atkins had earned a college degree in Texas, and had attended the University of Oklahoma where she had been active in campus ministry. While at SSU she took a human sexuality course and read the book Our Bodies, Ourselves. A touchstone of the second wave of feminism and the women's health movement, the book was created "by and for women." First published in 1970, the book was born of cooperative effort. At a women's liberation conference in Boston in 1969, women shared their accounts related to sexuality, pregnancy, childbirth, menopause and other topics largely considered taboo at the time. Some continued to meet and research, and together they published the book which was then distributed at women's centers and regularly taught on liberal college campuses.

Photo courtesy Hope Clinic for Women

Hope Clinic for Women sponsored this billboard on I-55/64, viewable by drivers to Illinois from Missouri.

"It freed me up to think more about my body and how that relates to my total life. And slowly, my values began to evolve," said Atkins. Atkins found out about an organization based in New York City called the Religious Coalition for Abortion Rights (RCAR). The organization still active and now called the Religious Coalition for Reproductive Care began as an "underground network of ministers and rabbis called the Clergy Consultation Service (CCS), formed in 1967, six years before the Roe v. Wade Supreme Court decision legalized abortion in the United States," according to the group's website. RCAR helped women find safe pathways to abortion. Many of those involved were also participants in the civil rights movement. They saw their work for racial justice to be connected to the fight for reproductive health access.

The 1970 book Our Bodies, Ourselves helped many women realize that a lack of adequate and comprehensive reproductive health care was a common problem.

A Methodist, Atkins felt called toward the intersection of faith and women's health. In 1971, she started a chapter of RCAR in Springfield. There were four clergy people who agreed to help counsel women and two volunteers, including herself. Atkins said two OB-GYN doctors in Springfield agreed to refer women to the local RCAR chapter.

At the time, abortion was legal in Kansas City, so women could be referred to seek assistance there. There were also doctors in Chicago who would perform abortions illegally. For later term abortions, some women would fly to New York City. Atkins said there was a couple in western Illinois, a doctor and a nurse practitioner, who would also perform abortions. She said RCAR members would visit providers they referred women to see. "We wanted to make sure that the places we told people about were safe." She would tell the women she counseled, "I'm not here to question you. I'm not here to make sure you're making the right decision. It's up to you. I just want to help you."

In Springfield, local women had founded the city's first birth control center in 1938. According to the Sangamon County Historical Society, the dominating presence of what is now St. John's Hospital meant doctors were largely averse to assisting the effort, as the Catholic health provider opposed all forms of "unnatural" birth control. Volunteers largely ran the clinic, and it went through a series of iterations and names before becoming officially affiliated with Planned Parenthood in the '70s.

Atkins became the executive director in 1973 and held the post until 1980. Her leadership came on the heels of the Roe v. Wade decision. Atkins went on to work in public health before retiring from St. John's hospice program as a social worker in 1997.

While religious leaders and people of faith, such as Atkins, have long been a part of the battle for women's health care access, it's the so-called religious right that is often given the biggest spotlight in the enduring national debate. Organizations such as the Eagle Forum and the Illinois Family Institute continue to lobby against abortion access, arguing that life begins at conception and embryos and fetuses should be protected by the state.

Photo courtesy UIS Archives

LuAnn Atkins addressed the crowd at an SSU honor dinner. This photo first appeared in the fall, 1975 edition of the universitys magazine. The magazine also had an article in it by Atkins where she wrote about how her experience taking a human sexuality course put her on a path to leading the local Planned Parenthood.

In 2017, at the age of 85, Atkins joined others in Springfield as they rallied to defend funding for Planned Parenthood, squaring off against protesters on the other side of the argument. Dressed in pink, her curly white hair under a floral visor, she held a sign that read, "I will not go quietly back to the 1950s."

"I have been very upset, frankly, over the last 15 or 20 years, that there's been a blurring of the lines between how church and state are separated," she said. "We are not a religious state. We are secular." Abortion access means lower mortality rates for women and bodily autonomy, said Atkins. She said of her ideological opponents, "I don't think it's about saving the fetus. It's about controlling women."

Onward

Jenna Gordon is a social worker with Planned Parenthood of Illinois who works downstate. Like Atkins, she said her role is not to tell clients what to do, but to let them know their options, and support their decisions. She counsels clients from a variety of backgrounds. "I'm typically able to help them with some things such as intimate partner violence, sexual assault or financial and familial strain." When it comes to the decision of how to handle a pregnancy, the approach is that the decision must be up to the patient, "in consultation with their health care provider," she said.

"No matter their reason, we want to be there to help and support them, and we always trust our patients to be making their own fully informed sexual and reproductive health care decisions." Planned Parenthood provides sexually transmitted infection screening and treatment, contraception, gender affirming hormone treatment and other services.

Photo courtesy state Rep. Ann Williams

Women dressed as handmaids, a reference to The Handmaid's Tale, to support passage of the Reproductive Health Act in Illinois and rallied at the Capitol in 2019.

When it comes to abortion, many clients still feel the harmful effects of stigma, said Gordon. "Plenty of my patients tell me about the fact that their family or their partner is going to ostracize them or leave them because of their decision to have an abortion," she said. "It is definitely a misconception that people making decisions regarding their abortions do so in a flippant manner. The reality is that most people are putting deep thought and consideration into their decision." She said even though it can be a heavy choice to make, the most common reaction she hears from clients after the procedures is that of relief.

Planned Parenthood of Illinois continues to push for better access and education throughout the state. While Illinois has become a beacon of access, Brigid Leahy said the work of expanding education and access goes on.

One measure the state chapter is lobbying for would repeal the Parental Notice of Abortion Act which requires health care providers to notify the guardian of anyone under the age of 18 prior to performing an abortion. Another proposal aims to ensure more comprehensive sexual education throughout the state. "There is so much more work to do, we are not done. Holding the line and keeping the status quo is not enough," said Leahy.

Contact Rachel Otwell at rotwell@illinoistimes.com.

More here:
Abortion haven - Illinois Times

Actress Emma Roberts says she decided to freeze her eggs when she was diagnosed with endometriosis (Getty)

Emma Roberts has revealed she froze her eggs before falling pregnant with her partner, fellow actor Garrett Hedlund, earlier this year.

The 29-year-old actor told Cosmopolitan: A few years ago, I learned that Ive had undiagnosed endometriosis since I was a teenager. I always had debilitating cramps and periods, so bad that I would miss school and, later, have to cancel meetings. I mentioned this to my doctor, who didnt look into it and sent me on my way because maybe I was being dramatic?

Read more: These will be the biggest dating trends of 2021

Endometriosis affects around 10% of women and occurs when tissue similar to the lining of the womb grows in other places like the ovaries or fallopian tubes. It can cause debilitating cramps and can also contribute to infertility.

When Roberts was officially diagnosed, her doctor also recommended that she should freeze her eggs or look into other options.

Just the thought of going through that and finding out, perhaps, that I wouldnt be able to have kids I did freeze my eggs eventually, which was a difficult process, Roberts continued.

When I found out about my fertility, I was kind of stunned. It felt so permanent, and oddly, I felt like I had done something wrong.

The UK fertility regulator, the Human Fertilisation and Embryology Authority (HFEA), has allowed the use of frozen eggs in fertility treatment in the UK since 2000. But one cycle of egg freezing can cost up to 8,000. A large sum to pay when the birth rate from freezing your eggs is 18%.

Read more: Children as young as 11 are being prescribed nicotine patches by the NHS

However, the data shows that 1,463 of egg freezing cycles were completed in 2017, compared to just 234 in 2010. According to the HFEA, the number of women freezing their eggs in Britain jumped by 523% between 2013 and 2018. This number is only set to increase as clinics have also reported a 50% rise in egg freezing enquiries during lockdown.

Egg freezing has become more common in the last decade or so, as women tend to wait longer to start a family. The Mayo Clinic says egg freezing could be an option for women who dont want to get pregnant now, but might want to at a later date.

Egg freezing is often recommended to women who have a condition that can affect fertility, who need treatment for cancer or anyone who wants to preserve their eggs now for future use.

Watch: Five friends who struggled to fall pregnant have babies within weeks of each other

Firstly, if this is something youre considering then speak to your GP who can give you a full rundown of the options. Egg freezing is not normally available on the NHS unless you are having a medical treatment that could affect your fertility. So youll likely need to seek out a specialised clinic.

Once youre booked in, the process will typically take between two to three weeks. Youll then start IVF which includes two weeks of hormonal injections to help stimulate the ovaries to produce multiple eggs. The eggs are generally collected while the woman in under general anaesthetic and up to 15 eggs can be collected.

Read more: What is squamous cell bladder cancer and what are the symptoms?

Instead of being injected with sperm, as would happen with IVF, the eggs are added to the freezing solution and the eggs are then stored for up to a decade.

Once ready to use, the eggs are thawed and injected with sperm from a partner or a donor. If the egg is successfully fertilised, the embryo is then transferred to the womb in the hope it will lead to pregnancy.

Only a select few are eligible for egg freezing on the NHS, like cancer patients about to start chemotherapy. Most women looking to freeze their eggs will need to pay for it themselves, which can be costly as its unregulated and private clinics set the price.

If you are looking to freeze your eggs, you should budget around 8,000 for the entire process.

This includes 3,350 for the collecting and freezing process, 1,500 for the hormone injections, 350 a year to have your eggs stored and 2,500 for the thawing and embryo transfer process.

According to HFEA, age is the most important factor in success when it comes to freezing your eggs. For example, if a woman freezes her eggs before she is 35 shes more likely to conceive than if she tried to become pregnant naturally over the age of 40.

However, youll need to consider the age you will want to become pregnant, as the eggs can only be stored for 10 years. So if youre getting your eggs frozen at 25, youll need to use them by the time youre 35.

Originally posted here:
Emma Roberts reveals she froze her eggs after fertility struggle: Everything you need to know about the process - Yahoo India News

Al Roker revealed Friday that he has been diagnosed with prostate cancer, saying on NBCs Today show that it was discovered following a routine checkup in September.

"It's a good news-bad news kind of thing," the weatherman said. "Good news is we caught it early. [The] not great news is that it's a little aggressive, so I'm going to be taking some time off to take care of this."

Al Roker ( Nathan Congleton/NBC/NBCU Photo Bank via Getty Images)

Prostate cancer is one of the most common types of cancer in men. In fact, the American Cancer Society estimates that onein ninemen will be diagnosed with it during their lifetime.

Heres what to know about prostate cancer following the news of Rokers diagnosis.

NBC NEWS' AL ROKER ANNOUNCES PROSTATE CANCER DIAGNOSIS

What is prostate cancer and what causes it?

Prostate cancer is a cancer of the prostate, what theMayo Clinic describes as a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm.

Though its not entirely clear what causes prostate cancer, this type of cancer can form when cells in the prostate become abnormal, per the clinic. Not unlike other cancer types, mutations within the DNA of these abnormal cells cause them to grow and divide more quickly than normal, healthy cells.

AL ROKER OPENS UP ABOUT RAISING HIS SPECIAL-NEEDS TEENAGE SON: HE'S 'FULL OF LOVE TO SHARE'

The abnormal cells continue living when other cells would die. The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. Some abnormal cells can also break off and spread (metastasize) to other parts of the body, according to the Mayo Clinic.

What are the signs of prostate cancer?

Prostate cancer usually grows slowly, so some men might not have any symptoms prior to their diagnosis. However, for some, prostate cancer can cause trouble urinating, blood in semen, discomfort in the pelvic area and erectile dysfunction, among other signs.

BELLY FAT MAY INCREASE DEATH FROM PROSTATE CANCER: STUDY

What are the risk factors?

The risk of prostate cancer typically increases with a mans age. Family history is also a factor, and chances can go up with obesity. Also, asRoker noted, Black men are more at risk for prostate cancer, although the reason for this is not clear. Its also more likely to be aggressive or advanced, according to the Mayo Clinic.

The American Cancer Society in its report entitled Cancer Facts & Figures for African Americans 2019-2021 saidprostate cancer is the most commonly diagnosed cancer in Black men.

How is prostate cancer treated?

In some cases, namely in those of low-risk prostate cancer, treatment right away may not be needed. In fact, some men may never need treatment. Instead, doctors sometimes recommend active surveillance, per the Mayo Clinic.

For more aggressive cases, surgery to remove the prostate may be required. Other treatment options include radiation therapy or hormone therapy. Freezing prostate tissue a process known as cryosurgery or cryoablation may also be recommended, as well as chemotherapy or biological therapy, according to the clinic.

Can prostate cancer be prevented?

In general, living a healthy lifestyle can help prevent prostate cancer in men. Eating a healthy diet full of fruits and vegetables as well as choosing healthy foods over supplements, exercising regularly and maintaining a healthy weight can all help to reduce the risk of a prostate cancer diagnosis, the Mayo Clinic says.

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Al Roker reveals prostate cancer diagnosis: What to know about one of the most common types of cancer in men - Fox News

A new study out from The Lancet found that 20 percent of COVID-19 patients are diagnosed with a psychiatric disorder within 90 days after the COVID diagnosis. New research on the virus also covers hospital readmissions, melatonin, testing and more.

The Hill:One In Five Coronavirus Patients Develop Mental Illness Within 90 DaysNew research suggests that people who have survived COVID-19 infections are at a greater risk of developing mental illness.This data, published in The Lancet Psychiatry Journal, indicates that 20 percent of observed COVID-19 patients are diagnosed with a psychiatric disorder such as anxiety, depression, or insomnia within 90 days after being diagnosed. (Kelley, 11/10)

Fox News:9% Of Hospitalized Coronavirus Patients Readmitted Within 2 Months Of Discharge: CDC ReportA report released by the Centers for Disease Control and Prevention (CDC) that looked at hospitalized coronavirus patients found that up to 9% were readmitted within two months of discharge. The likelihood of readmission increased for patients over age 65, those with chronic conditions, those who were discharged to a nursing facility or home health care, and those who had been hospitalized within three months prior to a coronavirus-related hospitalization. (Hein, 11/10)

In other COVID science and research news

Fox News:Melatonin Eyed As Possible Coronavirus Treatment, Study SuggestsMelatonin could possibly have more use than just aiding in a good nights sleep. A new study from the Cleveland Clinic suggests the hormone could be a possible treatment option for those infected with thenovel coronavirus. In an analysis of patient data from the Cleveland Clinic's COVID-19 registry, researchers found that melatonin, a hormone that regulates the bodys sleep-wake cycle, was associated with a nearly 30% reduced likelihood of testing positive for SARS-CoV-2 after adjusting for age, race, smoking history and various disease comorbidities, according to a news release accompanying the study published in the journal PLOS Biology.(Farber, 11/10)

CIDRAP:Preemie Tests Negative After Drinking COVID-19Infected Breast MilkA preterm baby girl delivered via emergency cesarean delivery at 32 weeks remained healthy despite drinking SARS-CoV-2infected breast milk from her mother, a case report today in Pediatrics notes. The infant was born at 1.6 kilograms (3 pounds, 9 ounces). During her first 3 days of life, she was largely on noninvasive mechanical ventilation and given donor human or expressed breast milk. The mother occasionally visited the neonatal intensive care unit (NICU) wearing a facemask and gown. (11/10)

The New York Times:New Type Of Test May Better Discern Immunity To The CoronavirusA new type of test can detect a persons immune response to the coronavirus better than a widely used antibody test, according to research released on Tuesday. The test, if authorized by the Food and Drug Administration, would be the first commercial product to detect the response of a T cell a type of immune cell to the virus. Antibodies have dominated the conversation on immunity since the start of the pandemic, but scientists believe that T cells may be just as important in preventing reinfection. (Mandavilli, 11/10)

The New York Times:Covid-19 Threatens People With Intellectual And Developmental ChallengesPeople with intellectual disabilities and developmental disorders are three times more likely to die if they have Covid-19, the illness caused by the coronavirus, compared with others with the diagnosis, according to a large analysis of insurance claims data. The finding raises complex questions about how to allocate new vaccines as they become available in limited supplies. The drug maker Pfizer announced this week that its experimental vaccine is performing well in clinical trials. (Rabin, 11/10)

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Mental Illness Appears To Be Yet Another COVID Side Effect - Kaiser Health News

Up until now, remdesivir is the only approved drug for COVID-19 treatment and favipiravir has received emergency use authorisation. Many other drugs are in various stages of research. As the number of fresh cases rises again in several parts of the world, scientists continue to work towards finding more preexisting and preapproved drugs to treat and manage the coronavirus infection.

Latest in this series, a group of researchers at the Cleveland Clinic claim that melatonin, the hormone that helps regulate the sleep-wake cycle in humans, may be effective in the management of COVID-19 .

The findings of their study are published in the peer-reviewed journal PLOS Biology.

The study

For the research, the scientists studied the genes and proteins of SARS-CoV-2, the causative agent of COVID-19 , using an artificial intelligence system developed by Lerner Research Institute.

They also identified clinical records from patients at the Cleveland clinic to check for similarities in host genes and proteins between COVID-19 and other diseases including autoimmune diseases, cancer, pulmonary, and neurological and metabolic diseases. The closer the genes, the similar the pathology of the two diseases.

Additionally, the researchers listed about 3,000 FDA approved drugs for their potential usein SARS-CoV-2 treatment.

The findings

Here are some of the findings of the study:

The authors of the study indicated that any medicines used for the treatment of the above conditions can also be used to manage COVID-19 . Out of the 3,000 drugs studied, they found 34 drug candidates could potentially treat the condition, melatonin being the chief candidate amongst them.

Melatonin use was found to be associated with reduced pulmonary inflammation due to a reduction in the levels of certain cytokines and an increase in the levels of anti-inflammatory cytokines.

Clinical registries from Cleveland Clinic also showed that regular use of melatonin was associated with a 30percent lesser chance of testing positive for COVID-19 even after adjusting for age, smoking history, race, and the presence of comorbidities.

However, the authors pointed out that this does not mean you start taking melatonin without consulting your doctor.

Explaining the importance of the findings, Dr Cheng, lead author of the study said in a news release by the Cleveland Clinic, Our study provides a powerful, integrative network medicine strategy to predict disease manifestations associated with COVID-19 and facilitate the search for an effective treatment.

However, the authors added that large-scale observational studies and randomized controlled trials are still needed to confirm the findings of the study.

For more information, read our article on COVID-19.

Health articles in Firstpost are written by myUpchar.com, Indias first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.

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COVID-19 treatment: Melatonin hormone that regulates..p-wake cycle may prove effective in managing infection - Firstpost

Naomi West keeps her medication in a navy blue briefcase in her room. She says its where she keeps all of the most important items in her life things like her research notes for her physics PhD at Rice University.

West started gender-affirming hormone therapy just over a year ago at the Planned Parenthood clinic in Houston. But earlier this spring, she left Houston to save money. Funding for her PhD dried up due to the pandemic. Luckily, it was right when office visits at her clinic went virtual.

Being 200 miles away, [telehealth] has been incredibly convenient, West said. Rather than going to Houston for just a quick discussion.

Early in the pandemic, many providers, including Planned Parenthood, scrambled to find a way to still provide health care. The stay-at-home order and new social distancing guidelines has pushed telehealth into the mainstream. And for transgender patients who often face a lack of access or discrimination, that can provide both an added sense of safety and flexibility.

West moved in with her sister in Austin, a city where she could have found a new provider but that would have meant an interruption in her care. Dr. Bhavik Kumar, medical director of primary and trans care at Planned Parenthood Gulf Coast, said that can be really tough for patients both physically and mentally.

When youve already made that connection and you trust your provider, being able to hold on to that can be so meaningful for folks, especially those already marginalized within healthcare, said Dr. Kumar.

Telehealth at Planned Parenthood took off this year, replacing almost one-third of all office appointments.

For check ups, patients can connect with their providers through video chat. In-person care like blood work or vital signs can be done at a local lab much closer to where the patient lives.

As a result, the clinics have started seeing patients from hundreds of miles away, including rural areas of Texas like Lufkin, Iola and Franklin, as well as out-of-state patients in Alabama and Mississippi.

We are definitely seeing folks from different parts of the state and further away than we did before, said Dr. Kumar.

One reason is because hormone therapy is hard to find in most Texas towns, especially providers trained in transgender competency.

As a transgender person, you have so many questions and uncertainties for your safety, said Evan Mahony, a patient advocate at The Kind Clinic in San Antonio and Austin. Are there going to be gender neutral restrooms at this doctors office? What if I feel afraid that somebody is going to confront me in the parking lot?

According to a 2017 poll by NPR, Harvard and the Robert Wood Johnson Foundation, 20% of transgender people surveyed said they have avoided seeking medical care for fear theyd be discriminated against.

Mahony says that telehealth can be a lot less risky for trans folks.

If this encounter doesnt go well, all I have to do is hang up, Mahony said. Im not going to have to strategize how Im going to leave a place that makes me feel physically unsafe.

Although the pandemic has improved access through telehealth, the economic impacts of COVID-19 on the trans community have added major barriers.

Job losses, especially in the service industry, has made it even harder to afford care that is expensive and not always covered by insurance.

In the spring, like many procedures deemed non-essential, gender affirming surgeries were postponed and some indefinitely canceled.

I know a lot of people in the community who had to cancel the surgery because they had lost income, Mahony said.

Even though Austin has many health care resources, Naomi West said she still travels to Houston every three months to get bloodwork done at her provider. In her experience, freestanding labs are more costly.

Even with the cost of gas, its significantly cheaper than it is to go to any other place, she said.

But West has no doubt that the drive is worth it. She said the therapy has helped her overcome feelings surrounding gender dysphoria.

What hasnt the medication done for me? said West. I feel like a completely different person.

From Houston Public Media

See more here:
COVID-19 Forced Clinics To Adopt Telehealth. That Helped Some Transgender Patients Access Care. - KERA News

Feminizing hormone therapy is a common way for transfeminine or gender non-binary individuals to achieve traditionally female characteristics and feel more comfortable in their own bodies. Here's how it works, what you can expect from the procedure, and important health risks to know.

Feminizing hormone therapy can involve taking estrogen and anti-androgen hormones. An anti-androgen is any drug that blocks the production of male sex hormones, mainly testosterone.

"I usually talk to most of my patients that, in general, hormone therapy is not quick to act. It's a process and it does take a couple of years," Iyengar says.

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To develop the right individualized treatment plan, you should talk with your doctor about what you'd like to gain from feminizing hormone therapy and your preferred timetable, as you can adjust your dosage accordingly.

"Every person is unique based on their own health factors and their family history," says Amy Weimer, MD, a primary care physician with a clinical interest in transgender care at UCLA Health. "But at the very baseline, we typically check blood count and a liver and kidney panel, then may check tests for cholesterol or diabetes or occasionally hormone levels as well."

Blood clots are the best characterized risks for estrogen therapies, says Joshua Safer, MD, an endocrinologist at the Center for Transgender Medicine and Surgery at Mount Sinai Hospital. However, they're not common. A 2017 study found that blood clots form within roughly two of 1,000 people on feminizing hormone therapy.

In some cases, potassium could build up to higher than normal levels in a condition called hyperkalemia, though it is also rare. You should check in with your doctor if you experience the following symptoms of hyperkalemia:

Weimer also says there are a few medical cases where feminizing hormone therapy may be more harmful to your health, such as having signs of breast cancer, colorectal cancer, or any cancer sensitive to estrogen.

Original post:
Feminizing hormone therapy: A guide to the medications, body effects, and health risks you should know about - Business Insider India

In late March, shortly after New York state closed nonessential businesses and asked people to stay home, Ashley Laderer began waking each morning with a headache.

The pressure was so intense it felt like my head was going to explode, said the 27-year-old freelance writer from Long Island.

She tried spending less time on the computer and taking over-the-counter pain medication, but the pounding kept on a drumbeat accompanying her equally incessant worries about COVID-19.

Every day, I lived in fear that I was going to get it, and I was going to infect my whole family, she said.

After a month and a half, Laderer saw a neurologist. But the doctor found no physical cause. An MRI scan was clear.

He asked: Are you under a lot of stress?

People who never had the coronavirus have been reporting puzzling, seemingly unrelated symptoms: excruciating headaches, hair loss, upset stomach for weeks on end, sudden outbreaks of shingles and flare-ups of autoimmune disorders.

Theres a common thread: chronic stress. A growing body of research shows high stress over an extended time can drastically alter physical function and affect nearly every organ.

Surveys have found increasing rates of depression, anxiety and suicidal thoughts during the pandemic. But many medical experts said its too soon to measure the related physical symptoms, which generally appear months after the stress begins.

Still, some early research points to an uptick. Data from FAIR Health, a nonprofit database that provides cost information to the health industry and consumers, showed slight to moderate increases in the percentage of medical claims related to conditions triggered or worsened by stress, like multiple sclerosis and shingles. The portion of claims for the autoimmune disease lupus showed one of the biggest increases 12%.

Perhaps the strongest indicator comes from doctors reporting a growing number of patients with symptoms for which they cant determine a cause.

Dr. Shilpi Khetarpal, a Cleveland Clinic dermatologist, used to see about five patients a week with stress-related hair loss. Since mid-June, that number has jumped to 20 or 25, Khetarpal said.

In Houston, at least a dozen patients have told fertility specialist Dr. Rashmi Kudesia theyre having irregular menstrual cycles, changes in cervical discharge and breast tenderness, despite normal hormone levels.

Stress also is the culprit dentists are pointing to for increases in people with teeth grinding, tooth fractures and TMJ.

When the body feels unsafe whether from a physical threat or fear the brain signals adrenal glands to pump stress hormones. Adrenaline and cortisol flood the body, activating the fight-or-flight response. They also disrupt bodily functions that arent necessary for immediate survival, like digestion and reproduction.

When the danger is over, the hormones return to normal. But during times of chronic stress, the body keeps pumping out stress hormones, leading to increased inflammation throughout the body.

Studies link chronic stress to heart disease, muscle tension, gastrointestinal issues and even physical shrinking of the area of the brain associated with memory and learning. Some people develop new allergic reactions, said Kate Harkness, a professor of psychology and psychiatry at Queens University in Ontario.

For Alex Kostka, pandemic-related stress brought on mood swings, nightmares and jaw pain. Hed been working at a Whole Foods coffee bar in New York City about a month before the pandemic hit, suddenly anointing him an essential worker. As deaths soared, Kostka kept riding the subway to work, interacting with co-workers and working longer hours for a $2-an-hour pay increase. It left the 28-year-old feeling constantly unsafes.

It was hard not to break down on the subway the minute I got on it, Kostka said.

He began waking in the middle of the night with pain from clenching his jaw.

By the end of summer, he started using the seven free counseling sessions his employer offered. That helped, he said. But as the sessions run out, he worries the symptoms might return if hes unable to find a therapist covered by his insurance.

With chronic stress, seeing a doctor can address physical symptoms. But the root is mental, medical experts say. That means the solution will often involve stress-management techniques such as:

Kaiser Health News, a nonprofit health newsroom, is an editorially independent part of the Kaiser Family Foundation.

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Pandemic stress taking its toll on healthy people - Chicago Sun-Times

Sleep is an essential part of the day and without getting the proper rest, it is hard to overcome the stress and the exertion which the body does all day. This sleep time is the bodys resting phase where it prepares itself for the next day. Thats why there are so many sleep aid products available in the market which help in including sleep. All of them are based on melatonin which is a naturally occurring hormone, responsible for sleep regulation. But when a person experiences sleep-related troubles, it means that his body is not making a sufficient amount of this hormone and, he needs a melatonin supplement. All of this makes sense but a new study has highlighted the link between these melatonin supplements and the deadly coronavirus.

According to this new study, melatonin supplements can actually help to fight against the coronavirus is currently involved in a global pandemic. This study is now published in the journal PLOS Biology.

Also read- Special Herbs to Add to the Air Pollution Diet

It investigated the patients who attended the Cleveland clinic from the start of this pandemic to June. Among these people, those who were using some type of melatonin supplement were less likely to diagnose positive for the coronavirus. This risk of coronavirus was 30% less for them as compared to people who dont take melatonin supplements. This risk was calculated after adjusting a number of variables for example age, health status, diet, alcohol and, smoking habits.

This study has discovered new molecular pathways, which are common in both COVID-19 and some other medical conditions. So, it implies that medicines that are FDA approved for treating those other medical conditions can also be tested on COVID-19 patients, assuming that it will help them heal.

For example, the research team identified proteins that were causing respiratory distress as well as sepsis in Covid patients. These two conditions are behind all Covid related complications and death in all patients.

Identifying more of such connections, they were finally able to shortlist 34 medicines which were approved by the US Food and Drug Administration for treating a number of diseases. All of these medicines were also helpful to heal chronic Covid symptoms.

All the data from patients was checked through an AI platform which is designed by Lerner Research Institute. It analyzed all the details collected from patients who attended this clinic which includes their history of medicines and supplements.

This connection between melatonin supplements and coronavirus risk is new and rare. There is absolutely no other study discussing this relation or coronaviruss connection with other hormones. However, it doesnt imply that people should start taking the melatonin supplements on their own as protection against coronavirus.

Previously, when the anti-Covid benefits of hydroxychloroquine came into the limelight, people rushed to the pharmacies and started taking these medicines even without consulting a doctor. Previous US President endorsed it on national television which led people to believe that this medicine will probably save them from the virus, however, this reckless use of hydroxychloroquine ended up with various deaths reported.

Only a randomized clinical-based trial on melatonin supplements given to COVID-19 patients can reveal its true benefits and how it might help in treatment. Unless that trial is done, taking melatonin supplements on your own is not recommended.

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Melatonin Supplements and Coronavirus are Weirdly Linked With Each Other - TheHealthMania

When the children at Sophia Drakes primary school in rural Wales used to talk about what superpower theyd like, she always told them she wanted to be a shapeshifter. But I didnt want to be an animal. I didnt want to be Spider-Man or Muhammad Ali, I just wanted to change into a woman.

Drake was born biologically male. For as long as she can remember, she felt different and uncomfortable, and experimented with whatever identities and fads she could in an effort to belong. Video games saved her. When she discovered them as a child, she found she could get lost in a world where she could embody any character she liked. They took me to places where I didnt have all those issues and problems; I wasnt this confused child, I could pick who I wanted to be, she told me.

While she was growing up, Drake didnt really know what transgender was, aside from something everyone laughed about in the playground when Nadia was on Big Brother or Chandlers dad was on Friends. Her experiments with makeup and cross-dressing were always secret. When she left home for university, she developed an eating disorder and lost half her body weight in a year. Controlling her food intake fed the fantasy that she could finally shapeshift, after all. It made me feel like I had power, for the first time in my life. In 2016, she married her girlfriend, hoping the discomfort would somehow go away. It never did.

Outwardly I was this confused, shy, reserved young adult. But internally, the person I wanted to be was very different. She found that internal person impossible to suppress. That was natural, that was innate, that was me. This, she splayed her palms across her face that people saw, was the mask. I didnt want to live as a fake person.

After she got divorced, in early 2018, Drake, now working in the games industry, was determined to transition as quickly as she could. She devoured whatever information she could find on Reddit pages such as asktransgender, transgenderuk and transtimelines, and specialist forums for trans women such as Susans Place. The nearest NHS gender identity clinic told her they had a two-year waiting list for an appointment. Some people are on the waiting list for four years, she said. Thats a long time to ask someone to put their life on pause. The point where you get the referral its taken you years, often, to get to that point.

The same year, she found the online, private GenderGP service, and had some consultations via Skype with doctors who prescribed her hormone replacement therapy. She pays about 50 a month for her hormone treatment, and will need to continue with it for the rest of her life.

Drake sought out videos of facial feminisation surgery, in which trans women had their masculine features hairlines, jaws and brows reduced and remodelled. On the Channel 4 programme Embarrassing Bodies, she watched the maxillofacial surgeon Keith Altman transform the face of a transgender patient. Its an expensive procedure, and not available on the NHS in most of the UK, but for some trans women, it can be life-changing.

I first met Drake a year ago, when she was 31, six days before she was to undergo facial feminisation surgery. She was curled up in an armchair at her parents house, a converted barn in St Asaph in north Wales that used to belong to her grandparents. Her hair was pulled back by tortoiseshell sunglasses, and she wore mascara but no other makeup. She was dressed in pink Converse and a patterned shirt dress, and constantly played with her hair, her coffee cup and her ring. Her handheld games console lay on the walnut coffee table.

For Drake, the surgery was about correcting her face so that, when she looked in the mirror, she no longer felt the profound discomfort of gender dysphoria. Im not trying to make a supermodel face, I just want to see the person I always saw in my head, she said.

By and large, facial feminisation is a process of subtraction. For Drake, it is the removal of the changes that testosterone made to her face during puberty. For Keith Altman, the maxillofacial surgeon, it is the removal of bone, skin and cartilage. Facial feminisation is not considered cosmetic surgery. Its goal is to reconstruct the face, not to improve it aesthetically. In his NHS work, Altman could remake your forehead if you smashed it against a dashboard in a car accident. In his private practice, he treats a different kind of trauma: the trauma of not being read as female.

Facial feminisation is a growing industry, with private clinics springing up across the globe over the past decade. It costs twice as much as genital surgery, which used to be considered the standard procedure for gender reassignment, and has been available on the NHS since 1966. People who have undergone facial procedures say they can make an equal, if not greater, difference to a trans persons life, as the face is where gender is first read. Those who can afford it can buy the capacity to pass to go through public life without being identified as trans, without everyone knowing their business.

Drake manages a global competition for independent games developers, a job that involves travelling around the world and speaking on panels to audiences of up to 1,000 people. She is proud of being trans, she told me, and her public-facing job means her transition could never be secret. But it takes her to places where being trans can mean being very exposed.

She said she has faced aggressive transphobic comments, and lots of stares: Sometimes quite disgusting stares. The greatest pain comes when people with no malicious intent misgender her. When you are called to get on a plane and someone calls you sir thats a huge dysphoria trigger. Its like a sickening in your stomach, a pit, a crunching. I find it hard to breathe. To discover that she has not passed is to be reminded that her identity may still exist only in her mind, and not the minds of other people.

Passing means that you probably dont get stared at, pestered, misgendered. Which means you can go through an entire day, maybe, without having a major bout of dysphoria. When youve spent your whole life with dysphoria, thats massive. It means you just get on with your life.

Drake described gender dysphoria as a deep longing to be comfortable. The American Psychological Associations diagnostic and statistical manual (DSM-5) defines it as a difference between your experienced/expressed gender and assigned gender, and significant distress or problems functioning. Untreated gender dysphoria is associated with a higher risk of depression, self-harm and suicidal thoughts.

Some trans people argue that the DSM-5 definition pathologises people when it should not, and that trans is an identity, not an illness. The medical anthropologist Eric Plemons, who specialises in the politics and practice of trans medicine and surgery, told me the current definition of gender dysphoria is an improvement, and that it replaces much more pathologising things that came before it. With gender identity disorder, the identity itself was the disorder. Gender dysphoria is more about moving the problem into the social [arena]. In other words, people are suffering not from their identity, but the stress it causes them in the world. But those codes and diagnoses are currently needed in most cases for trans people to get access to the resources they need, which is unfortunate, Plemons said.

Drake had to take out a bank loan to cover two-thirds of the 14,500 cost of her facial feminisation surgery. But she saw it as vital to her wellbeing, as mental health surgery. She recognised how lucky she was to be able to afford a procedure that she could not get on the NHS. When it comes to the whole inequality in transgender treatment in the UK, I think its just short of criminal, she said.

Drake had no definite idea of how she would look after the surgery. In one sense, I expect to see the person I always wanted to be, to be comfortable, to feel euphoria, a relief from dysphoria. But in the long term, I expect to feel nothing. What does the everyday person think when they look in the mirror and see their face? Its their face.

Under angled hexagonal lights in a Brighton operating theatre in early October 2019, Drake was covered by green surgical draping that exposed only her lower face. As the surgeon, Keith Altman, prised back her cheek with a stainless steel retractor and peered inside her mouth, beams from the three bulbs fixed to his glasses illuminated the furthest interior reaches of her jawbone. From the thick brows above their surgical masks, it was evident that the two surgeons, two anaesthetists and two doctors observing were all men.

Taped to the wall above the nurses station were black-and-white portraits of the patient. In one, she looked directly into the camera with a calm determination in her eyes, bleached-blond hair, an elegant nose, full lips and dimpled cheeks. Another, above it, was shot in profile. Her jaw looked square, and her brow jutted in a prominent ridge. It was Drakes profile that threw into relief the reality that she had been born biologically male.

Altman has operated on the faces of more than 100 trans women in the past 10 years. They have ranged in age from 18 to almost 70, and include a barrister, several academics and three airline pilots. They are generally white, and wealthy enough to afford the typical 20,000-25,000 cost of facial feminisation surgery. Altman is one of only a handful of British surgeons to specialise in it.

The week before Drakes surgery, Altman operated on someone who had a thyroid shave, forehead reduction, brow lift and scalp advance (bringing the hairline forward), jaw angle shave, lip lift, cheek implants and rhinoplasty. She was on the table for seven hours. (By comparison, Drake was having pretty light work done, which was why her surgery was cheaper than average.)

Drake would undergo four procedures that morning. The mandibular angle reduction, to make the jaw narrower and the face more slender, was the first. Altman made a swift incision inside her mouth and pulled back the thin skin covering her lower jaw. A surgical nurse handed him a drill with a stainless steel bit. Music on, he declared, and soon the sound of There She Goes by the Las was wafting through the room, above the gentle whirr of Altmans drill.

When the job was done, Altman flicked his green surgical glove into a bin and left the theatre for a coffee break while the anaesthetist moved the breathing tube from Drakes nose to her mouth. Next, her brow bone would be shaved, a section of her forehead would be filed, and her hairline would be moved down. The whole procedure would take two-and-a-half hours.

When a trans woman called Candice had breast implants and genital surgery in California in 1982, she returned to her surgeon, Darrell Pratt, a few months later to say that it had had no impact on how other people perceived her in everyday life, because her face looked masculine. Pratt asked a colleague, the San Francisco-based maxillofacial surgeon Douglas Ousterhout, if there was anything he could do for his patient.

Ousterhout busied himself in the study of early-20th-century physical anthropology. He examined 1,500 male and female skulls in search of a clinical, craniofacial basis for the maleness people were apparently seeing in Candices face. He noted differences in jaws, upper lips, foreheads and chins. (Male chins are 17% longer than female chins, according to his calculations.) He considered mathematical takes on beauty, the golden ratio of pleasing proportions first theorised in ancient Greece. The formula for femininity he came up with has formed the basis for facial work ever since.

While there is no doubt that testosterone does change skulls in puberty, how much is up for discussion. Mathematical formulas for beauty have fallen out of fashion, and surgeons have different opinions about what kind of work can be done to a skull to make a face look feminine. There are no standard clinical protocols, and the 120 pages of guidelines published by the World Professional Association for Transgender Health contains a single line on FFS. It says only that there are no criteria for standards of care for facial surgery, but that mental health professionals can play an important role in helping their clients to make fully informed decisions about the timing and implications of such procedures.

Sophia Drake spent six years playing in secret with apps that make faces look more masculine or feminine, creating folders full of gender-transformed selfies and hiding them on her computer. There are sites, such as virtualffs.co.uk, that are specifically aimed at trans women, and will, for a fee, apply Ousterhout-like principles to photos. Im not trying to make myself beautiful, Drake said. I see testosterone as a poison in my body, a poison that I had to deal with for 20 years. I want to put my face to the way it would have been if testosterone had never been pumping through my body. And thats it.

Altman talked me through his working principles over coffee before Drakes surgery. Youre not doing this to beautify or rejuvenate, youre doing it to feminise, he said. If you have an attractive male face, youll end up with an attractive female face. I asked what he meant by attractive symmetrical? and he replied without missing a beat. No. I mean pleasing. What we feel is attractive. Of course, its subjective.

A female face has rounder edges and fewer angles, Altman explained. You have a more obtuse angle between your forehead and your nose here, he said, smoothing a finger between the middle of his brows. High cheekbones, a curved jawline, pointed chin. Lack of an Adams apple. Nice skin. No hair on the face, generally. And then theres the female hairline, a low hairline. The focus of his work was to bring attention to the eyes. If you file off the forehead, it looks as though the eyes have come forward, and raising the brow opens up the eyes.

Altman came to this field relatively late in his career, which has largely been spent in the NHS, remaking the faces of people who have been in car accidents, or breaking and remaking peoples jaws in orthodontic surgery. Ten years ago, a London-based GP began referring trans women to him. He contacted a surgeon in Antwerp who was experienced in facial feminisation surgery, and who invited Altman over to watch him at work. After two visits to Belgium, he began operating on his own patients in the UK.

The greatest accolade his patients can give him is to tell him that no one calls them sir any more. Thats what I want to hear. Not Im beautiful. They dont stick out. They blend in. They dont want to be going, Im a woman!, flying a flag. They can quietly go about their business, without risk of violence.

Altman was gearing up to hand his practice over to his trainee, Nikhil Maini. Demand remains steady. Many of his patients travel from Northern Ireland, where the procedure is covered by the NHS. But the lack of provision in the rest of the country leaves desperate people open to exploitation. He has heard of several trans women who have had consultations with so-called fly-in-fly-out doctors: surgeons from overseas who might not have a licence to practise in the UK, but see prospective patients in hotel rooms and offer cut-price surgery abroad.

He was confident about Drakes forthcoming surgery. She looks pretty good anyway. Shes got a nice nose. She could get away without having this done, he rubbed his jawbone but the forehead, she does need. Youll see the difference there and then on the table. I cant remember anyone whos been really upset with the outcome, he added. And certainly no one has ever said they want to be a man again.

On 28 October 2013, a thread appeared on the Susans Place message board titled Ive stopped HRT today. It had been posted by Joanna Holford, a trans woman who had had facial feminisation surgery with Altman the year before. Holford has been documenting her transition on her YouTube channel since 2012.

I pass as female but often with a second glance or prolonged look, her post read. Im tired of the stress and constant insecurity and I am not sure I can take it any more. She had written two lists, for and against detransitioning. The against column included the line: Giving up on my dream of being a fun and vivacious woman.

She decided against, in the end. She now recognises the post as a low point, triggered by the loneliness of being single for the first time in a decade and moving to a new city, and the suspicion that, despite having had facial surgery, she still wasnt always read as female.

After the surgery, Holford had moved to London to be by herself, just completely anonymous, and go stealth I hate that term, but thats what they call it, she told me. She was finding her feet enjoying life, even when a series of small incidents rattled her. She noticed people staring at her on the tube. A female colleague who had always been friendly came into work one day and blanked her. Then there was a man who looked Holford up and down in the staff canteen, then turned away, only to look back and stare again. And the time she overheard a man from another department asking the woman at the desk next to Holford whether Holford was a man or a woman, and whether she felt uncomfortable sitting so close to her.

I just died. I couldnt work out what Id done wrong. I suddenly rechecked myself. Is there something wrong with my hormones? Am I sitting in the wrong way? Is the lighting really bad? Is my clothing really bad?

Even after more surgery, and even though her videos are shared on message boards as an example of a transition to be envied, Holford still finds passing a daily effort, a daily chore. The gender dysphoria she felt before her transition has transmuted into a real, chronic paranoia. FFS isnt the golden ticket to passing. It definitely helps. If youre able to afford to do it, Id always say its a good idea. But there are so many other elements to passing: the way you handle yourself, the way you speak, the clothes that you choose, the belief you have in yourself.

Holford accepts that facial feminisation surgery perpetuates the idea that there is such a thing as a normal female face, that there is a standard expectation of what a woman should look like, and that any woman who falls outside of that is less feminine. She said the pressures women are under to look a certain way were unfair. Not just for trans women, but for women in general. There are women with heavy brows and square jaws but they still look absolutely beautiful in their own way. It puts completely unfair pressure on cisgendered women I think its awful but for trans women its double, and youd do anything just to feel like you fit in. Just to feel you can get on with your life. Because you dont want to keep fighting all the time. If this is going to help, why wouldnt you do it?

Some trans people object to facial feminisation surgery on the grounds that it reinforces a culture that cant accept trans people, instead of challenging it. Many trans women choose not to alter their bodies with surgery. In 2015, while Caitlyn Jenners feminised face was on the cover of Vanity Fair, the actor Laverne Cox began using the #TransIsBeautiful hashtag, starting a movement for trans people to be accepted without surgical intervention. Juno Roche, author of Trans Power, argues that being recognisably trans means refusing to allow gender norms to control you. The history of the trans journey is a cis male, hetrosexual, often white, middle-aged, middle-class doctor saying hes going to make you look as close in proximity to a woman so that you can pass without being noticed, so you can blend into the background, Roche told me.

Facial feminisation has allowed for the creation of a kind of two-tier system where, on the whole, the most successful trans people are beautiful people that pass, Roche continued. People who are proud to be trans, and those people who cant afford the surgery, fall into a separate category. Thats most people. And we have to create safety for everyone. It impacts on so many people, not just trans people.

Roche understands the appeal of facial surgery for so many trans women. If somebody wants to have an easy life, then boy, trans people deserve an easy life. This is a tough gig. But the truth is, if testosterone has shaped your face, it will have shaped your shoulders, your shoulder-to-hip ratio. It will have shaped your hands. Where does it stop?

There was no more easy chatter between the doctors when Altman returned to the theatre to operate on Drakes brow and forehead. This was the most difficult part of the surgery. It would remove the parts of Drakes face she thought were most male, the features she hated so much. Altman brushed sterile aqueous iodine over her face and hair, rendering her first rusty red and then yellow. He made an incision into her hairline with a swift, steady hand.

He drew back her skin in either direction from her hairline until it gathered in folds on one side at the tip of her nose, and draped back across her crown on the other. With a tiny steel mallet and a chisel, Altman set to work carefully chipping away her brow bone, before filing it with a tiny drill bit. Then he stopped, and everyone in theatre craned in to see the difference.

When he was satisfied with the result, Altman changed his gloves and turned his attention to her forehead. The MRI on the lightbox showed Drake had a large sinus cavity with a thin wall; the challenge was to saw the bone down without perforating the sinus, and the best way to do this was to remove part of her forehead entirely. Altman drew a 5cm by 3cm rectangle on to her skull with marker pen. He sliced into it with another fine tool, then prised out the section of bone. He held it in his hand as he filed it back, turning a flat plane into a gentle curve. When he put it back in place, he pulled the skin over it, tilting his head to the side to check his work. Finally, the piece of forehead was fixed back in the skull with two 4mm titanium plates, which his trainee, Maini, secured using a tiny screwdriver. Drakes skin was smoothed back for a last time. Good, Altman nodded.

The final procedures were on Drakes brow and hairline. First, the brow was lifted and anchored by two stitches. Then Altman drew in a new hairline, a centimetre below Drakes natural one, and sliced out the excess strip of skin. He fixed the hairline in place with a ladder of surgical staples at her temples and blue stitching along the top of her forehead, with a practised tilt of his wrist. Altman was right I could see the difference there and then on the operating table. Drake protruding brow bone, which she had struck with the side of her index finger when she told me about the poison of testosterone, was gone.

Altman gently rinsed the blood from Drakes hair, and wrapped her head in a tight bandage before she was wheeled out of theatre. That went well, he said, as he pulled the black-and-white portraits of Drakes old face down from the theatre wall.

The moment Drake opened her eyes in recovery, she asked the nurse beside her to take her picture, but she fell back asleep immediately. By the time she was properly awake and back in her hospital room, the Face ID on her iPhone no longer worked because her face was so swollen.

Drake had been warned that recovery could be difficult. For the first couple of days, whenever she got out of bed, she would vomit the blood that had collected in her stomach from the surgery inside her mouth. When she finally felt ready to eat, using her jaw was agony; she lived on soups, sorbets and mushed-up jelly. Drains collected the fluid that was accumulating under her skin.

But, two months later, Drake was delighted with the results. I met her in a busy cafe near Euston station when she was in London for work. The change was almost imperceptible to me, at first. But I could soon detect a new poise: her face seemed narrower, and strangely her shoulders did, too. Her dimples were more prominent, her eyes looked brighter and more expressive. There was a faint, pale pink sliver of a scar along her hairline, mostly covered by the dark roots of her fringe.

It was just enough, without being too much, she told me. The hairline frames my face better. I find that my eyes arent sunken, theyre further out. I feel that Ive got a lot more expression in my eyebrows now. Other people spot this she cupped her hands around her jaw more than I do. But when I go back and look at old pictures, I see a massive difference.

The biggest change was in Drakes demeanour. She no longer sat with her arms across her chest or played with her jewellery. She was open, at ease, comfortable.

Its made me so much happier. Calmer. I can sit and relax in ways Im not sure Ive ever been able to, she said. I dont walk around any more worrying that people are looking at me, and looking at my brow bone.

She once feared wearing too much makeup would draw attention to her brow, but now accentuated her eyes with flicked eyeliner. Where she once might have been met with stares, she told me she now gets nothing. For the first time, shes confident enough to go shopping and try on clothes in womens changing rooms as long as there are private cubicles. Before, there was a constant feeling of not wanting to make other people uncomfortable, a self-censorship. Now, I dont need to worry.

The sole NHS youth gender clinic in England and Wales has experienced an average 40% annual increase in referrals over the past four years, with many of their child patients asking for puberty blockers so their bodies will not go through the kinds of changes Drake has spent thousands of pounds trying to address. Perhaps, in the future, the availability and acceptance of hormone treatment will mean there will be fewer people requiring or wanting facial procedures. Drake thinks there may always be a need for it, because there will always be people like her who understand who they are later in life.

Facial surgery was only one step in a long journey for Drake. Things will tighten up, obviously the scar will slowly reduce over time. We wont see the full effects until next year, she said. But the authentic Sophia Drake she is looking for in the mirror is still several procedures away. On my face, Im 75% there. I still have things I want to do on my body. She nodded. Im planning other surgeries.

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'I just want to see the person I always saw in my head': the story of a face - The Guardian

Patients with advanced hormone receptorpositive, HER2-negative breast cancer still face acquired resistance, even with the most effective agents, namely CDK4/6 inhibitors, which have demonstrated unprecedented overall survival (OS) benefit in the metastatic setting. Investigators in the field, however, are continuing to explore pathways implicated in resistance, said Komal Jhaveri, MD, explaining that FGFR inhibitors, PI3K inhibitors, and selective estrogen receptor downregulators (SERDs) are just a few of the therapeutic classes under investigation in combination with CDK4/6 inhibitors.

Were really trying to understand how to appropriately treat our patients and [determine] the next line of therapy for a patient who progresses on a CDK4/6 inhibitor. [To that end], were trying to understand the genomic alterations and the next-generation sequencing data from tissue and plasma to better address that question, Jhaveri, a medical oncologist at Memorial Sloan Kettering Cancer Center, in New York, New York, said in an interview with OncLive.

Before diving into some of the novel combinations under investigation, she spoke to the profound effects that CDK4/6 inhibitors have had on the field.

The unprecedented, near doubling if not more of progression-free survival compared with endocrine therapy alone in the first-line setting has certainly changed our treatment paradigm, Jhaveri said. For patients who havent seen a CDK4/6 inhibitor in the first line, even in the second-line setting, weve been able to show a statistically significant progression-free [survival] benefit, justifying the use of this class of agents in the first- or second-line settings.

At the European Society for Medical Oncology Congress 2019, two approved CDK4/6 inhibitorsribociclib (Kisqali) and abemaciclib (Verzenio)were shown to prolong OS as well. According to findings from the phase 3 MONALEESA-3 trial (NCT02422615), the median OS was not reached with ribociclib versus 40 months with fulvestrant (Faslodex) alone in postmenopausal women with advanced HR-positive, HER2-negative breast cancer (HR, 0.724; 95% CI, 0.568-0.924;P=.00455).1 These data were presented shortly after the 2019 American Society of Clinical Oncology Annual Meeting, where findings from the MONALEESA-7 trial (NCT02278120) showed that the median OS was not reached with ribociclib versus 40.9 months (95% CI, 37.8-not reached), with endocrine therapy alone as first-line therapy in premenopausal women with advanced hor-mone receptorpositive, HER2-negative breast cancer (HR, 0.71; 95% CI, 0.54-0.95; P=.00973) (TABLE1,2).2

Table. Efficacy Results in MONALEESA Trials1,2

Moreover, in the phase 3 MONARCH 2 trial (NCT02107703), abemaciclib led to a median OS of 46.7 months versus 37.3 months with fulvestrant alone in patients with advanced hormone receptorpositive, HER2-negative breast cancer who progressed on prior endocrine therapy (HR, 0.757; 95% CI, 0.606-0.945; P=.01).3 Such findings have set the stage for investigation into combinations with CDK4/6 inhibi-tors and novel targets, such as FGFR, explained Jhaveri.

There is some [indication] from the PALOMA-3 [NCT01942135] and MONALEESA-2 [NCT01958021] trials, and other preclinical data, that perhaps FGFR1 amplification is a mechanism of resistance [to CDK4/6 inhibitors] and a benefit [might be seen] if one were to potentially target it with an FGFR inhibitor, said Jhaveri.

Jhaveri also pointed to research led by Carlos Arteaga, MD, director of the Simmons Comprehensive Cancer Center and associate dean of Oncology Programs at UT Southwestern Medical Center, which suggests a potential role for triplet therapy with an FGFR inhibitor and CDK4/6 inhibitor plus endocrine therapy.

Such research is being investigated in a phase 1 trial (NCT03238196) evaluating the addition of erdafitinib (Balversa) to palbociclib (Ibrance) and fulvestrant in women with FGFR-amplified estrogen receptor (ER)positive, HER2-negative breast cancer. To be eligible for enrollment, patients must have had at least 1 line of therapy in the metastatic setting. Notably, prior CDK4/6 inhibition will not serve as an exclusion criterion. As such, the preliminary results from the trial, which will be presented at the 2020 San Antonio Breast Cancer Symposium, will not only illustrate the activity of the triplet in an FGFR-amplified population but also potentially inform the utility of continuing CDK4/6 inhibition upon progression.

There are many important questions that were still now trying to understand in the clinic, and these research efforts are underway, including whether theres a role for continuing CDK4/6 beyond progression, said Jhaveri. The paradigm that we use in HER2-positive metastatic breast cancer is that targeting the HER2 pathway remains important and we continue anti-HER2 therapy beyond progression. The same is not yet clear for the utilization of CDK4/6 inhibitors beyond CDK4/6 [progression]. Thats something were actively evaluating in ongoing trials, such as MAINTAIN [NCT02632045].

Another approach under investigation is that of combined PI3K and CDK4/6 inhibition, explained Jhaveri.

CDK4/6 is downstream of the PI3K/AKT/mTOR pathway, so if one were to consider dually vertically inhibiting these pathways together, we might be able to see better synergistic activity, she said.

Key trials in this regard include PASTOR (NCT02599714), PIPA (NCT02389842), LeeBLet (NCT02154776), and TRINITI-1 (NCT02732119), among others.

ESR1 mutations are another viable target, arising in approximately 30% of women who have received prior aromatase inhibitors. Oral SERDs are currently the subject of investigation in this setting, but whether they will pan out, either as single agents or in combination, has yet to be determined, said Jhaveri.

Although the data are still in early stages, findings from a phase 1/1b trial (NCT02734615) indicated that the oral SERD LSZ102 was well tolerated and was active in combination with ribociclib or alpelisib (Piqray) in patients withER-positive breast cancer who had progressed on endocrine therapy. In the 3-arm study, investigators evaluated LSZ102 alone (arm A), in combination with ribociclib (arm B), and in combination with alpelisib (arm C). In arm A, LSZ102 elicited an objective response rate of 1.3%, a clinical benefit rate of 9.1%, and a medi-an progression-free survival of 1.8 months (95% CI, 1.7-2).4

In arm B, the addition of LSZ102 to ribociclib led to a 15.8% ORR and a CBR of 35.5%; the median PFS was 6.2 months (95% CI, 4.4-6.4). The combination of LSZ102 and alpelisib demonstrated an objective response rate of 5.4%, a clinical benefit rate of 18.9%, and a median progression-free survival of 3.5 months (95% CI, 1.8-5.5).

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Novel Combinations Carry CDK4/6 Inhibitors Into the Future in HR+/HER2- Breast Cancer - OncLive