Archive for the ‘Hormone Clinic’ Category

A Doctor's Journey

I started to realize something was wrong when I saw a patient who was on 10 medications. The first five dealt with ailments while the second five were for the side effects of the first five. Despite the medications, the patient didn't feel any better. This was the beginning of my inquiry into another way to practice medicine.

Sometimes our practice gets lumped into the alternative medicine category. And while we are open to additional ways to treat illness, our protocols are based on science and deduction.

As it relates to hormone balancing, we practice integrative medicine, which is sometimes confused with functional medicine. We will examine all of your hormones including thyroid, adrenals and sex hormones and ensure that they are in balance with each other as opposed to just being within the normal ranges.

We believe that medications are not always the answer and can often mask the true underlying conditions and imbalances. Even my kids chuckle when they see drug commercials that spend 15 seconds on the benefits and 45 seconds on the side effects.

And unfortunately 'healthcare in the U.S. is mistitled. It should be called sick-care because most people only engage the medical system when theyre sick, not when theyre healthy.

Our "hormone specialists" believe the following:

We believe that most people dont want to be on medications or live a sub-standard life but they often don't know what else to do.

At our core, we believe that from an evolutionary standpoint, the body is built to heal itself. Our job is to clear the obstacles and support the body, before resorting to more invasive measures. If this belief makes us alternative medicine doctors, then so be it.

We look forward to meeting you!

- Lauren D. Loya, M.D.

Founder and Medical Director of The Hormone Center

At The Hormone Center, we put an underlying focus on the cause, not the symptom. We are an integrative medicine practice and put our clients first. Some of our most sought-after services include:

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The Hormone Center - Integrative Medicine | Hormone ...

For people with gender dysphoria, hormone therapy can significantly reduce mental distress and improve quality of life. NYU Langones multidisciplinary transgender program takes an intensely personalized approach to these treatments, centered on the individual patients goals, life circumstances, comorbidities, and evolving clinical response.

Although many medical centers offer gender-affirming hormone therapy, NYU Langone does so under the direction of an endocrinologist who specializes in transgender care. For these patients, the clinicians expertise can be crucial to optimizing outcomes, explains Michele B. Glodowski, MD, clinical instructor in the Department of Medicine, whose fellowship training included extensive clinical rotations at the University of Colorados Integrated Transgender Program.

Gender-affirming hormone therapy typically uses different doses and modalities from hormone replacement therapy for postmenopausal cisgender women or cisgender men with low testosterone. The risk of complications, including certain types of cancer, may be heightened as well. With testosterone, we often see weight gain, changes in LDL and HDL cholesterol, elevations in hematocrit, and increases in insulin resistance and blood pressure, Dr. Glodowski notes. Feminizing regimens, such as estradiol, can also trigger weight gain, raise the risk of cardiovascular disease, and often affect liver enzymes and triglycerides.

Besides enhancing her ability to monitor and manage side effects, Dr. Glodowskis training helps her tailor treatment to patients unique needs. Theres a whole spectrum of gender identity and gender expression, she says, so its important to provide a whole spectrum of care. It looks different for every individual. Some patients, for example, may identify as definitively male or female, others as nonbinary or gender-fluid. Some may choose to have hormone therapy in conjunction with gender confirmation surgery; others may choose hormonesor surgeryalone. And a wide range of external factors may influence patients therapeutic pathways.

Theres a whole spectrum of gender identity and gender expression, so its important to provide a whole spectrum of care.Michele B. Glodowski, MD

Even in 2020, people still lose their jobs or get kicked out of their homes because theyre trans, Dr. Glodowski observes. I want to make sure patients are comfortable with all the social aspects that can come into play with gender transition. If someone says, Im not ready to come out at work yet, we might slow the process down a bit. If they say, my parents have 30,000 questions, we might arrange a visit with mom and dad. Patients may wish to have their eggs or sperm frozen before hormone therapy begins, to preserve their fertility. Those who do sex work might benefit from screening for sexually transmitted diseases, or consultation with a social worker who can connect them with supportive services.

In collaboration with her colleagues in the multidisciplinary transgender programwhose specialties include plastic surgery, gynecology, and urology, in addition to endocrinologyDr. Glodowski is able to ensure that patients receive precisely the care they require.

NYU Langone Health has been certified for 7 consecutive yearswith a score of 100 percentby the Human Rights Campaign Foundation Healthcare Equality Index Report, which evaluates the work of medical facilities in providing equal healthcare access to LGBTQ+ Americans. One factor in that success is the centers patient-centered approach to transgender care.

In some practices, patients can walk into the office and have someone use the wrong pronoun, Dr. Glodowski says. The doctor might see them briefly, write a prescription, and thats basically it. At NYU Langone, everyone from the receptionists to the medical assistants to the physicians have been trained to be sensitive to gender identity. I spend 40 minutes with each new patient, and 20 minutes with any follow-ups. In addition, we have one clinic a week specifically dedicated to gender-affirming hormone therapy.

The 2019 coronavirus disease (COVID-19) pandemic has also made telehealth a crucial component of the transgender programs endocrinology practice. Although the crisis has waned in New York City, many patients prefer to continue with video visitsciting both safety and convenienceafter an initial in-person consultation. At the height of the pandemic, many providers turned to telehealth to limit in-person visits for non-urgent care, Dr. Glodowski explains. But there is a high rate of suicidal ideation and suicide in patients who are trans-identified. For this patient group, almost all care can be described as urgent, especially for someone whos new to hormones and may be experiencing severe dysphoria.

With those who are beginning a course of hormone therapy, Dr. Glodowski typically schedules a video visit to discuss treatment goals, the expected timeline of physiological changes, and potential side effects. We want to make sure that every patient is very well informed, she explains. As treatment progresses, she will order lab work and discuss results with patients via video link, as well as checking on therapeutic progress and the patients comfort level with the regimen.

Whether a visit is in-person or remote, she adds, its always essential that we provide patients with a safe, gender-affirming space.

The rest is here:
Helping Transgender Patients Reap the Benefits & Navigate the Challenges of Hormone Therapy - NYU Langone Health

Increasing evidence suggests that COVID-19 can cause blood clots, and the risk for those complications may be increased among people who are pregnant or who take estrogen-containing medicine (including some kinds of birth control). So researchers are warning that we need to learn a lot more about how these two factors could converge with potentially lethal results.

In a recent article, published last month in Endocrinology, the two authors lay out the emerging connection between COVID-19 and blood clotsand call for more research into how the coronavirus might impact those who are already at risk for developing blood clots.

People who already are at an increased risk for blood clots and the complications associated with them (such as pulmonary embolism, deep venous thromboembolism, and strokes) include those who are pregnant, those who are taking hormonal birth control, and those on oral estrogen therapy (hormone replacement therapy). So, the authors write, its worth examining whether or not people in those groups who also get COVID-19 are at an especially high risk for blood clots and health issues related to them.

To be clear, there are currently no reports of increased cases of COVID-related blood clots among those who are pregnant, on birth control pills, or taking estrogen therapy, co-author Daniel Spratt, M.D., director of reproductive endocrinology and infertility at Maine Medical Center and professor of Medicine and Obstetrics-Gynecology at Tufts University School of Medicine, tells SELF. However, its definitely plausible those two things in combination would increase your risk, Taraneh Shirazian, M.D., gynecologist at NYU Langone Health, tells SELF, because both being in one of those elevated-risk groups and having COVID-19 individually increase the risk.

However, were still learning quite a bit about how COVID-19 affects the body, including how it might contribute to blood clots. [Were] realizing that were just at the beginning of getting information and understanding if theres a risk or not, Dr. Spratt says.

What we do know is that the association between COVID-19 and blood clots is there, especially among young and otherwise healthy patients, Dr. Spratt says. In general, age and underlying health conditions tend to be some of the most powerful risk factors for severe complications of COVID-19, but that doesnt seem to be the case for coronavirus-related blood clots.

We also dont yet know why or how the infection causes blood clots. There are essentially two major theories right now, Dr. Spratt says, and its likely that both may be at work to different degrees in different patients. According to one theory, the virus responsible for COVID-19 affects the lining of the arteries and veins, setting off a series of molecular signals that make clotting more likely. The second theory has more to do with platelets, a type of blood cell thats involved in clotting. It appears that the coronavirus somehow makes platelets hyperreactive, possibly causing them to clot more frequently.

We also know that theres an association between the hormone estrogen and blood clots, Dr. Shirazian says. In particular, people who are pregnant, taking birth control pills, or taking estrogen therapy are known to be at a higher risk for developing blood clots, she explains. We know a little bit more about why people in these groups may be more likely to experience clots.

During pregnancy, there are physical changes taking place that simply make it more likely for blood to coagulate (a hypercoagulable state, as its known in medical literature). A pregnant person has a 50% increase in blood volume, Dr. Shirazian explains, but also has a significant slowing of blood flow. That creates a situation where theres slowing of the blood and these clots can start [to form] inside of blood vessels, she says.

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What People Taking Birth Control Should Know About COVID-19 and Blood Clots - Self

Design

The study was designed as a single-center, prospective, double-blind, randomized, placebo-controlled trial, which randomized participants into two groups in a 1:1 ratio. The study adhered to CONSORT guidelines and was approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University (IRB No. 039/2561). The study was also reviewed by the Thai Clinical Trial Registry Committee and prospectively approved for registration since 2018-02-19 11:33:21 and Thai Clinical Trial Registry identification number TCTR20180219001. After approval, participants were included from August 2018 to March 2019. A thorough explanation of the study details was given to all enrolled women. Informed written consent was obtained prior to the start of the study.

Literate Thai women aged 4570years who experienced spontaneous menopause attending the General Gynecologic Clinic, Climacteric and Gender Health Clinic at King Chulalongkorn Memorial Hospital were recruited. Menopause was defined according to WHO criteria as the cessation of the period for at least 12 consecutive months [17].

These women were asked for their vaginal atrophy symptoms and other detailed histories. Participants were included if they reported at least one self-assessed vaginal atrophy symptom in moderate or severe intensity and reported engaging in penile-vaginal penetrative sexual intercourse at least once a month. Those with pathological or surgical causes of menopause, using menopausal hormone therapy (MHT) or non-hormonal treatment that might affect the vaginal epithelium, having abnormal vaginal bleeding/discharge without prior appropriate investigation and treatment, cervical or vaginal surgical history within the previous 3months, history of sex steroid hormone use 2months prior to study, history of psychiatric disorders or having partner with sexual dysfunction, contraindications for MHT including personal or family history of estrogen-related cancer, severe liver or kidney diseases and any suspected allergy to MHT, were excluded from the study. The recruited subjects were then asked to complete a 19-item Thai version of the Female Sexual Function Index questionnaire, and those that scored >26.55 points were then excluded as having no FSD. The Thai version of the Female Sexual Function Index questionnaire was validated in previous study among Thai postmenopausal women, aged 4060years, with high reliability coefficients and internal consistency (r=0.790.86, Cronbachs alpha value=0.82) [18]. After pelvic examination and test for vaginal pH, those with pH more than 5 were qualified for the study as they were likely to have poor estrogenic vaginal mucosa and might benefit from the treatment.

A computer generated block of four randomizations was used to randomize participants into two groups in a 1:1 ratio. The allocation and concealment of placebo and the drugs into identical opaque envelopes were done by a nurse who was not involved in contacting with patients or analyzing any data, thus blinding investigators, assessors, cytologist, microbiologist and all participants.

The sample size of this study was estimated based on our pilot study, conducted with 10 participants enrolled in both arms. The following formula was used for comparing continuous data in a randomized controlled trial [19].

$$ {displaystyle begin{array}{c}{n}_{trt}=frac{{left({z}_{1-frac{alpha }{2}}+{z}_{1-beta}right)}^2;left[sigma {}_{trt}{}^2 + frac{sigma {}_{con}{}^2}{r}right]}{varDelta^2}\ {}r=frac{n_{con}}{n_{trt}},varDelta ={mu}_{trt}-{mu}_{con}end{array}} $$

According to our pilot study, trt (mean value) and trt (standard deviation) of total FSFI at 12week follow up in treatment group were 26.8 and 5.7, respectively; con and con of total FSFI at 12week follow up in control group were 23.0 and 4.7, respectively. The ratio between groups (r) was set as 1 for 1:1. With using =0.05 and =0.2, the sample size needed for this study was 30 participants per group. Predicting a 10% drop out rate, the sample size was increased to 33 participants per group.

After completion of history taking and filling all the questionnaires, participants who met the inclusion criteria mentioned above were asked to undergo a pelvic examination, all conducted by single investigator (T.B.). A dry speculum was inserted without lubrication. A pH-indicator strip (pH range 014, Merck, Germany) was placed over the upper to the middle third of the lateral vaginal wall with contact time between the pH-indicator strip and the examined vaginal wall for 3s.

Two dry cotton buds were used to scrape contralateral vaginal wall. Each cotton bud was smeared onto each different glass slide. One slide was left to air dry and sent for evaluation of Normal Flora Index (NFI) with Gram staining by single microbiologist (T.C.), unaware of treatment allocation, participant symptoms and characteristics. NFI, representing vaginal microenvironment, consisted of 4 parameters, i.e., the number of lactobacilli, pathogenic microorganisms, leukocytes, and vaginal pH. Each parameter was graded on a 4-point scale (Table1). Pathogenic microorganisms included Gardnerella, Bacteroides, Mobiluncus and gram-variable bacilli [21, 22].

The other slide was fixed with 95% ethanol solution for 30min and sent for staining in accordance with Papanicolaou test. The slide was evaluated for Vaginal Maturation Value (VMV) by single cytologist (C.A.), unaware of treatment allocation, participant symptoms/characteristics. VMV, calculated from the formula: (% of intermediate cells 0.5)+(% of superficial cells 1), is considered as a surrogate of vaginal epithelium estrogen status [23, 24,25,26].

The number of lactobacilli, pathogenic microorganisms and VMV was evaluated under the microscope with 1000x magnification (HPF). The number of leukocytes was evaluated under the microscope with 400x magnification.

Participants were then examined with transvaginal ultrasonography for baseline endometrial thickness [Samsung SONOACE R7, 2D imaging mode, grayscale 256 (8 bits), EVN49 probe 3.5MHz, single operator (T.B.)]. Blood samples were taken for baseline hematocrit, SGOT, SGPT, alkaline phosphatase, total cholesterol, LDL, HDL, triglycerides and estradiol level. The samples were analyzed immediately, or stored at 4 degrees Celsius until analysis no more than 24h later. All blood sample analyses were done with routine laboratory testing platform for research projects at the King Chulalongkorn Memorial Hospital, strictly adhering to the manufacturers protocol and in accordance with the laboratorys standard operating procedures for good laboratory practice.

After the recruitment process, participants were randomized into the conjugated estrogens or the placebo groups. The estrogens or placebo was given in numbered as identical opaque envelopes with instruction leaflet. The treatment arm was conjugated estrogens tablet (EstromonTM, 0.625mg). The placebo arm was lactose 90%, polyvinyl pyrrolidone K30 5%, magnesium stearate 3%, talcum 1% erythrosinelahe dye 1% and water which was evaporated completely during manufacturing. The placebo was made by the Faculty of Pharmaceutical Science, Chulalongkorn University and was visually identical to the conjugated estrogens tablet. No participants reported allergic reactions to lactose, talcum or any substances used in the study. Participants were required to insert each pill vaginally as deeply as possible every day for 3weeks. After 3weeks of participation, the investigator called to each participant to check on adherence, problems of drug administration or adverse reactions and willingness to continue the study, after which participants were advised to continue the study by inserting a pill vaginally twice weekly on every Monday and Friday night for the next 9weeks. The regimen was extrapolated from recommendation for treating dyspareunia with conjugated estrogen vaginal cream [11].

After the 12th week of study, each participant came back for reevaluation of symptoms, filling out questionnaires, undergoing pelvic examination for vaginal pH, smear for NFI and VMV, transvaginal ultrasonography and blood samples.

The primary outcome of this study was the changes of FSFI of the two treatment arms. FSFI was one of the validated standard questionnaires frequently used for assessing female sexual function and quality of life in clinical trials or epidemiological studies concerning sexual study [20, 27]. Since there were no validated measurement tools specifically designed for female sexual function and dysfunction in menopausal population, and FSFI was frequently used in researches concerning female sexual function and quality of life in menopausal population, the index was selected for this study. The questionnaires consisted of 19 self-reporting rating-scale items, assessing 6 domains of sexual function; desire, arousal, lubrication, orgasm, satisfaction and pain. Each item has a scaled response ranging from 0 to 5 or 1 to 5; with higher scores representing better sexual function (Table1). Each domain score is calculated by summation of scores from every item in the domain multiplied by the domain factor (i.e., 0.6 for desire, 0.3 for arousal and lubrication, 0.4 for orgasm, satisfaction and pain), thus the full score of each domain is 6. The possible full scores of total FSFI ranges from 2.0 to 36.0, with cut-off point of 26.55 or less considered FSD in premenopausal and postmenopausal women population [28]. However, there is no specific cut-off score for FSD in a population with GSM [29].

Secondary outcomes were changes in vaginal pH, VMV, NFI, and the Most Bothersome Symptoms (MBS). The MBS, also known as the vaginal atrophy symptoms consists of 4 symptoms; vaginal dryness, vaginal/vulvar irritation/itching, vaginal/vulvar soreness, and dyspareunia. Each symptom is self-graded by participants on a 4-point scale (0=no symptom, 1=mild, 2=moderate, 3=severe) [30]. Only those reported at least one self-assessed vaginal atrophy symptom in moderate or severe intensity were included. The safety parameters assessed were changes in hematocrit, SGOT, SGPT, alkaline phosphatase, total cholesterol, LDL, HDL, triglycerides, estradiol level and endometrial thickness.

IBM SPSS statistics version 18.0 for Windows was used for statistical analysis. The treatment effect was evaluated with intention-to-treat analysis, with missing data assumed by multiple imputation method. Baseline demographic characteristics were presented using descriptive statistics; mean and standard deviation (SD), median and interquartile range (IQR), or number and percentage as appropriate. Primary and secondary outcome comparisons between groups were evaluated with Mann-Whitney U test or analysis of covariance (ANCOVA), with treatment arm as a fixed effect in the model and the baseline value used as a covariate, according to data distribution characteristics. P-value of less than 0.05 is determined statistically significant.

Continued here:
Effects of vaginal administration of conjugated estrogens tablet on sexual function in postmenopausal women with sexual dysfunction: a double-blind,...

Set on Spains Costa Blanca, SHA Wellness Clinic is one of the worlds premier wellness destinations. This health resort has been known to attract everyone from elite athletes, to Hollywood celebrities and Victorias Secret models, as well as assorted oligarchs and billionaires. They come to lose weight, detox, or participate inSHAs Healthy Aging program. Others want to reset their minds and bodies, adopt new healthy habits, or simply get away from it all.

Set on a hillside overlooking the Mediterranean Sea, SHA Wellness Clinic is one of the world's ... [+] premier wellness destinations.

Devised by wellness guru Alfredo Bataller, the immensely successful SHA method is based on aholistic approach to wellness that combinesthe latest advances in Western medicine and progressive natural therapies, with a particular focus on healthy, balanced nutrition and exercise.

Since reopening in July, SHA has introduced a series of new services specially designed for the COVID-19 era. Immunotherapy and lymphocyte profile consultations have been added to all bookings to assess the state of the guests immune system, while a new immune system strengthening pack has also been developed. A comprehensive SHA insurance covers medical and related expenses in the event of positive COVID-19 test on arrival.

People from all over the world come to SHA Wellness Clinic in Spain to reset their bodies and minds.

So, how can we apply the SHA method to our everyday lives to give our immune systems an extra boost in times of COVID-19? Here are some tips from Alfredo Bataller and his team of experts at SHA Wellness Clinic:

Alfredo Bataller, founder of SHA Wellness Clinic: A balanced diet that includes plenty of fruit and vegetables, vitamin C and antioxidants helps reinforce the immune system andprevent disease. Its highly recommended to choose fruit and vegetables that are in season to ensure that they are as fresh and nutritious as possible.

Melanie Waxman, healthy nutrition expert: To keep the immune system in perfect working order, we should enjoy a diet based on fresh food that helps to maintain the balance of the intestinal microbiota. It should include whole grains, beans, seaweed (spirulina), nuts, seeds, green leafy vegetables, such as kale, onions, garlic, leeks and asparagus, and fruit, such as apples.

The diet at SHA Wellness Clinic is based on organic, seasonal fruit, vegetables, seeds, nuts, and ... [+] some fish and seafood. Like this red shrimp ceviche with cucumber and yellow aj peppers.

Luis Ganso, personal trainer: Moderate exercise, such as 30 minutes of fast-paced walking, has been shown to improve the function of the immune system. This type of exercise strengthens our respiratory capacity, mobilizing antibodies and white blood cells to circulate more quickly, and detect and neutralize external attacks. Meanwhile, raising the body temperature helps to prevent the development of infection.

Alfredo Bataller: Its always a good idea to spend some time during the day walking outdoorspreferably in nature. Spending time outdoors is important for breathing fresh air and absorbing the vitamin D provided by the sun, which is so crucial to support calcium absorption and the proper functioning of the immune system.

Exercise is always good for us and even better if we can do it outdoors. "Spending time outdoors is ... [+] important for breathing fresh air and absorbing the vitamin D provided by the sun," says SHA's founder Alfredo Bataller.

Alfredo Bataller: Exercise is always good, even if we may have lost motivation during lockdown or if we feel tired or low on energy. Exercise strengthens the immune system and makes our bodies secrete happy hormones, or endorphins, while reducing the level of the stress hormone, cortisol. Stress is harmful to the body, and, having less of it actually strengthens the immune system.

Rachel Rose, body and mind expert and yoga coach: Stable mental health is basic to managing stress, which, in turn, impacts the immune system. Lymphocytes are found in lymph nodes and organs, and in the blood. Lymph nodes are the bodys first line of defense against disease.Breathing is directly related to lymph flow, and lymph flow is directly related to immunity.

The diaphragm muscle, located between the lungs and the abdomen moves down when we inhale and up when we exhale. This movement causes a series of pressure differences that generate movement in the body. Lymph flow, or the mechanism that transports thelymph containing our infection-fightingwhite blood cellsthroughout thebody, is one of the most crucial movements supported by deep breathing.

Some people come to SHA to get fit, detox or lose weight, while others just want to get away from it ... [+] all.

Alfredo Bataller: Getting quality sleep is essential to reinforcing our immune system, while not getting enough sleep can cause our immunity to decline, making us more prone to infectious diseases. Adults should sleep at least seven to eight hours a day.

Maria Romeralo, healthy nutrition expert: When we start the day with sugary coffee and a pastry, we instantly feel good and full of energy. However, after a while, our energy levels drop and our bodies demand more sugar. This is why its important to avoid refined sugar, artificial sweeteners and honey at breakfast.

At SHA, we serve miso soup for breakfast. Miso soup is a great source of protein, vitamins, minerals and enzymes. You can make it even richer by adding wakame seaweed, onions, tofu, carrots or pumpkin. It's a wonderful way to cleanse the body while providing quality nutrients. Miso is a fermented food and therefore a source of probiotics that also help strengthen our immune systems.

Miso soup is a breakfast staple at SHA Wellness Clinic. It is a great source of protein, vitamins, ... [+] minerals and enzymes.

Alfredo Bataller: Confinement can lead to loneliness, sedentariness and depression, all of which are detrimental to the proper functioning of the immune system. Contact with our loved ones helps calm the mind, enables us to cope with the stress of these uncertain times, and also reduces the risk of obesity and alcohol and tobacco abuse.

Melanie Waxman, healthy nutrition expert: Its important to transition to a healthy lifestyle gradually, with a view to maintaining it long term. At SHA, we give our guests the necessary tools to start leading that lifestyle once they leave: healthy cooking classes, yoga classes, outdoor exercise, nutrition and medical advice on everything from quitting smoking, to sleeping, and strengthening the cognition. Once back in their routine, theyre encouraged to adopt these activities until they become habits.

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10 Ways To Boost Your Immune System In Times Of COVID-19, According To SHA Wellness Clinic - Forbes

For a world crippled by the coronavirus, salvation hinges on a vaccine.

But in the United States, where at least 4.6 million people have been infected and nearly 155,000 have died, the promise of that vaccine is hampered by a vexing epidemic that long preceded COVID-19: obesity.

Scientists know that vaccines engineered to protect the public from influenza, hepatitis B, tetanus and rabies can be less effective in obese adults than in the general population, leaving them more vulnerable to infection and illness. There is little reason to believe, obesity researchers say, that COVID-19 vaccines will be any different.

Will we have a COVID vaccine next year tailored to the obese? No way, said Raz Shaikh, an associate professor of nutrition at the University of North Carolina-Chapel Hill.

Will it still work in the obese? Our prediction is no.

More than 107 million American adults are obese, and their ability to return safely to work, care for their families and resume daily life could be curtailed if the coronavirus vaccine delivers weak immunity for them.

In March, still early in the global pandemic, a little-noticed study from China found that heavier Chinese patients afflicted with COVID-19 were more likely to die than leaner ones, suggesting a perilous future awaited the U.S., whose population is among the heaviest in the world.

And then that future arrived.

As intensive care units in New York, New Jersey and elsewhere filled with patients, the federal Centers for Disease Control and Prevention warned that obese people with a body mass index of 40 or more known as morbid obesity or about 100 pounds overweight were among the groups at highest risk of becoming severely ill with COVID-19. About 9% of American adults are in that category.

BMI of 30 is at risk

As weeks passed and a clearer picture of who was being hospitalized came into focus, federal health officials expanded their warning to include people with a body mass index of 30 or more. That vastly expanded the ranks of those considered vulnerable to the most severe cases of infection, to 42.4% of American adults.

Obesity has long been known to be a significant risk factor for death from cardiovascular disease and cancer. But scientists in the emerging field of immunometabolism are finding obesity also interferes with the bodys immune response, putting obese people at greater risk of infection from pathogens such as influenza and the novel coronavirus. In the case of influenza, obesity has emerged as a factor making it more difficult to vaccinate adults against infection. The question is whether that will hold true for COVID-19.

A healthy immune system turns inflammation on and off as needed, calling on white blood cells and sending out proteins to fight infection. Vaccines harness that inflammatory response. But blood tests show that obese people and people with related metabolic risk factors such as high blood pressure and elevated blood sugar levels experience a state of chronic mild inflammation; the inflammation turns on and stays on.

Adipose tissue or fat in the belly, the liver and other organs is not inert; it contains specialized cells that send out molecules, like the hormone leptin, that scientists suspect induces this chronic state of inflammation. While the exact biological mechanisms are still being investigated, chronic inflammation seems to interfere with the immune response to vaccines, possibly subjecting obese people to preventable illnesses even after vaccination.

An effective vaccine fuels a controlled burn inside the body, searing into cellular memory a mock invasion that never truly happened.

Blunted response to vaccines

Evidence that obese people have a blunted response to common vaccines was first observed in 1985 when obese hospital employees who received the hepatitis B vaccine showed a significant decline in protection 11 months later that was not observed in non-obese employees. The finding was replicated in a follow-up study that used longer needles to ensure the vaccine was injected into muscle and not fat.

Researchers found similar problems with the hepatitis A vaccine, and other studies have found significant declines in the antibody protection induced by tetanus and rabies vaccines in obese people.

Obesity is a serious global problem, and the suboptimal vaccine-induced immune responses observed in the obese population cannot be ignored, pleaded researchers from the Mayo Clinics Vaccine Research Group in a 2015 study published in the journal Vaccine.

Vaccines also are known to be less effective in older adults, which is why those 65 and older receive a supercharged annual influenza vaccine that contains far more flu virus antigens to help juice up their immune response.

By contrast, the diminished protection of the obese population both adults and children has been largely ignored.

Im not entirely sure why vaccine efficacy in this population hasnt been more well reported, said Catherine Andersen, an assistant professor of biology at Fairfield University who studies obesity and metabolic diseases. Its a missed opportunity for greater public health intervention.

In 2017, scientists at UNC-Chapel Hill provided a critical clue about the limitations of the influenza vaccine. In a paper published in the International Journal of Obesity, they showed for the first time that vaccinated obese adults were twice as likely as adults of a healthy weight to develop influenza or flu-like illness.

Curiously, they found that adults with obesity did produce a protective level of antibodies to the influenza vaccine, but they still responded poorly.

That was the mystery, said Chad Petit, an influenza virologist at the University of Alabama.

One hypothesis, Petit said, is that obesity may trigger a metabolic dysregulation of T cells, white blood cells critical to the immune response. Its not insurmountable, said Petit, who is researching COVID-19 in obese patients. We can design better vaccines that might overcome this discrepancy.

Historically, people with high BMIs often have been excluded from drug trials because they frequently have related chronic conditions that might mask the results. The clinical trials underway to test the safety and efficacy of a coronavirus vaccine do not have a BMI exclusion and will include people with obesity, said Dr. Larry Corey, of the Fred Hutchinson Cancer Research Center, who is overseeing the phase 3 trials sponsored by the National Institutes of Health.

Although trial coordinators are not specifically focused on obesity as a potential complication, Corey said, participants BMI will be documented and results evaluated.

Dr. Timothy Garvey, an endocrinologist and director of diabetes research at the University of Alabama, was among those who stressed that, despite the lingering questions, it is still safer for obese people to get vaccinated than not.

The influenza vaccine still works in patients with obesity, but just not as well, Garvey said. We still want them to get vaccinated.

This story was first published Aug. 6, 2020, by Kaiser Health News (KHN), a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

See original here:
Americas obesity epidemic threatens effectiveness of any COVID vaccine - The CT Mirror

This story was published in partnership with The 19th, a nonprofit, nonpartisan newsroom reporting on gender, politics and policy.

Eugene Robinson recovered from his double mastectomy on a hospital porch in Durham, North Carolina. It was August 1956, and as a Black child in the Jim Crow South, Robinson wasnt allowed to heal next to White patients.

Sarah Robinson, Eugenes mother, brought a daughter to the hospital. She returned home with a son. It was his third of four surgeries. Two of his nine siblings had undergone similar operations, but his relatives never talked about the fact that androgen insensitivity syndrome, a genetic intersex condition, ran in the family.

Nearly 65 years later, Sean Saifa Wall, 41, sifts through Robinsons medical records, looking for answers about his uncles story that might shed light on his own. Wall, like Robinson, is intersex.

Sean Saifa Wall is a co-founder of the Intersex Justice Project, which has protested intersex surgeries at Lurie Children's Hospital of Chicago for years. Since the 1960s, medical convention has been that intersex variances should be "corrected," often through a combination of surgeries and hormone therapy starting from infancy or before a child can consent.(Photo: Sarah-Ji/Intersex Justice Project)

Intersex is an umbrella term for people with variations in sex characteristics that dont fit neatly in the binary of male or female. Some intersex people are born with varying reproductive anatomy or sex traits some develop them later in life.About 1.7 percentof people are born intersex, according to a 2000 report byDr. Anne Fausto-Sterling.

Since the 1960s, medical convention has been that intersex variations should be corrected, often through a combination of painful surgeries and hormone therapy starting from infancy or before a child can consent. But on July 28, the Ann and Robert H. Lurie Childrens Hospital of Chicago became the first hospital in the United States to suspend the operations. The news comes after a three-year campaign against the hospital led by Wall and Pidgeon Pagonis, co-founders of the Intersex Justice Project.

Activists have been protesting intersex surgeries since 1996, when a group demonstrated outside the American Academy of Pediatrics convention in Boston. Since then,the U.N. has condemned the surgeries,which remain legal in almost every country in the world,as irreversible and unnecessary procedures that can cause permanent infertility and lifelong pain, incontinence, loss of sexual sensation, and mental suffering.

Wall knows that pain intimately.

Wall came out as gay at age 14. Then, he came out as transgender. In both cases, his mom lost it, he said. She was like, Why do you want to wear mens clothes, mens underwear?

But Walls oldest aunt reminded his mom about his intersex uncle, now deceased. His aunt said, Do you not remember playing with Queen Esther as a child?

And my mom was like, Whos that? And shes like, 'Thats Gene.

Wall says the memory blew my moms mind for seven years she had a sister. Looking back, she did remember Esther.

Eight of his family members were intersex, Wall says. The more that Wall started to talk about himself, the more his family opened up about their own histories.

Up until the time he was 13, Walls mom resisted doctors insistence that he have surgery to remove undescended testes, he says. She saw his older intersex siblings suffer through their own operations and thought they were unnecessary.

They told my mom that the testes were cancerous, Wall said. So his mom agreed to the surgery. Wall never had cancer.

He had spent two years under the care of a doctor that he says studied him, asking him questions about whether or not hormones made him less gay. Still, it wasnt until college, while doing a Yahoo internet search, that Wall pieced together that he is intersex.

I was so angry, he said. I was like, Oh, this is not fair. Its not right.' I didnt talk about it for a while. I would tell people here and there, but I didnt talk about it publicly because I had so much shame.

I was so angry. ... I would tell people here and there, but I didnt talk about it publicly because I had so much shame.

When he was 25, he started taking testosterone, something he wanted to do as a trans person to confirm his gender. But he wasnt metabolizing the testosterone the way most people on the hormone do.

I think I felt really suicidal, he said, referring to people constantly misgendering him. But I knew that if I took my own life, that no one would ever know what happened to me, and no one would ever know my side of the story.

Thats when Wall decided to start organizing for intersex rights.

For 19 years, Lurie patient Pidgeon Pagonis also believed they had survived ovarian cancer. The surgeries and exams started before Pagonis could remember, at 6 months old. They had another operation when they were 3 or 4 years old, and another when they were 10.

Pidgeon Pagonis, co-founder of the Intersex Justice Project, at a protest in 2017.(Photo: Sarah-Ji/Intersex Justic Project)

Since I was like 11 they would always just lift my shirt off, touch my chest and then pull my pants down and look at my vulva area, Pagonis recalls. And then theyd ask me questions like, How are you? How are your grades?

Pagonis thought that because of the cancer, they would never be able to have a baby. In truth, Pagonis never had cancer. Years of intersex surgeries to make their body conform to the idea of the female sex had left them unable to feel most sexual sensation.

They spent 18 years in and out of Lurie for surgeries, hormones and exams. Doctors would ask Pagonis if they had questions. Pagonis wanted to know why they were experiencing puberty differently than other kids.

I didnt know I had a vaginoplasty, and I didnt know I was intersex, Pagonis said. I did not know I had a castration, and I did not know I had a clitorectomy at that point. I thought I survived cancer.

Pagonis attended college practically in the shadow of the hospital at DePaul University, watching doctors come and go as they studied for finals. It wasnt until they learned about intersex issues at DePaul that they realized that all those visits to Lurie hadnt been about cancer at all.

I just thought these were my doctors that I had to go to because I had cancer when I was a kid, Pagonis said. And also, I was so unlucky that I had this urethra problem.

No other major U.S. hospital has ever stated that they dont perform intersex surgeries, so Lurie was far from the only institution performing such procedures. However, Lurie has enjoyed a sterling reputation among LGBTQ+ people since 2013, when it opened one of the first pediatric gender clinics in the nation under the leadership of Dr. Robert Garofalo, a nationally renowned expert in transgender health. Under Garofalos leadership in the Gender & Sex Development Program, Lurie became thefirst hospital in the United Statesto adopt a trans-inclusive policy for its young patients.

That prestige made Lurie a prime target for a campaign to end intersex surgeries. Intersex activists have long pointed to a disconnect between the gender-affirming care for trans and non-binary youth at the hospital and surgeries done on intersex children without their knowledge or consent.

The truth of the matter is they are very distinct and separate populations in many ways, said Garofalo. But there are areas where there are some overlaps.

And those cast a pall on the gender clinic as calls to end the surgeries overwhelmed its social media channels.

The Intersex Justice Project Pagonis and Walls organization of intersex activists of color led its first protests against Lurie in 2017 and again in 2018, when the Androgen Insensitivity Syndrome-Differences of Sex Development Support Group held its conference in Chicago. About 70 people showed up to protest outside Lurie. Since that time, Lurie has been the target of a relentless campaign to end the surgeries, and protests outside the hospital have only grown.

In July, Pose star Indya Moore excoriated the hospital for using their image to promote LGBTQ+ inclusion.

You cannot stand W/ trans ppl & step ON intersex ppl! Moorewrote on Twitter. The tweet set off a firestorm of bad press for the hospital as an old petition against the surgeries at Lurie racked up 45,000 signatures.

Garofalo said the hospital has long been revising its polices on intersex care, but it had never apologized for the harm those surgeries had caused.

I mean, the truth of the matter is that it has been uncomfortable for me at times, conceded Garofalo, who does not oversee intersex care at the hospital.

On July 28, the same day the hospital announced it was suspending the surgeries, the hospital apologized.

We empathize with intersex individuals who were harmed by the treatment that they received according to the historic standard of care, and we apologize and are truly sorry, the hospitalstatedin a letter signed by President and CEO Dr. Thomas Shanley. When it comes to surgery, we are committed to reexamining our approach.

Intersex is an umbrella term for people with variations in sex characteristics that dont fit neatly in the binary of male or female. About 1.7 percentof people are born intersex, according to a 2000 report byDr. Anne Fausto-Sterling.(Photo: Oleksii Liskonih, Getty Images/iStockphoto)

A number of staffers within Lurie pushed for an end to the surgeries, most notably transgender research coordinator Dr. Ellie Kim, who publicly criticized the practice.

I really owe Ellie a debt of gratitude for really stepping forward and not being shy about her thoughts on the matter, Garofalo said. And to that extent, Im really proud to be where Im at.

Luries end to intersex surgeries marks a watershed moment for intersex rights. Lurieis rankedamong the top pediatric hospitals in the nation, and intersex rights activists hope that other hospitals follow suit.

But for advocates like Wall, the campaign has also taken a deep toll. Pagonis and Wall garnered support and educated the public by sharing intimate personal stories. Its largely considered disrespectful for reporters to ask transgender people about their surgeries or genitalia. Intersex activists dont have that luxury yet, says Hans Lindahl, director of communications for youth intersex organization InterAct.

Something that we say a lot is that we have not yet had our Laverne Cox moment, said Lindahl. Were still so under the purview of being medicalized that I think theres a pressure that we almost have to tell these stories at this point in our movement in order to get people to listen.

For Pagonis and Wall, that has meant revealing details about their own traumas, sexual experiences, anatomy and family histories.

And largely lost in this moment is the history of intersex surgery itself. Intersex operations were born out of gynecology, a practice developed byJames Marion Sims, who performed brutal experiments on enslaved Black women without anesthesia. Although intersex surgeries were popularized in the 1960s, doctors had been doing them for years before, as Walls family history shows.

Wall says his family was already harassed as a Black family in the segregated South. But a Black family with three kids whose sex characteristics varied meant they were tormented endlessly.

So for me, my intersex story comes out of this legacy thats rooted in the South, thats rooted in North Carolina, Wall said. By the time this intersex variation appeared in my family, there was knowledge and awareness of it, but people didnt talk about it, because there was shame and stigma and secrecy.

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After years of protest, a top hospital ended intersex surgeries. For activists, it took a deep toll. - USA TODAY

Stomach pain is something pretty much everyone is acquainted with at some point in their lives. While some conditions are mild enough to be treated with at-home remedies, its possible youre dealing with something more serious if your pain is severe or happening all the time. So you definitely want to get to the bottom of that tricky Q: Why does my stomach hurt?

There are various causes of stomach pain, which can be acute or chronic and can be caused by issues relating to the stomach, appendix, gallbladder, spleen, bowel, liver, gynecological issues, or other issues, says Michael D. Dann, MD, a gasteroenterologist at Manhattan Gastroenterology in New York City. A thorough examination and further investigation can help you to understand and properly treat the cause of your pain.

Because the list of possible causes is pretty long, Dr. Dann recommends that all persistent or intense abdominal pain always be evaluated with a thorough consultation and examination by a gastroenterologist for an accurate diagnosis and treatment plan. While there are tons of totally harmless reasons that you're stomach hurts (hi, indigestion!), you def want to rule out a serious illness or condition.

Read on for 32 potential causes of stomach pain, as well as how to identify and treat them.

IBS is one of the most common causes of abdominal pain, says Dr. Dann. Symptoms typically include pain in the belly and abdomen area that is nagging and chronic, altered bowel habits, nausea, and vomiting.

How to treat it: Treatment will vary depending on symptoms can include dietary modifications, medication, and lifestyle behavior changes (think: adapting new stress management techniques, as stress can exacerbate IBS symptoms).

Symptoms of lactose intolerance include a crampy abdominal pain (often in the lower abdomen), bloating, flatulence, nausea, diarrhea and vomiting, all after eating dairy products that contain the sugar molecule lactose.

How to treat it: The most obvious way to treat lactose intolerance is to eliminate or limit dairy products from your diet, says Dr. Dann. You can also take an enzyme replacement to relieve symptoms, or treat secondary causes of lactase deficiency, such as with calcium and vitamin D supplementation.

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Patients with gastroesophageal reflux disease (GERD) typically complain of heartburn, regurgitation, and difficulty swallowing, says Dr. Dann. However, some patients may also deal with abdominal or chest pain, nausea, chronic cough, hoarseness, or wheezing.

How to treat it: Mild and intermittent symptoms can be managed with lifestyle and dietary modification, says Dr. Dann. Medication may be needed for persistent or frequent symptoms and can include antacids, histamine H2 receptor blockers (such as Pepcid, a.k.a. famotidine), or proton pump inhibitors such as Prilosec (omeprazole). Severe symptoms may require surgery.

4. Gas and bloating

Gas in your digestive tract comes from either swallowed air and the normal breakdown of certain undigested foods by harmless bacteria that are naturally present in the large intestine, per Dr. Dann. Although it can often cause embarrassing moments, its a normal aspect of digestion. Gas pain and other symptoms like burping, flatulence, bloating, and cramping can be exacerbated by certain foods such as dairy products and artificial sweeteners, according to the Mayo Clinic.

How to treat it: If its not related to another condition, gas can often be treated and managed with various over-the-counter medications (such as Beano or Gas-X) and dietary changes. If you experience chronic gas and severe pain, it could be a sign of another underlying GI condition, which a doc can help to diagnose.

5. Food poisoning

Food poisoning results from eating contaminated food, causing symptoms such as nausea, vomiting and diarrhea, in addition to abdominal pain, according to the Mayo Clinic.

How to treat it: Food poisoning can often be treated at home by replacing fluids and electrolytes and letting it run its course. But if you experience severe symptoms like dehydration, bloody stool, and a fever over 100 degrees, you should seek medical attention.

6. Indigestion

Indigestion is pretty much just the formal name for having an upset stomach, marked by upper abdominal pain, often after a meal. Other symptoms can include gas and nausea, according to the Mayo Clinic.

Gastritis is the term for inflammation involving the lining of the stomach. Symptoms are similar to GERD and include abdominal discomfort/pain, heartburn, nausea, and vomiting. Gastritis can be caused by irritation due to excessive alcohol use, stress, medication such as anti-inflammatory drugs, bile reflux, and infections caused by bacteria like Helicobacter pylori, the latter of which can also lead to ulcers and stomach cancer.

How to treat it: Treatment depends on the specific cause, of course. For example, acute gastritis caused by nonsteroidal anti-inflammatory drugs or alcohol may be relieved by stopping use of those substances. Medications that block or reduce acid production and promote healing can also help, as can antacids and antibiotics to treat H. pylori infection.

This condition typically includes upper abdominal pain with the pain occasionally localizing to one side, says Dr. Dann. Additional symptoms include abdominal bloating, fullness, nausea, and the inability to eat a full meal, or feeling full after only a small amount of food.

How to treat it: To treat this condition, with the guidance of a doctor, discontinue use of nonsteroidal anti-inflammatory drugs and work to eliminate H. pylori with appropriate medications to promote ulcer healing, says Dr. Dann.

This is the term used to describe gastrointestinal symptoms where the cause seems to be unknown. Symptoms of functional dyspepsia can overlap with GERD and gastritis, says Dr. Dann.

How to treat it: Patients under 60 years of age should be tested and treated for H. pylori, says Dr. Dann. This sometimes will include an upper endoscopy, particularly if theyre over age 60. Patients who are H. pylori negative or who continue to have symptoms after gettiing rid of the bacteria should be treated with antisecretory therapy with a proton pump inhibitor.

These are the terms for inflammation in the lining of the intestines and colon, respectively. Symptoms will vary based on the location and cause. In both cases, the underlying cause could be due to a condition such as Crohns disease or even something more benign such as a lack of blood flow to the abdominal area, says Dr. Dann. Patients with infectious colitis generally have diarrhea associated abdominal pain, which may be severe.

How to treat it: Depending on the severity of symptoms, antibiotics may be needed.

Acute appendicitis typically presents initially with pain around the belly button which radiates into the right lower quadrant of the abdomen area, says Dr. Dann. It is associated with nausea, vomiting, and loss of appetite.

How to treat it: For patients with non-perforated appendicitis (meaning the appendix hasn't bursted), you'll likely need an appendectomy in a fairly timely fashion. If the appendix hasnt been ruptured, you may be able to treat it solely with antibiotics. If the appendix has ruptured? You'll need emergency surgery.

Gallstones can cause intense discomfort or sharp pain located in the right upper quadrant or other area below the chest. That's because gallstones occur when digestive fluid deposits have hardened in the gallbladder, and these "stones" have temporarily blocked the duct, causing discomfort and pain. The pain may radiate to the back and right shoulder blade and symptoms can also include nausea, vomiting, and sweating. Pain can last 30 to 90 minutes at a time, and an abdominal examination unfortunately wont tend to show much, says Dr. Dann.

How to treat it: During a gallstone attack, pain can be controlled with nonsteroidal anti-inflammatory drugs. Elective gallbladder removal should be considered for patients with gallstones on imaging to prevent future attacks and complications of gallstone disease, says Dr. Dann.

This is the term for when inflammation occurs in the gallbladder, typically from a clogged duct (like from a gallstone). Acute cholecystitis symptoms can include severe, prolonged, steady pain (like for more than four to six hours) involving the right upper quadrant. You may also have a fever and an elevated white blood cell count, and you may be hypersensitive when you put pressure on the area below the ribs while breathing deeply.

How to treat it: This is a more serious condition that requires hospitalization, says Dr. Dann. Treatment will include intravenous hydration (meaning through an IV), pain meds, IV antibiotics, and surgery to remove the gallbladder.

Acute cholangitis can present similarly to acute cholecystitis but is typically more severe, says Dr. Dann. It occurs when a stone becomes impacted in ducts draining bile from the liver into in the small intestine, leading to an infection. Symptoms include fever, jaundice (yellowing of the skin or the whites of the eye), and abdominal pain. The abdominal pain is typically vague and located in the right upper quadrant.

How to treat it: Similarly to the previous condition, treatment will include hospitalization with intravenous hydration, pain medications, antibiotics, and surgery.

The OG reason for going gluten-free, celiac disease sufferers tend to experience abdominal pain and excessive flatulence in addition to diarrhea, which is often foul-smelling due to malabsorption, says Dr. Dann. Symptoms can present as early as infancy but most commonly present between the ages of 10 and 40. Patients may also experience weight loss, anemia (low red blood cell count), neurologic disorders from deficiencies of B vitamins, and osteopenia (thinning of the bones) due to vitamin D and calcium deficiencies.

How to treat it: Most patients can manage celiac disease with a gluten-free diet, as well as by monitoring and reporting any complications to their doctor.

Pancreatitis can be acute and chronic. The pain is typically severe and can even radiate to the back. Symptoms can also include nausea and vomiting, and you might feel a little bit of relief when you sit upright or lean forward, says Dr. Dann.

How to treat it: Most cases of pancreatitis require hospitalization, along with fluid replacement and pain meds.

Hepatitis is when there is inflammation in the liver due to one fo the five hepatitis infections. Patients with acute hepatitis may have pain in the right upper quadrant, fatigue, nausea, and vomiting. Other symptoms include jaundice, dark urine, and light colored stools.

How to treat it: Treatment will vary depending on the underlying cause and may require hospitalization for supportive care, says Dr. Dann.

Gastroparesis is a condition when the stomach can't properly empty itself of food contents. In addition to abdominal pain, a person with gastroparesis will have nausea, vomiting, early satiety, bloating, and in severe cases, weight loss. The cause is often unknown, but gastroparesis can be seen in diabetics and post-surgery patients.

How to treat it: Treatment typically includes making changes to your diet, getting your blood sugar levels and changes under control if you're diabetic, and hydrating. Medication such as metoclopramide (Reglan) may be necessary, and some patients may require a feeding tube, says Dr. Dann.

Kidney stones occur when a stone passes from the kidney into the ducts carrying urine to the bladder. Mild to severe pain is the most common symptom and can occur in the back or abdomen. Additional symptoms include nausea, vomiting, painful or urgent urination, and blood in the urine.

How to treat it: Kidney stones are most often treated with pain medication and hydration until the stone passes naturally through your urinary system. Large stones may require additional treatment, like lithotripsy (a procedure used to help break up the stones) or surgical removal.

Bladder infections can definitely cause abdominal pain, as well as painful and urgent urination, and/or blood in the urine. If its a kidney infection youre dealing with, you may also have a fever, chills, thigh pain, and joint tenderness.

How to treat it: Most cases can be treated with a course of oral antibiotics, though severe cases may require hospitalization and IV antibiotics. In rare cases, surgery may be required, says Dr. Dann.

You may be surprised by this, but symptoms for acute myocardial infarction (the medical term for heart attack) can include abdominal pain, belching, nausea, and indigestion, as well as shortness of breath or chest pain.

How to treat it: Management will depend on the underlying cause but will always requires prompt recognition and hospitalization, says Dr. Dann. Heart attacks are no joke.

Endometriosis is a disorder in which tissue that normally lines the uterus grows outside of it, often leading to lower abdominal/pelvic pain. Symptoms include painful periods with abdominal cramps, painful during sex, and/or infertility. Endometriosis can also lead to bowel and bladder issues, says Dr. Dann.

How to treat it: Initial treatment typically includes oral contraceptives and nonsteroidal anti-inflammatory drugs, says Dr. Dann. However, recurrence rates are high if you stop taking medication. If treatment isnt successful, surgery to remove the tissue growth is an option.

Also known as leiomyomas, uterine fibroids typically lead to chronic lower abdominal/pelvic pressure or pain. Symptoms will vary depending on the size and number of fibroids and can include abdominal tenderness and low-grade fever, and your gyno may be able to feel large fibroids during an external abdominal exam.

How to treat it: Treatment can include oral contraceptives or GnRH agonists (medications that affect hormone levels). Some women also find relief with an IUD as a birth control method. In other cases, myomectomy (a surgical procedure to remove uterine fibroids) might be necessary.

Ovarian cysts are solid or fluid-filled sacs or pockets in or on top of an ovary. Pain is often a sign that the cyst has ruptured or burst, says Dr. Dann. The most common symptom is lower quadrant pain, and especially pain after sex.

How to treat it: Ovarian cysts can often be managed with monitoring by your doctor and with over-the-counter pain-relief meds. In severe cases, surgery may be required.

This pain can occur in the middle of your menstrual cycle, coinciding with timing of ovulation. It may be right- or left-sided, depending on which side youre ovulating from during that cycle.

How to treat it: This pain usually goes away within 24 hours, says Dr. Dann. You can treat it with over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen. If ovulation is particularly painful for you, taking birth control pills to prevent ovulation may be a solution worth talking to your gyno about.

An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, typically on the fallopian tube. It typically occurs during the first trimester, with symptoms such as abdominal pain and or vaginal bleeding that can be life-threatening.

How to treat it: With an early diagnosis, most patients may be treated with a drug called methotrexate (MTX). But in some cases, a woman may need surgery, says Dr. Dann.

Pelvic inflammatory disease (PID) typically includes acute lower abdominal and or pelvic pain. Patients may also have pelvic organ tenderness and evidence of inflammation of the genital tract. Any sexually active woman is at risk of developing PID, and it most often happens when an STD is left untreated, causing this infection of the reproductive organs.

How to treat it: Treatment can include antibiotics used to treat gonorrhea, chlamydia, and other bacterial infections. Severe or complicated PID may require hospitalization.

Ovarian torsion occurs when an ovary becomes twisted around the ligaments that hold it in place. Symptoms can include moderate to severe pelvic pain, typically associated with nausea, a noticeable mass or bloating in the pelvic area, and sometimes vomiting, says Dr. Dann.

How to treat it: Ovarian torsion can sometimes resolves itself, but it often involves surgery. Surgical removal of the ovary may sometimes be required as well, says Dr. Dann.

Ovarian cancer has a reputation as a silent killer, as its often asymptomatic until its in an advanced stage. But early symptoms may include bloating or abdominal/pelvic pain, urinary urgency or frequency, and postmenopausal bleeding.

How to treat it: Treatment will require surgery followed by chemotherapy, says Dr. Dann.

Ovarian hyperstimulation syndrome (OHSS) can cause abdominal discomfort from enlarged ovaries in women undergoing fertility treatment. Early symptoms are usually mild to moderate and begin four to seven days after the ovulatory dose of the human chorionic gonadotropin (hCG) hormone. Late symptoms are typically more severe and begins at least nine days after the ovulatory dose of hCG during a conception cycle.

How to treat it: Mild or moderate OHSS and can be managed with analgesics such as Tylenol (acetaminophen), and by avoiding intense physical activity, says Dr. Dann.

Endometritis is the inflammation of the inner lining of the uterus, a.k.a. the endometrium. It typically involves lower abdominal and pelvic pain, as well as painful periods with cramping, pain during sex, and/or infertility. It can also lead to bowel and bladder issues, notes Dr. Dann.

How to treat it: Most infections are mild and cured with antibiotic therapy, though some may require IV antibiotics or curettage, a surgical scraping procedure to remove the affected tissue.

Crohns disease is another type of inflammatory bowel disease that causes inflammation in the digestive tract. Its marked by symptoms such as abdominal pain, severe diarrhea, cramping, and bloody stool, according to the Mayo Clinic. If you have have symptoms that could be consistent with Crohns disease or have already been diagnosed, you should always be evaluated with a thorough consultation and examination by a physician for an accurate diagnosis and treatment plan, and to exclude a more serious or urgent condition, says Dr. Dann.

How to treat it: While theres unfortunately no cure for Crohns, its often treated and managed with medications such as corticosteroids, immune system suppressors, and antibiotics. In severe cases, surgery may be required.

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Why Does My Stomach Hurt? 32 Causes Of Stomach Pain And Bloat - Women's Health

The Bone Marrow Transplant Rejection Treatment market report offers an all-inclusive analysis of this industry vertical with emphasis on the key growth drivers, limitations, and opportunities shaping the market dynamics in the upcoming years.

As per the report, the market is projected to show decent growth, recording a CAGR of XX% over the analysis period (2020-2025).

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Fluctuations in supply and demand share due to enforcement of stringent lockdown measures to address the COVID-19 pandemic have left several businesses in disarray. In addition to uncertainty of profit in the short term, some industries are expected to face grueling challenges even once the economy arises from the pandemic.

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Essentially, almost all organizations across various sectors have renewed their budget to restore profits for the coming years. Our complete analysis of this business vertical is designed to help you chart a plan of action and make well-informed decisions.

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Bone Marrow Transplant Rejection Treatment Market segments covered in the report:

Regional scope: North America, Europe, Asia-Pacific, South America, Middle East & Africa, South East Asia

Product terrain: Azathioprine, Adrenocorticotropic Hormone, Cyclophosphamide, Cyclosporine A and Others

Applications spectrum: Hospital, Clinic and Others

Competitive landscape: Bellicum Pharmaceuticals, Inc., Cell Source, Inc., Boryung Pharmaceutical Co., Ltd., Bio-Cancer Treatment International Limited, Capricor Therapeutics, Inc., Biogen Inc, CellECT Bio, Inc., Cantex Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Cell2B S.A., Dompe Farmaceutici S.p.A., F. Hoffmann-La Roche Ltd., Cleveland BioLabs, Inc., Generon (Shanghai) Corporation Ltd., Dr. Falk Pharma GmbH, Cytodyn Inc., Compugen Ltd., Fate Therapeutics, Inc., Escape Therapeutics, Inc., Cynata Therapeutics Limited, Gilead Sciences, Inc., GlaxoSmithKline Plc, Idera Pharmaceuticals and Inc

A rundown of all business-related facets, including marketing strategies, market concentration ratio, and commercialization rate.

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The report offers a complete company profiling of leading players competing in the global Bone Marrow Transplant Rejection Treatment marketSize with a high focus on the share, gross margin, net profit, sales, product portfolio, new applications, recent developments, and several other factors. It also throws light on the vendor landscape to help players become aware of future competitive changes in the global Bone Marrow Transplant Rejection Treatment market.

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Chapter 1 Industry Overview

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Chapter 3 Sales Market Analysis

Chapter 4 Consumption Market Analysis

Chapter 5 Production, Sales and Consumption Market Comparison Analysis

Chapter 6 Major Manufacturers Production and Sales Market Comparison Analysis

Chapter 7 Major Product Analysis

Chapter 8 Major Application Analysis

Chapter 9 Industry Chain Analysis

Chapter 10 Global and Regional Market Forecast

Chapter 11 Major Manufacturers Analysis

Chapter 12 New Project Investment Feasibility Analysis

Chapter 13 Conclusions

Chapter 14 Appendix

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Bone Marrow Transplant Rejection Treatment Market Size, Share, Statistics, Demand and Revenue, Forecast 2025 - CueReport

From Runner's World

If you follow the more esoteric health scene circles, you'll have come across Dutch extreme athlete Wim Hof a man so fond of the cold that he holds the current world records for swimming under ice and prolonged full-body contact with ice. He believes that leaving your central heated palace for the elements comes with a 'cascade of health benefits', from enhanced sleep to the production of endorphins and a fortified immune system. Given the current state of the UK heatwave now's the time to brave it, hey?

While the prospect of dunking yourself in a paddling pool of cubed frozen water might feel like one for the, erm, future even in this heatone impact of Hof's influence is the proliferation of people taking cold showers, for their alleged health benefits.

While still not an enticing prospect, they're eminently more accessible than climbing Mount Kilimanjaro in shorts (another achievement of the 60-year-old). But are they backed up by science?

Here's those that have grounding in research.

Youve heard about athletes taking ice baths after training to promote recovery? Well, the principles behind taking a cold shower instead are very similar.

Cold generally stimulates a response of the blood vessels, which causes vasoconstriction (narrowing of the blood vessels), says Hasit Jethwa, health and fitness tutor at The Training Room.

Essentially, this occurs in order to direct the blood to where its needed the most, in this case, vital organs. So, blood is forced to return to the heart where it can then be transported to the lungs to replenish and this oxygenated blood can then be pumped around the body, meaning you are now getting fresh oxygen and nutrients to the right areas.

'The cold also helps to reduce any potential inflammation you might experience post exercise, which can help to speed up your recovery and reduce your aches and pains.

According to a study from experts at Virginia Commonwealth University School of Medicine, taking cold showers for two to three minutes, once or twice a day, preceded by a five minute 'adjustment period' of slowly cooling water, could be a helpful part of relieving the symptoms of depression.

How? The team put the positive findings down to the fact that exposure to cold activates the sympathetic nervous system and, due to the high density of cold receptors in the skin, sends lots of electrical impulses from peripheral nerve endings to the brain. While they concluded that larger studies would be requited to corroborate the findings, it's a promising start.

Theres a reason why you put ice on a burn or a bad back cold can have anaesthetic-like effects says findings published in the North American Journal of Medical Sciences.

The principles are the same as those outlined by Jethwa above: cold constricts blood vessels, reducing swelling and it also potentially slows the rate at which pain signals are transmitted to the brain.

This one is pending further research. But one 2016 study found that participants were 29% less likely to need to call in sick to work, when they practiced the hot-to-cold approach of showering. The data showed a link between those who have a hot shower, with 30-90-second bursts of cold water reported fewer sick days than those who took warm showers.

This is supposedly due to the increase in metabolic rate caused by the shock of temperature change, says Jethwa. Your body then accelerates its functions, in order to try and compensate.

No surprises with this one the reduced difference in temperature of a cold shower comes as a bit of a shock to your body.

This places your body under stress, says Jethwa. Which sends your sympathetic nervous system into a fight or flight response so, you may, all of a sudden, feel much more focused and alert.

Being under the physical stress of cold temperatures means your requirement for oxygen also greatly increases, which promotes a higher breathing rate and forces more oxygen into the body.

Story continues

The key word here is support. Yes, a study published in Cell revealed that exposure to cold temperatures can protect against obesity, improve your metabolism and alters the composition of your gut bacteria so its better suited to burn fat but the studies were based on mice placed in cold conditions for ten days.

However, there is evidence that taking a cold shower can activate brown fat, a type that helps to generate heat around the body by burning calories.

Cold water is great for the skin, says Kay Greveson, Aesthetic Nurse Practitioner at Regents Park Aesthetics. Even a simple splash of cold water after cleansing can give you brighter skin.

In addition to this, to lock in our core temperature our skins pores shrink, which can help improve the overall texture and appearance of the skin, says Dr. Michael Barnish, Aesthetic Doctor at the Dr. Jonquille Chantrey Clinic.

Oh, and those benefits weve already mentioned that cold reduces inflammation and boosts your bodys immune response? Well those both work together to reduce the lifespan of spots.

Pretty impressive stuff.

Perhaps one for the brave to try out in a study from 2000, researchers placed participants in 14 degree C water for one hour. It may sound extreme, but the experience did trigger a reduction in levels of cortisol the stress hormone in the body.

As Jethwa has already identified, cold showers cause the bodys blood vessels to constrict. Blood rushes around to the organs to stay warm promoting blood flow. An improved circulation is associated with better cardiovascular health meaning your heart stays healthy and happy.

However, its also important to remember that cold temperatures force your heart to work harder to keep your body warm which could, in turn, according to the British Heart Foundation, put your health at risk.

The takeaway? There are many other ways of keeping your heart healthy like a balanced diet and exercise plan so dont rely on cold therapy alone.

Keen to give it a go? Great. But before you dive right in, like with anything new, cold showers are worth giving your body time to adjust to.

There is not really an optimum way of taking a cold shower, says Jethwa. Some people may have a short, five to 10-minute shower at a consistently cool temperature, whilst others may vary between heat and cold intermittently.

Ultimately, its about what works best for the individual, as everyones bodies are different. With some trial and error, you should be able to figure out which method is the most effective for your body.

And remember, cold showers arent for everyone. If you have a history of heart conditions, high blood pressure, a weakened immune system or any concerns as to whether cold showers would be of benefit to you, seek the advice of a medical professional, first.

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9 cold shower benefits that will make you want to turn down the heat - Yahoo Lifestyle UK

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Bone Marrow Transplant Rejection Treatment Market ? What Factors Will Drive The Market In Upcoming Years And How It Is Going To Impact On Global...

Twenty women participated in five focus groups held during December 2017 to February 2018 in two health care locations in Edmonton. Groups ranged in size from two to six women.

Characteristics of the participants are presented in Table1. The majority of women were aged in their 50s, had attended higher education, worked full time and were married or living with a partner. The women were in menopause transition or post-menopausal. The group reported a wide range of physical activity, from high to low (including 2 self-proclaimed couch potatoes).

All participants suffered from severe, often multiple, symptoms of menopause that had significantly impacted their QOL over an extended period of time. Insomnia, night sweats/hot flashes and fatigue were the most prevalent symptoms discussed. In addition, lack of sex drive and vaginal dryness, memory loss, depression, and lack of motivation were described as troubling symptoms. Participants stated that the severity of the symptoms and their impact on the QOL were undermined by their primary care physicians. Most participants also reported feeling socially isolated, without connection to women with similar menopause problems.

In this context, participants discussed the features of a walking program that would be suitable for women in menopause. Four distinct characteristics emerged: (A) sensitivity to health related realities of women in menopause; (B) inclusivity of various expectations and levels of readiness (fitness) among participating women; (C) attentiveness to the need for social support, and (D) flexibility in planning locations and scheduling of the program.

The current health status and ability to be physically active varied among participating women. Participants who reported being able to exercise, described a positive impact on their wellbeing, such as improved sleep and better mental stability. Others, who were more active in the past, but developed co-morbidities or injuries, felt regret that they had to reduce the intensity and/or type of exercise. Participants who reported currently being less active, highlighted symptoms of fatigue and lack of energy as the de-motivating factor to exercise, stating Tired women will not walk (P2, FG5) and Youre too tired to do it (P1, FG5).

Walking was perceived by the participants across all five focus groups as a type of exercise that could be easy, accessible, relaxing, less risky for the body, and open to any level (P1, FG5). Still, many worried that the incapacitating nature of their menopause symptoms described by one participant as struggling to get out of bed in the morning (P4, FG2) as well as other health issues would be a potential barrier to joining a walking program. Therefore, the participants suggested that the walking program should be sensitive to different health realities among menopausal women, such as fatigue, the worry about injury (P1, FG3) (especially during the winter), and possible overheating/hot flushes while walking.

I get so hot and then I get really irritated when you get that hot and you're irritated and when you can only take off so much clothes, right (P2, FG1).

Several suggestions were put forward to overcome these challenges such as indoor walking as a safer winter solution, cooling aids to manage overheating and hot flashes and basic coaching to prevent injury.

but Im thinking for people who have not been active, the worry about injury and just having somebody who can maybe coach them through that a little bit and what to expect or how to stretch out or what to watch for because even though we talk about walking and it seems like a simple thing, I wonder if its possible to have walking injuries (P1, FG3).

In addition, as some of the participants stated, the program should incorporate a right kind of encouragement to keep women motivated, included, and overcoming their concerns.

In the context of these health realities, the focus groups further discussed the programs goals and expectations. While there was a range of opinions how specific the goals of the walking program should be, the participants believed that the sense of clear expectations and purpose should be transparent, [] something that keeps us in check as to what the purpose of the walk is (P6, FG2).

Some participants stressed the need for disciplined commitment to the programs schedule, emphasizing the importance of predetermined health outcomes, something to achieve, you know, to look forward to (P2, FG2) to ensure that the program will make a difference (P3, FG1).

I also think being out and getting out giving you a sense of accomplishment that you know that I'm you know I'm doing this for me and I'm committed to it and I'm actually getting it done. I want some real rewards (P4, FG2).

A more flexible approach was suggested by others. Some participants believed that establishing high-achieving goals may be attractive to some women, but these could also deter less active and less competitive women. The program therefore should respect womens different initial fitness, offering different levels of walking intensity and leave room for individual goals.

As somebody who like I said is just starting to be a functioning human being again [] the expectations [should not be] too great []so that they can start out small but grow as it can like expand as they feel like they can take on more (P4, FG2).

I like to be able to keep track of my steps, thats my own personal goal so I think if people had individual goals thats great too (P1, FG3).

While developing specific goals would be important for some participants, others would be comfortable with a more general purpose of wellness, envisioning a less competitive program that will improve health (P2, FG4) or contribute to feeling better (P1, FG5). Openness to and inclusion of women with various expectations and levels of fitness surfaced as consequential characteristics of the walking program.

In discussion about the appropriate nature of the program, the importance of the social support to women, described by one participant as connecting with someone who is walking the same steps as I am (P2, FG5), was emphasized across all focus groups.

The participants envisioned an organized, regularly scheduled walking group that would be fun, with an optional coffee time at the end. Such a program would simultaneously provide an opportunity for physical activity and mutual emotional and social support to women who often do not have a place to share their menopause experience. This was discussed for example in FG3:

[] and its not necessarily about the walk [] its about the socialization. (P3) Yeah thats a big part (P4). Because that helps, its not the exercise that helps, its the socialization and realizing that they're not alone (P3). [] I think if the main focus is socialization, just all in the same boat, but were going to walk down the block and talk about our menopausal symptoms, [] the walking is the secondary piece (P2).

The concept of a buddy system was also broadly discussed across the focus groups in the context of the lack of motivation to be physically active that women often experience. One exchange, which occurred in FG1, suggested that peer encouragement and mutually developed accountability to one another would be an incentive to continued participation:

I would need a buddy because I wouldn't want to do it on my own (P3). Walking partners are great (P1). Thats true too (P2). I would need a buddy. I think definitely the, you know like, group or buddy I think it would, like for me that would be great. []and yeah to be accountable to go, yeah theres an accountability piece, theres a social piece, there is just that Yeah theres a lot of features to the buddy thing (P3).

An additional suggestion, made in two focus groups described a virtual community that would use a Facebook and/or a mobile application accessible to all its members. This was described as multipurpose tools that could increase motivation, keep the social network engaged, and keep track of individual achievements.

And if you set it up something like you know on one of the social aspects on Facebook whenever you set a group up and say ok this is the plan for the day, this is where everybody is going, love to see you there, you know and kind of just whoever shows, shows. You know its not a hardcore that you have to be there, its you know feel free when you feel up to it or when you're having a day or when you just need to talk (P3, FG3).

While most participants anticipated a face-to-face walking program that provides social group activity, some participants mentioned the possibility for a combination of group and individual activities. In FG4, this was suggested as an additional opportunity to clock our own walking (P2, FG4). In FG2, two participants (one who lives out of town, and one self-described loner), proposed a virtual community where participants would exercise on their own, but could connect periodically in person with the rest of the walkers:

they should make a menopause walking app or something so you check in or something like that (P3, referring to MyFitnessPal). if we did something like that and there was an app that could be adapted to be used then you're doing it alone but you're not alone (P2). I would want to see how everyone else is doing you know like P1 did 10,000 steps or she walked 10 miles this week. [] so if theres an app [] and if were all willing to provide that information [] to motivate us (P6).

By developing in- person and virtual community, as well as individual and group activities, the walking program would demonstrate adaptability and flexibility to suit different lifestyles, while simultaneously creating a space for social interaction.

The weather and seasonal changes were emphasized as a key aspect of developing a walking program. The severity of winters with low temperatures and icy sidewalks on one hand, and hot summer days on the other, call for flexibility in identifying appropriate locations and venues for walking. All focus groups discussed summertime walking along the many city walking trails, except when the temperature is too high and walking would be more comfortable in air-conditioned spaces.

During the winter, walking inside was preferred as a safer option by the majority of participants, for example walking in recreation centers or shopping malls; though some participants felt inside walking was a less attractive option.

Discussions about geographical locations for the walking program provided less consistent suggestions. While some of the participants were willing to drive and meet the group wherever it is located, the majority would prefer the program being closer to home, to save time and avoid unnecessary driving. The following exchange in FG4 exemplifies this point:

Well I guess it depends on where the women are all located right? You want to make it feasible, like you want to make it, you know, easily accessible; if somebody has to travel a half an hour plus to get there, its best to sort of have it in three to four different areas in the city (P2). I totally agree with that [] because if there was a walking group that just met downtown I wouldnt join it because I live [in the part of the city] thats a half an hour drive to get there (P1). I agree, I wouldn't drive far to go for a walk because I would just go for a walk out of my house (P5). Im a driver so that wouldn't bother me; that would be fine for me (P2). Its just the time I think for myself anyways you know its just, its making the time (P4).

Possible solutions included providing the program simultaneously in different neighborhoods or parts of the city, or be mobile and move around the city on a weekly basis, with the various time schedule options, such as evening walking (during the week) and mid-days or afternoons (on weekends).

As participants discussed a number of factors related to the logistics of the planning (weather, location, time), the need for accommodation and flexibility has emerged across all focus groups, to ensure the access and commitment to and feasibility and sustainability of the program. Most important for all women was the commonality of menopause for the walking group; as one woman sums it up: There is always the one constant, its the menopause group, so that constant there (P1, FG1).

Link:
Walking together: women with the severe symptoms of menopause propose a platform for a walking program; outcome from focus groups - BMC Blogs Network

In this study, 16 women with POI, aged between 28 and 47years, and a POI duration of 215years were interviewed. The demographic characteristics of the participants are summarized in Table1.

After content analysis of the interviews with a focus on the factors influencing the QOL of women with POI, three themes emerged (disease effect, distorted self-concept, and hormone replacement therapy effect), explained as follows (see Table2).

Consisting of two main categories i.e. physical and psychological, the theme is defined here as the direct negative influences POI exerts on the various aspects of a womans health, taking a toll on her QOL.

The very first complaints of POI in these women were menstrual disorders including menstrual irregularities, oligomenorrhea, and in some cases, metrorrhagia, occurring 6months to 6years prior to the final diagnosis. Two of them had primary amenorrhea. Many of the women with POI complained about vasomotor disorders such as hot flushes, night sweats, and heat intolerance.

I cant bear heat or thirst. Its been more intense in the last six months. When I begin to fall asleep at night, suddenly the hot flushes come about. Its as if I am burning from the inside. I cant go to sleep anymore when this happens, you know, because of the rapid heartbeat and all the sweating (20's-30's, disease duration: 2 years).

Fertility disorders were also caused by POI. The women inclined to have a baby complained about infertility. Those resorting to assisted reproductive technology (ART) mentioned donor egg pregnancy, abortion, and in-vitro-fertilization (IVF) as factors reducing their QOL and putting a long-lasting strain on them.

As for bone complications, two of the most commonly experienced issues were joint pain and osteoporosis. Also, a few of the women complained about post-menopausal tooth pain and sensitivity.

I have osteoporosis and severe joint pain. I feel pain deep in my bones. I cant take long walks (40's-50's, disease duration: 13 years).

The mucocutaneous complications were reported by almost all participants as occurring in the form of vaginal or skin dryness; vaginal itchiness and tightness; and reported by a few, there were falling hair and wrinkled skin.

Dryness and itchiness drive me crazy. Sometimes I scratch myself to bleeding. You wouldnt want to know how awful it is when at work, it hurts so much that I like to chop it off. (40's-50's, disease duration: 3 years)

The afflicted women would mainly experience sexual function disorders due to ovarian hypofunction. They experienced dyspareunia, reduced sex drive, and anorgasmia.

The disease has affected my sex life. I dont feel like having sex at all. Last time I had sex, it was so, so painful and hurt a lot. I just tried to cope up with it and make as if it wasnt there but I could never have an orgasm. (30's-40's, disease duration: 6 years)

Despite these disorders, most women expressed that their frequency of having sex remained unchanged.

Now that I am disabled and not a perfect woman anymore, I want to manage it and have a kind of normal sex life. I dont want my husband to feel deprived. I would like him to have a normal sex life. (30's-40's, disease duration: 3 years).

Many women were in good health, however, some of them reported conditions like weariness, loss of physical strength, and sleep disorders.

I feel as if I had become heavier when you dont get period, youre down youre not that agile anymore. Youre bored and not fresh. (30's-40's, disease duration: 4 years).

According to a majority of the participants, being diagnosed with the disease was shocking and unbelievable:

It came to me like a blow. I felt awful. I was shocked and frustrated. I was in shock for some time. (30's-40's, disease duration: 3 years).

The women experienced grief for quite a long time after being diagnosed with the disease. They were concerned about the complications of the disease (e.g. infertility, sexual problems, and osteoporosis), and couldnt easily talk or even think about it:

I am so disappointed. Everyone dreams of having a baby. I cry when Im alone and think of it , that I cannot experience it naturally. When others are talking about children or I see a little child, I get even more disappointed (30's-40's, primary amenorrhea).

There were many cases of becoming aggressive, agitated and losing control over anger associated with POI, reported by the interviewees. The conditions associated with fits of moodiness in these women included rage, mood swings, impatience, and, as reported by some of them, introversion.

Before receiving the treatments, I experienced all those changes of temperaments, you know, you suddenly get happy and then, for no reason you start to cry. I was beginning to feel helpless because it hurt so much. (30's-40's, disease duration: 5 years)

Also, there was a large number of these women complaining about stress-related problems such as anxiety, tension, and lack of concentration while before having POI, they never had such an experience at this level.

I am anxious; I very much like to read a book but I just cant seem to be able to finish it because of all the anxiety I have. I am trying to tell you that I lack concentration. (30's-40's, disease duration: 4 years)

The leading causes of POI womens anxiety were as follows: losing health, having children, and getting married. Other causes had roots in physical effects of the disease, its economic burden, fear of future incidence of the possible related complications, and its turning into a chronic disease:

Im worried about getting married. Im afraid there will be no Mr. Right accepting me as a girl getting to menopause at an early age who cannot give him a baby. (30's-40's, disease duration: 4 years)

Subsequent to POI-induced infertility as well as menopausal complications, many women experienced negative feelings including hopelessness, emptiness, being cursed, and unhappiness:

I feel empty for being infertile. I cant enjoy real happiness why should I be that unlucky? My peers get periods and are healthier than me. (40's-50's, disease duration: 10 years)

The analysis of the experiences of women with POI yielded factors such as threatened identity and disease stigma, distorting their self-concept and adversely affecting their QOL.

Femininity was threatened by amenorrhea and followingly, infertility; as a consequence, women would experience feelings like deficiency, losing self-confidence, femininity defect, being different from other women, and embarrassment. Some women even resisted entering a relationship with the opposite sex:

I feel disabled; I am not an all-around woman anymore. Compared to normal women, I lack something. Its as if Im weaker than other women. I feel I am sterilized. (30's-40's, disease duration: 3 years)

The identity, and as a result, the maternal role of POI women who wanted to have children were threatened since they couldnt have the natural experience of a genetic mother. Their main concerns turned out to be: forced acceptance of a donor egg, the donor egg childs lack of resemblance to them, not being accepted as a mother by the child, and the egg donor claiming the baby.

I accepted the donor egg to save my marriage, but there are some things to worry about. What if the child leaves me because I am not his/her genetic mother? What if the egg donor shows up and claims the baby one day or another? (30's-40's, initial amenorrhea)

POI had caused an undesirable self-image in women making them feel aged, withered, disabled during intercourse, and with deteriorated self-confidence as a result of breast sagging and poor fitness. One of the women explains:

A woman with POI is like a flower withered before blooming. I feel so old; it is as if I am too old for my age. Im not youthful anymore, Im withered. (30's-40's, disease duration: 4 years).

Another interviewee states that:

I feel like old women when I have to take calcium pills at this age to maintain strong bones. (30's-40's, disease duration: 5 years)

Most of the participants resorted to concealment due to the disease stigma. The afflicted women and the donor egg receivers intended to hide the disease and the donor egg from others. Also, some women reported feelings of isolation after having POI.

One of the problems I have with the diseases is that I have to hide it because I dont like anyone to find out about it. You need to make believe that you are fine while having it with you. (20's-30's, disease duration: 2 years)

The interviewees reported that they suffered consequences of the disease stigma such as being judged, being labeled, being blamed, looking pathetic, peoples scornful look, and the bad reputation of the disease.

I kind of feel like its becoming a drawback for me and my husband is using it against me. The moment something comes up, he brings it up and then its me with egg on my face. (30's-40's, disease duration: 6 years)

As a symptomatic therapy influencing the QOL, hormone replacement therapy (HRT) was administered to POI women. Two main categories emerged out of the participants experiences, i.e. positive or desirable effects, and negative or undesirable ones.

I take medicine to regulate my menstruation. My period is regular now and I have no hot flushes. I dont think of how it affects my health (40's-50's, disease duration: 3 years)

I have gained lots of weight since I took the medicines. Now, I have stopped using them by myself. I couldnt swallow the pills. I was fed up with them. (30's-40's, disease duration: 5 years)

See the original post here:
An exploration of factors affecting the quality of life of women with primary ovarian insufficiency: a qualitative study - BMC Blogs Network

Type 2 diabetes can mean one of two things: the body doesn't produce enough insulin, or the body's cells don't react to insulin - this is known as insulin resistance.

Insulin is a hormone that regulates the amount of blood sugar - the main type of sugar you obtain through eating food.

This sugar is an important source of energy and provides nutrients to the body's organs, muscles and nervous system.

However, consistently high blood sugar levels can inflict permanent damage to parts of the body such as the eyes, nerves, kidneys and blood vessels.

READ MORE:Type 2 diabetes: The cooking oil shown to lower blood sugar and reduce heart disease risk

Specific nerve damage can lead to a paralysis on one side of your face, otherwise known as Bell's palsy, it says.

Other telltale signs associated with Bell's palsy include:

You can stabilise your blood sugar levels by making healthy lifestyle decisions.

Diet forms an essential component of blood sugar control, and, while there's nothing you cannot eat if you have type 2 diabetes, you'll have to limit certain foods.

That's because certain food groups send your blood levels soaring.

One of the worst offenders are foods with a high carbohydrate content such as rice, pasta and flour (therefore including pastry, bread and other dough based foods).

Carbohydrate is broken down into glucose relatively quickly and therefore has a more pronounced effect on blood sugar levels than either fat or protein.

To help identify high and low carb items, you should refer to the Glycemic Index (GI).

The GI index is a relative ranking of carbohydrates in foods according to how they affect blood glucose levels.

Physical exercise also helps lower your blood sugar level.

According to the NHS, you should aim for 2.5 hours of activity a week.

"You can be active anywhere as long as what you're doing gets you out of breath," says the health body.

See more here:
Type 2 diabetes symptoms: Have you noticed this happen to one side of your face? Sign - Express

The mention of diabetes usually refers to type 2 diabetes (T2D) a worryingly common chronic illness among Malaysians.

Type 1 diabetes (T1D) is lesser known, but its impact on life is equally serious.

T1D (previously known as juvenile or insulin-dependent diabetes) is a chronic condition that comes about because the pancreas stops or only produces a little insulin.

Insulin is a hormone that helps control sugar (glucose) levels in the blood and allows our cells to use sugar from food for energy.

The lack of insulin causes sugar to accumulate in the bloodstream, leading to the many symptoms and complications of diabetes.

One possible cause of T1D is an autoimmune reaction that mistakenly destroys the insulin-producing beta cells in the pancreas.

Exposure to certain triggers in the environment, such as a virus, is also linked to T1D.

A major point that differentiates T1D from T2D is that T1D is not caused by lifestyle factors such as unhealthy eating habits or lack of physical activity.

It commonly occurs during childhood and adolescence, and is relatively rare, affecting around 5% of all diabetes patients.

Symptoms and complications

Unlike T2D, the symptoms of T1D may appear suddenly.

Early diagnosis is important to avoid serious complications such as diabetic ketoacidosis (DKA), but misdiagnosis as acute gastroenteritis or urinary tract infection can happen and should be avoided.

Common symptoms include:

Acute complications include:

> Hypoglycaemia

This is when blood sugar levels become too low due to high insulin levels when a T1D child delays a meal/snack, does not eat enough or exercises too much after her insulin has been administered.

It happens quickly and needs immediate treatment.

Symptoms include shaking, nausea, sweating and fatigue.

> DKA

The body breaks down fat cells when it cannot get enough glucose for fuel, resulting in chemicals called ketones.

This happens when the child misses his insulin injections or during inappropriate management of sick days.

The combination of high glucose, dehydration and ketone build-up leads to ketoacidosis, which can be fatal.

If it occurs, DKA must be treated as an emergency.

In Malaysia, about 70% of T1D patients are diagnosed with the condition after first going to the clinic or hospital with DKA symptoms, which includes vomiting, abdominal pain, rapid breathing and loss of consciousness.

Meanwhile, chronic complications of T1D include:

> Cardiovascular disease

The risk of cardiovascular problems, such as heart attack, stroke, atherosclerosis, high blood pressure and coronary artery disease, increases with diabetes.

> Organ damage

Blood vessels in organs like the eyes and kidneys can be damaged due to diabetes, causing kidney failure and serious eye conditions like cataract, glaucoma or blindness.

> Nerve damage

It starts with tingling, numbness or a burning sensation in the feet, and gradually spreads upward.

Over time, it can lead to total loss of sensation, and even loss of limbs.

Nerve damage also affects the gastrointestinal tract.

If a diabetic child starts a new physical activity, e.g. badminton or another sport, his or her insulin dose and meal plan needs to be adjusted to take into account their new energy expenditure. Filepic

Management

While there is no cure for T1D, there are ways to manage it so that the patient can live a regular life.

These include:

> Insulin administration

A child with T1D needs lifelong insulin therapy to control her blood sugar levels.

It can be administered via multiple daily injections or an insulin pump.

There are short-acting, rapid-acting and long-acting insulin.

Following a proper schedule for daily insulin administration is key to managing T1D.

> Blood sugar monitoring

Careful and regular monitoring of the patients blood sugar level is important to ensure that it remains within the target range.

Blood sugar levels need to be checked before and after eating, sleeping, exercising, driving, or when low blood sugar is suspected.

Self-monitoring with a chemically-treated paper strip is the standard way of measuring blood sugar, while intermittent and real-time continuous glucose monitoring systems are more advanced.

> Healthy eating

The child and his family needs to understand how different foods affect his blood sugar.

A dietician can propose a suitable diet plan focusing on whole grains, veggies and fruits.

Insulin doses should be tailored to the amount of carbohydrates taken, so the child and his caretakers need to learn to count the carbohydrate content in his food and drinks.

There is no specific diet restriction for T1D patients, but healthy eating is mandatory!

> Physical activity

Regular exercise is still necessary, but the child needs to know it can lower her blood sugar level.

Thus, her blood sugar needs to be monitored more frequently when starting a new activity to observe any effects.

Her meal plan or insulin doses may need to be modified to suit the new activity.

Being diagnosed with T1D can be a huge challenge for a child and his family.

Apart from the need for cautious management, T1D is also a costly disease while insulin is free at government hospitals, other medications, equipment and overhead costs can strain a familys finances as diabetes is a long-term condition.

However, T1D can be managed successfully.

With the right help and support, especially from parents, family members and a good healthcare team, a T1D child can cope with his condition and live a regular, healthy life.

Associate Professor Dr Muhammad Yazid Jalaludin is a consultant paediatrician and paediatric endocrinologist. This article is courtesy of the Malaysian Paediatric Associations Positive Parenting programme in collaboration with expert partners. For further information, please email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the readers own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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Dealing with type 1 diabetes in children - The Star Online

While advocacy groups say that bringing intersex people to the table is a start, interACT argued in a statement posted to its website that at least two intersex people with backgrounds in intersex human rights advocacy should participate in the dialogue. Hans Lindahl, the organizations communications director, also wants to see institutions like Lurie commit to reparations for generations of adults who have been irreparably harmed by these surgeries; that includes working to provide them with free or low-cost care that meets their particular needs.

The massive amount of focus is on infants, which I think clouds the issue for people, Lindahl told BuzzFeed LGBTQ. There's a population of decades worth of damaged intersex adults who have nowhere to go. Theres no adult intersex care specialty. Endocrinology or hormone doctors who can offer us knowledge and safety are truly rare. It often feels like theres nothing. Were left out to dry completely."

While activists say the ultimate goal is to encourage all medical centers to take proactive, comprehensive steps in support of their intersex patients, resources to staff a large-scale advocacy effort remain limited. Organizations like Intersex Justice Project and interACT are extremely small and predominantly volunteer-led, and Pagonis said the majority of donations that their group takes in go toward art supplies. To help fill that gap, Intersex Justice Project has provided toolkits, how-to guides, and even YouTube tutorials for activists who wish to start their own campaigns. That callout has led to protests in cities like London and Berlin in recent years.

Wall believes that empowering the next generation of intersex activists is critical for the movement to continue and hopes the recent victory against Lurie proves to them that change is possible. During a recent trip to the National Museum of African American History and Culture in Washington, DC, he was inspired by an exhibit on the Black Panther Party, the revolutionary political group that, like the Intersex Justice Project, was founded by just two people: Bobby Seale and Huey P. Newton.

They inspired a generation of young Black people and really pushed an idea, an ethos, and a cultural stance of Black liberation, Wall said. Their movement defined a generation. I think this is a lesson that we should never doubt the power of a few people making a difference.

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Activists Got A Chicago Childrens Hospital To End Intersex Surgeries. For Them, It's Just The Beginning. - BuzzFeed

As the Covid-19 pandemic progresses, researchers are reporting many unpleasant and downright weird side effects of this disease from neurological ailments such as confusion, to "Covid-toes"and rashes.

But it seems some Covid-19 patients are experiencing yet another side-effect hair loss. According to a report byScience Alert, 56-year oldPeggy Goroly, a Covid-19 patient from Long Island, New York, experienced severe fatigue, brain fog and heart palpitations. One perplexing symptom, however, was "traumatic" hair loss.

She asked members of a Facebook Covid-19 support group if she was the only one losing hair in clumps, and it turned out many patients were experiencing the same effect.

But how can Covid-19 affect your hair?

Hair loss and illness

Although hair loss is not listed as an official symptom, and the reports from Facebook support groups are anecdotal, Dr Shilpi Khetarpal, a dermatologist from Cleveland Clinic, confirms they have seen Covid-19 patients with severe hair loss.

According to Dr Khetarpal, the phenomenon is known as telogen effluvium, a form of temporary hair loss that occurs after a stressful, traumatic event. This condition is not the same as alopecia areata, a hair loss disorder resulting from an autoimmune disorder.

Harvard Health explains that 85% to 90% of the hair on the average person's head is in a so-called active stage of growing (anagen phase) while the rest of the hair is in a "resting" phase (telogen phase).

Shedding hair is normal, as hairs remain in the anagen phase for two to four years, then move into the telogen phase, where they "rest" for a couple of months, and then fall out to be replaced by new hairs.

But with telogen effluvium, more hairs are pushed into the "resting" phase, which results in more hair falling out, mostly from the top of your scalp.

There are many factors that can trigger telogen effluvium:

In the case of Covid-19 infection, patients may spot hair loss two to four months after the most severe symptoms, as hair will first enter the "resting phase" before falling out.

According to Dr Khetarpal, hair loss is therefore not listed as a symptom, but rather a side effect of Covid-19.

"This is why we're seeing these patients now, several weeks after Covid-19 symptoms resolve. Telogen effluvium isn't a symptom of Covid-19 as much as it is a consequence of the infection."

Hair loss can occur for six to nine months and will usually resolve on its own.

How can you manage Covid-19-related hair loss?

While the hair loss is mostly temporary, it can still be traumatic. But Dr Khetarpal states some people have a greater genetic predisposition for hair loss than others, and proper nutrition is a key factor in restoring hair growth, especially iron and vitamin D.

If you experience any other symptoms such as itching, burning or a rash on the scalp, you should preferably see a dermatologist, but if it's only hair loss, you can continue your normal washing and styling routine without worrying.

Consult your doctor about your iron and vitamin D levels and ask if it's necessary for a supplement. Dr Khetarpal also states that a biotin supplement should help restore hair growth.

'I don't have Covid-19, but I'm experiencing major stress during the pandemic could I lose my hair?'

While Covid-19 can be a devastating disease, you don't have to be physically ill to experience major psychological stress during this period. Therefore, hair loss can occur if you've had any increase in stress levels.

"There are so many pandemic-related stresses. There's financial stress, concern for ill family members, anxiety about contracting the virus, social isolation and changes related to working and schooling from home. We are absolutely seeing hair loss in non-Covid patients that seems related to pandemic stress."

READ:More symptoms of coronavirus: Covid toes and skin rashes

READ:Is Covid-19 now linked with strokes in young patients?

READ:Coronavirus hangs around even after symptoms subside

Image credit: Getty Images

Marelize Wilke

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Could hair loss be another Covid-19-related side effect? - Health24

Its always sad when somebody passes away, but things can get contentious for the deceaseds family when it comes to figuring out what happens with the estate when the person dies. That is especially true in the case of businessmen who own successful businesses and NFL teams are often among the most successful businesses around.

When longtime Denver Broncos owner Pat Bowlen passed away 2019, it kicked off a family feud that saw his survivors fighting over who would get control of the football franchise. And the leadership struggle turned ugly, tearing the family apart.

Bowlen bought the Denver Broncos in 1984, and he served as the teams CEO until stepping down in 2014, when his mental capacity became compromised with the onset and progression of Alzheimers disease.

The team won three Super Bowls under his ownership and found much success with having long runs of consistency, with the likes of QB John Elway and head coach Mike Shanahan sticking with the team for long tenures, and then signing QB Peyton Manning as a free agent late in his career to get the franchises third Lombardi Trophy.

RELATED: Art Rooney II and the 8 Other NFL Team Owners Who Arent Multi-Billionaires

Bowlen fathered many children, as reported by The Athletic. He had two daughters with his first wife, Sally, and with his second wife and widow, Annabelle, he had five more children.

When he stepped down from the Broncos, Bowlens ownership stake in the team about 77% was put into a trust overseen by three non-family members. When Anabelle passes away, Bowlens interest in the Broncos will be passed down to his seven children by marriage, with each receiving an equal share.

But Bowlen also has an eighth child, daughter Alexandra, who was born out of wedlock in 1988. Some older members of Bowlens knew he had an eighth child, but his younger children found out about her two months after his funeral. That led to questions about whether she was looking to join the battle for control of the team.

RELATED: Jerry Jones Is Surprisingly 1 of the Few NFL Owners to Play Football

Bowlens trust doesnt detail a clear line of succession for control of the Denver Broncos, which has led to hostility and multiple lawsuits in the battle over control. Bowlen hoped one of his children would emerge as the best candidate to take over principal ownership, but seven years into the search for a successor no one has been named yet and it doesnt seem like the trustees are close to picking the new controlling owner.

That has caused some people to speculate the trustees are intentionally dragging out the process to keep themselves in charge; they deny that claim. Team president and CEO, Joe Ellis, who is also one of the trustees and controlling owner delegee, has admitted that the situation looks messy. He says that the trustees are going to follow Pats plan, no one elses, saying that he knows exactly what Bowlen told him.

One of Bowlens sons, former college defensive back Johnny, worked in marketing for the team until being put on indefinite leave in 2015 after being arrested for domestic violence. He has said in the past that his father told him hed be the one to take over the team when the time came.

Johnny said that made a ton of sense because hes the most qualified and the most well-trained to take over. He claims to have all of the credentials other (than) this silly senior management job, and he expressed frustration with not getting to do what his dad wanted him to.

Johnny also says he hopes someone will at least let him try, which does not appear to be on the verge of happening.

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The Denver Broncos Are in the Middle of a Nasty Family Argument Over Ownership - Sportscasting

Getting aching legs even though youre on your feet less? There are a couple of likely culprits both related to your circulatory system. Varicose veins affect about 30pcof the population roughly half of patients can see them on the surface, but the rest will only know they have them when they get aching legs, swollen ankles, red or brown stains around the ankles, phlebitis or leg ulcers,"explains Mark Whiteley, consultant venous surgeon and founder of The Whiteley Clinic. "During lockdown, many people have been less active and so we have seen more people coming in who have deteriorated quicker than we would expect.

Theres also another concern. Deep vein thrombosis, or clotting in the deep veins of the legs, can form in patients who are unwell or dehydrated, or less mobile than usual. DVT is also associated with underlying cancers in 10pcof people and because many people have not gone to doctors during lockdown because they are worried about Covid, then there may be a proportion of patients who have had undiagnosed cancers continue to grow, causing DVTs.

How to fix it: If you suspect you have either of this issues, then the only permanent fix is a diagnosis and treatment but if youre still isolating, then mobility and good health are a sensible stopgap. Keep well hydrated and walk as much as possible, says Whiteley.For varicose veins in particular, you can elevate the leg when youre resting, and wear graduated compression stockings if your circulation is good. However, none of these will give a good long-term outcome without finding the underlying problem and treating it.

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What lockdown has done to our bodies and how to fix it - The Telegraph

The physical, mental and emotional benefits of meditation have been studied extensively in recent years. While theres still much to uncover about its potential, the practice has proven to be an effective tool that can help to improve our quality of life reducing stress, improving attention, enhancing self-awareness and more.

We asked Dr Elena Touroni, consultant psychologist and co-founder of The Chelsea Psychology Clinic; Richard Reid, psychologist, author and founder of Pinnacle Therapy; and Valerie Teh, yoga, breathwork and meditation instructor at the House of Wisdom, to share advice about establishing a regular practice to enjoy the benefits of meditation:

Research into the benefits of meditation has been promising so far, with clinical studies reporting outcomes like improved memory, greater emotional intelligence, increased creativity, better stress management, improved listening skills and increased focus, says Reid.

Not only does a regular meditation practice help us become healthier, happier, and more self-aware as individuals, its also beneficial in terms of our productivity, relationships and ability to connect and support other people, he says. And who doesnt want that?

As the benefits of meditation reveal, fostering a regular practice can be nothing short of life-changing. And best of all, its accessible to everyone and totally free.

Here, we talk you through the science behind 13 proven benefits of meditation:

When stress strikes, your body releases stress hormones such as adrenaline and cortisol, causing a cascade of physiological effects. Chronic stress can have a catastrophic impact on your health, causing disrupted sleep, high blood pressure and impaired concentration. Practicing meditation affects the body in the direct opposite way that stress does, by triggering the bodys relaxation response. A brief mindfulness meditation practice just 25 minutes for three consecutive days is enough to alleviate stress, according to research.

Meditation is a powerful form of anxiety management that works by quieting the mind and reducing tension in your body. In a study of 89 patients with generalised anxiety disorder characterised by chronic and excessive worrying those who had undertaken a mindfulness meditation course exhibited sharply reduced stress-hormone and inflammatory responses to a stressful situation. Meanwhile, patients who took a non-meditation stress management course recorded worsened responses.

Meditation can lead to better emotional health by boosting your self-esteem and confidence. One study observed the brain activity of participants using an MRI scanner before and after completing a two-month meditation course. The participants showed increased self-esteem, increased positive and decreased negative self-endorsement, increased activity in a brain network related to regulating attention, and reduced activity in brain systems related to self-image.

Meditation can help you develop a greater understanding of yourself and how you relate to people around you. This mindful self-awareness also allows you to recognise self-defeating thought patterns, and is associated with decreased activation of brain regions linked to rumination, according to research.

Meditation heightens your attention and concentration span, and you dont have to practice for hours upon hours to enjoy the effects. Researchers at the University of Pennsylvania reported that small doses of daily meditation enhanced performance and the ability to focus attention, even for those new to the practice. Meditation may even reverse patterns in the brain that contribute to mind-wandering and poor attention, according to one review.

Mindfulness meditation acts on core brain networks that play a key role in many cognitive tasks. This includes working memory, which allows the brain to hold onto information temporarily just ten minutes a day can improve working memory by 9 per cent, one study found. It can also help to fight age-related memory loss a review of 12 scientific studies examining the potential effects of meditation on age-related cognitive decline found that the practice increased attention, memory and mental quickness in older participants.

As well as altering brain chemistry to promote positive thinking and optimism, meditation teaches you to pay attention to thoughts and feelings and observe them without passing judgment. For this reason, it can help to ease symptoms of depression, which include low mood, sadness and low self-esteem. Meditation therapies have been shown to reduce symptoms in patients with clinical depressive disorders, according to one analysis.

A short meditation in the evening can relax your body and mind, preparing you for a better nights sleep. In a study that assessed the value of mindfulness meditation in the treatment of insomnia, participants who meditated fell asleep sooner and stayed asleep longer than those who didnt.

Meditation regulates the functioning of the lateral prefrontal cortex, which is the part of the brain that is responsible for logic, reasoning and rational thinking. By cultivating awareness of the present moment and clearing the mind of other thoughts, the practice helps us feel more in control. Just one 15-minute breathing meditation may help people make smarter choices, according to research.

Meditation has been shown to both reduce pain sensations in the body and build resilience to it, resulting in a greater ability to cope with pain. In fact, just ten minutes of mindfulness meditation could be used as an alternative to painkillers, according to research by Leeds Beckett University, which found the practice improved pain tolerance and threshold and decreased anxiety towards pain in participants. Another study, which assessed how meditation could be used to comfort the terminally ill, found that practising may help mitigate chronic pain at the end of life.

Meditation can help people who are undergoing treatment for addiction by improving self-regulation and willpower, cultivating better awareness and understanding of triggers, and alleviating withdrawal symptoms. A small study of 19 recovering alcoholics found that participants who received meditation training reported a reduction in the severity of relapse triggers, which included depression, anxiety, stress, and cravings.

High blood pressure puts stress on your heart, forcing it to work harder to pump blood around your body. It can also cause hardening and thickening of the arteries, which can lead to a heart attack or stroke. Meditating lowers blood pressure by altering the expression of genes particularly immune system-linked genes in a select set of biological pathways, according to research by Beth Israel Deaconess Medical Centre.

Many of the benefits of meditation go hand-in-hand with exercise, but the practice can also benefit your workout in a variety of ways. Not only does it help to clear limiting thoughts and self-beliefs thus boosting motivation but research has shown that people who intentionally focus on the feeling of moving and consciously take in their surroundings report enjoying exercise more than those who dont.

Choosing between a guided and unguided meditation is often the first step in starting a meditation practice. Guided meditations use various techniques to anchor your wandering mind to a chosen point of focus, Teh explains.

These include, but are not limited to:

By contrast, unguided meditation also known as resting awareness asks that you let go of focus and return to a state of pure awareness, she says. Try these different methods of meditation and see which ones resonate most our minds all wander differently, and we carry different stresses, so I believe there is no one correct or best way for all to meditate.

The benefits of meditation are not pertinent to a specific time of the day, so the best time to meditate will be different for everyone. Starting the day with a short meditation is great, says Dr Touroni, because it gives you a sense of what emotional state youre in so you can plan a day that is sensitive to that. Meanwhile, meditating at the end of the day gives you a chance to wind down, she says. A short three-minute breathing exercise can also be really beneficial in moments of stress, helping you create distance from the situation.

While a daily practice is optimal, it doesnt need to be a structured meditation, explains Dr Touroni. It can be as simple as a five-minute meditation exercise to start your day he says. A daily practice is the kind of frequency where youll start to see the benefits of staying in the present moment, and the consistency will also make it easier to turn into a habit.

A short breathing exercise can be really beneficial in moments of stress, helping you create distance from the situation.

Feel free to experiment with different durations, depending on your schedule. Not only is short meditation better than none at all, but once you get started, you might decide that youd like to continue meditating for longer.

Start with an amount of time that feels easy to incorporate into your current routine and commitments I like to say take 10 slow breaths and start there as a baseline, says Teh. Build your way up to at least 10 minutes a day, or 15 to 30 minutes a few times each week, depending on your level of stress and reactivity when you arrive at your meditation.

Its different for different people, says Dr Touroni. Some people see results very quickly within a week, for instance others take longer, she says. It largely comes down to whether youre able to relax into it, and engage with the practice in a non-judgmental way. Some people find themselves making judgements on whether theyre doing it right. In these cases, it can take a bit longer to see results.

Additionally, different types of practices work for different people, so theres as aspect of finding your groove. Some people prefer an external focus e.g. bringing their attention to sounds in the room, Dr Touroni continues. Other people find focusing on the breath the most grounding. Its about working out what works for you.

Commit to meditating each day for a week, says Teh. This could be guided, unguided or a bit of both, for an amount of time that feels easily achievable to you, she says, one minute, 10 breaths or whatever is right. It can help to add it into your daily morning routine every day, or take this time for yourself during your lunch break each day.

And if you miss a day, carry on without guilting or shaming yourself, Teh continues. Life is busy! When you do manage to commit to a short daily practice, and feel the benefits it brings, you are more likely to make time for meditation for the rest of the month, year, or your life.

Last updated: 28-07-2020

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Pregnancy ByGardy ChachaHaving a supportive spouse would greatly minimise the negative experiences of pregnancy (Shutterstock)

Pregnancy reorganises every aspect of a womans body, says Dr Njoki Fernandez, an obstetrician and gynaecologist and a wellness practitioner.

ALSO READ: Why you should avoid excess sugar while pregnant

Pregnancy changes a womans body due to hormones, Dr Fernandez explains.

When you become pregnant, progesterone and oestrogen hormones rise dramatically. A new hormone one thats special to pregnancy called human chorionic gonadotropin, begins to be produced.

As the foetus develops, new hormones are secreted (while others fizzle out) and concentrations of hundreds others fluctuate to aid the process of pregnancy.

In short, pregnancy is one elongated hormone fest. As a result, pregnant women are predisposed to physiological, psychological and behavioural changes.

Physiologically, Dr Fernandez says, the woman might suffer swollen legs, gestational diabetes, pre-eclampsia (hypertension) and a myriad of other afflictions.

Psychologically she might go through major anxiety and mood swings; all of which will affect how she behaves around people.

Having a supportive spouse, says Lucy Muchiri, a nurse and a doula at Evesmama Birth Centre, would greatly minimise the negative experiences of pregnancy.

ALSO READ: Pregnancy made me hate my husband's voice, cooking Chef Alis wife on her journey

What can men do to be supportive during pregnancy?

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What men can do to brighten the pregnancy experience for their partners? - The Standard

Any one who has ever tried to drop some unwanted weight over the years has probably tried and heard of countless tips and strange weight loss advice from drinking celery juice to replacing meals with so-called weight loss cookies, and most often these pointers are promoted by those without any actual health expertise.

It is true that there are pages and pages full of misguided weight loss advice out there that one really should avoid, but there are also a ton of legitimate tips that are science backed and expert approved suggestions such as picking a time to exercise and sticking with it as a study published in the journal Obesity found that exercising at a certain time every day consistently may help successful weight loss.

Another helpful tip is to choose nuts over heavily processed snacks as a report published in BMJ Nutrition, Prevention & Health found that eating up to one ounce of nuts each day is linked with less weight gain and lower odds of obesity.

JAMA Internal Medicine published a report suggesting that a weight loss counselor may be helpful in helping to trim waistlines, showing that those with type 2 diabetes utilizing such counseling sessions with group medical visits helped them to lose weight and lower their blood sugar levels.

Losing weight can be challenging and even though it may be daunting every effort made is worth the benefits when it comes to improving health. The Journal of the National Cancer Institute published a study showing that overweight women who lost weight after turning 50 years old lowered their risks of developing breast cancer.

Diabetic Medicine published a report suggesting that it may be possible to potentially put type 2 diabetes into remission, finding that among those with type 2 diabetes losing 10% or more of their body weight within the first 5 years of diagnosis was associated with better odds of putting the disease into remission. Additionally, according to the American Heart Association carrying extra weight increases the odds of heart disease and stroke.

Whether you only have a few pounds to drop or a lot to lose experts can offer science backed tips and pointers to effectively help you on your weight loss journey such as eating slowly, portion control, keeping a food diary, totally body movement, keeping a gratitude journal, meal prep, getting enough sleep, not skipping meals, staying hydrated, cutting calories, eating more whole foods, avoiding sweetened beverages, removing unhealthy food from your home, and eating breakfast among others.

Janet Zinn, a licensed clinical social worker and psychotherapist says: I have my clients learn how to choose foods they like, really taste each morsel going into their mouths, and chew deliberately. I advise them to chew slowly, swallow only when the food is all chewed up, and repeat. It takes time to know we're full. Eating slowly allows us to not only enjoy our food more, but gives us better cues of satiety.

Christine King, the founder and CEO of the health and wellness company YourBestFit suggests that if You bite it, you write it! Thats my rule, and numerous studies have shown the effectiveness of food journaling for weight loss. One of my clients went out of town for one week. She stopped journaling and gained 13 pounds. I promise that keeping a food journal helps!

Exercise anything that moves.Thats my mantra and I started this after I broke my back and was paralyzed from the waist down. Do it in bed, while seated, standing, or walking. Just move. People have a misconception that five minutes doesnt make a difference, but every minute makes a difference. (And research published in January 2014 in the journal Progress in Cardiovascular Diseases showed that physical activity is critical when it comes to actually keeping lost weight off.) King

Lauren Manganiello, RD, a nutrition counselor and fitness coach suggests that Our eating habits are usually connected to our emotions whether we realize it or not. When we're stressed, we tend to reach for sweets. I tell clients that by keeping a daily journal of things you're grateful for, youre better able to cope with the stress by acknowledging it rather than reaching for dessert.

According to Angela Lemond, RDN, a registered dietitian nutritionist: A lack of sleep increases your hunger hormone ghrelin and decreases your satisfaction hormone, leptin, which can contribute to weight gain. When we are sleep deprived, we crave more salty and sweet foods. Why? Because anytime you feel more intense hunger, your cravings for higher energy aka higher calorie foods intensify. We also know that the way we think and process our emotions is affected by inadequate sleep, so its easy to connect this with an impaired ability to make sound choices in many areas of life, including with food. If we flip the coin, we can safely assume that when we are well rested, we will make better choices. When it comes to eating, that would mean that we would eat when we are truly hungry, and eat just until satisfied. Our hormones are also going to be better balanced because our bodies got the time needed to sleep, repair, and refresh.

Dont skip meals. You may think that this is helping you to burn calories, but you may be damaging your metabolism. The proper way to skip a meal is to begin an intermittent fasting schedule, but skipping a meal and intermittent fasting are not the same thing. In general forgoing eating can have negative consequences for the body, while intermittent fasting helps to get cravings under control and is a scheduled mindful eating practice. Intermittent fasting may not be best for everyone. When a person skips a meal they tend to overeat at some point to make up for it. When you split up your meals to be consumed throughout the day, the body will use the nutrients from the food more efficiently. Most experts agree that you should be eating three balanced meals a day and a healthy snack.

Megan Casper, RDN, a nutrition counselor and the founder and CEO of Nourished Bite points out that: Research has found that people who drank two glasses of water before a meal lost more weight than people who didnt drink water before meals and they kept it off. This simple tip works in two ways. Thirst can mask itself as hunger, causing you to eat more. And water makes you feel fuller, causing you to eat less during a meal.

According to the USDA ChooseMyPlate.gov half of your plate at any given meal should be nutrient dense fruits/veggies. Perhaps aim to make a balanced plate consisting of half vegetables, a quarter whole grains, and a quarter lean protein. Additionally, the Cleveland Clinic suggests not to eat until you are full rather to the 80% point to help tame overeating. There is no need to be part of the finish the plate club, instead pack any extra food away. This is good advice for over eaters who are just learning how to fill their stomach without going overboard, aiming for 80% is a good gauge to help with this as it instructs you to stop eating when you are beginning to feel slightly full. Slowing down helps with overeating because it takes around 20 minutes for the stomach to digest food.

Theres a strong relationship between sugar-sweetened beverages and weight gain in adults. If you regularly have a sip of something sweet, consider this: Research has shown that reducing intake of sugar-sweetened beverages can result in meaningful weight loss, even if it's the only change you make. Replacing a 20-ounce soda with sparkling water every day would save more than 20,000 calories over a few months, which could translate into more than five pounds of weight loss! Brittany Markides, RDN, the founder of Choose Food in Austin, Texas.

Meals consumed away from home tend to be higher in calories and lower in nutrients. A study published in the Journal of the Academy of Nutrition and Dietetics found that the average restaurant entre contains over 1,000 calories, and an entire days worth of sodium and fat. When dining out to save on those calories, try splitting the entre or asking to substitute extra green veggies or a salad for the starchy potato or rice.

When looking for a snack and in doubt, reach for a low calorie, fiber rich and nutrient dense vegetable or fruit. You can even make fruits/veggies the star of your meal, for example rather than a main dish of pasta, lessen the pasta amount and add in some broccoli, cauliflower, and zucchini, with some small amount of chicken, garlic and lemon zest. Try considering a few squares of organic dark chocolate with an orange for a sweet dessert. This way you can still enjoy a small amount of pasta and a sweet treat while still being satisfied without depriving yourself.

Most people eat with their eyes and like to see that full plate; using smaller plates, bowls, and cups will reduce the amount of food you consume, while at the same time allowing yourself to fill your dish up and keep you from feeling deprived. For example, an observational study showed that people who used a 9-inch plate versus a 10- or 12-inch plate ate up to 22 percent less. Size matters, research consistently shows that people will consume more food when they are offered larger portions, according to the Mayo Clinic. There are many apps that offer visual cues that can help you to gauge what a portion size is to help you get a better handle on what you are eating.

Don't feel like you need to overhaul your entire life starting immediately. Assess where you are currently and then figure out where youd like to be in the future. A great starting point for mostly sedentary people is to get a step counter and see how much you walk on a normal day. Then set a step goal slightly higher than the norm and strive for that, working your way up slowly to a goal of 10,000 steps per day. Esther Avant, an ACE-certified personal trainer in Kapolei, Hawaii.

Try to avoid if not eliminate highly processed foods from your diet. That does not mean your meals will now be bland, healthy whole food options are far from being boring. There are many exciting colours from the rainbow and flavours to experiment with that come in a variety of textures and tastes ranging from naturally sweet to savory which can easily be enhanced with a wide selection of herbs and spices.

At some point in your weight loss journey you may experience some setbacks, but please keep in mind that this is not failure. Rather think of these minor speed bumps as an opportunity to learn and grow from. Pick yourself up and start over. The only true failure is if you give up.

So you say that you cant exercise for very long. That will change, your endurance, coordination and flexibility will gradually improve. You say its taking too long. Well unfortunately, there is no magic pill, you will need to work for it, and it may take some time. Stick to the healthy lifestyle path to achieve your goals. Most importantly remember that you are well worth every effort and the benefits that you will experience with improved health. You CAN do it!

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In late January, when hospitals in the United States confirmed the presence of the novel coronavirus, health workers knew to watch for precisely three symptoms: fever, cough, and shortness of breath. But as the number of infections climbed, the symptom list began to grow.

Some patients lost their sense of smell and taste. Some had nausea or diarrhea. Some had arrhythmias or even heart attacks. Some had damaged kidneys or livers. Some had headaches, blood clots, rashes, swelling, or strokes. Many had no symptoms at all.

By June, clinicians were swapping journal papers, news stories, and tweets describing more than three dozen ways that COVID-19, the disease the coronavirus causes, appears to manifest itself. Now researchers at UC San Francisco and around the world have begun taking a closer look at this dizzying array of symptoms to get at the diseases root causes. They are learning from people inside the hospital and out; people on the brink of death and only mildly sick; people newly exposed and recovered; people young and old, Black, brown, and white. And they are beginning to piece together the story of a virus unlike any known before.

Viruses lead a curious purgatorial existence of being neither fully alive nor dead. Enveloped in a protein cloak, a virus consists almost entirely of genetic material DNA or RNA, the blueprints for all of life. But it cant reproduce on its own. To survive, it must break into a cell and co-opt the cells gene-copying machinery.

The novel coronavirus, an RNA virus named SARS-CoV-2, has become notorious for its skill at breaking and entering human cells. Its tools of choice are the protein spikes protruding from its surface a feature that distinguishes all coronaviruses. The spikes of SARS-CoV-2 are the crme de la crme: By the luck of the evolutionary draw, they are able to easily grab hold of protein gates on human cells known as ACE2 receptors and, like jackknives, pry these gates open.

You can think of an ACE2 receptor like a docking site, says Faranak Fattahi, Ph.D., a UCSF Sandler Fellow. When the coronavirus pandemic hit San Francisco, Fattahi repurposed her laboratory to study this key receptor, which normally plays a role in regulating blood pressure. When the virus lands on it, she says, it initiates a molecular process that brings the virus inside the cell.

If youre exposed to SARS-CoV-2 say, from a cough or sneeze the virus will likely first encounter ACE2 receptors on cells in your nose or throat. But these receptors also populate your heart, gut, and other organs. Fattahis team has found evidence suggesting that male sex hormones such as testosterone may increase the number of ACE2 receptors that cells produce, which could help explainwhy SARS-CoV-2 seems to wreak greater havoc on men than on womenand why kids rarely get sick. The fewer ACE2 receptors, the less risk of infection thats the idea, she says, adding that this hypothesis for the diseases gender gap is only one of several.

Once inside a few initial host cells, the virus sets them to work churning out copies of itself. Within hours, thousands of new virus particles begin bursting forth, ready to infect more cells. Although SARS-CoV-2 is less deadly than the original SARS virus, which emerged in 2002, it replicates more rapidly. Also unlike SARS, which primarily infects the lungs, SARS-CoV-2 replicates throughout the airway, including in the nose and throat, making it highly contagious like the common cold.

However, infection with SARS-CoV-2 usually doesnt feel like a cold. Fewer than 20 percent of infected people who eventually show up at a hospital report having had a sore throat or runny nose. During the first few days of being infected, youre more likely to have a fever, dry cough or, peculiarly, lose your sense of smell or taste.

Most likely, though, you wont feel sick at all. When UCSF researchers tested people for SARS-CoV-2 in San Franciscos Mission District,53 percentof those infected never had any symptoms. Thats much higher than expected, saysMonica Gandhi, M.D., MPH, a UCSF professor of medicine with expertise in HIV. Surveys of outbreaks in nursing homes and prisons show similar or even higher numbers. If we did a mass testing campaign on 300 million Americans right now, I think the rate of asymptomatic infection would be somewhere between 50 percentand 80 percentof cases, Gandhi says. Millions of people may be spreading the virus without knowing it, she points out, making asymptomatic transmission theAchilles heelof efforts to control the pandemic and highlighting theimportance of universal masking.

The majority of people who have COVID-19 are out in the community, and they are either asymptomatic or only mildly ill, saysSulggi Lee, M.D., Ph.D., a UCSF assistant professor of medicine. When the coronavirus pandemic hit San Francisco in early March, Lee conceived a study to investigate why. She scrambled to assemble a team andprocure fundingand equipment. She borrowed a colleaguesmobile clinic a van outfitted with an exam table and a phlebotomy chair so that her team could drive around the city, collecting samples from infected people. Lee hopes data from the study, called CHIRP (COVID-19 Host Immune Response Pathogenesis), will show how peoples immune systems respond as SARS-CoV-2 starts to gain a foothold in their bodies.

A lot is riding on that initial response, she says. If Lee and her collaborators can figure out the biological processes that allow some infected people to stay relatively well, they can perhaps use that knowledge to prevent others from falling severely ill.

True to its name, SARS-CoV-2 (which stands for severe acute respiratory syndrome coronavirus 2) is first and foremost a bad respiratory virus. If your immune system doesnt defeat it at its landing site in your nose or throat, it will advance down your windpipe, infiltrating the cells lining your lungs branching air tubes. At the tubes ends, tiny air sacs called alveoli pass oxygen to your blood. As the virus multiplies, the alveoli may fill with fluid, shutting down this critical gas exchange. Your blood-oxygen level may drop and, typically about six days into an infection, you may start feeling short of breath.

What causes this mayhem? Some of it is definitely caused by the virus itself, saysMichael Matthay, M.D., a UCSF professor of medicine who has studied acute respiratory diseases for more than 30 years. Inevitably, a fast-replicating virus will kill or injure many of the lung cells it infects; the more cells it infects, the more ruin it will leave in its wake.

But SARS-CoV-2 doesnt appear to be a savage destroyer of cells. Although its too early to know for sure, the viruss fatality rate seems to be roughly 10 times that of the flu. You would think thats because its just a killing machine, saysMax Krummel, Ph.D., UCSFs Smith Professor of Experimental Pathology and chair of the Bakar ImmunoX initiative. So far, however, the science suggests otherwise.

One of the weirder things about this new coronavirus is it doesnt seem to be incredibly cytopathic, by which we mean cell-killing, Krummel says. Flu is really cytopathic; if you add it to human cells in a petri dish, the cells burst within 18 hours. But when UCSF researchers subjected human cells to SARS-CoV-2, many of the infected cells never perished. Its pretty compelling data that maybe were not dealing with a hugely aggressive virus, Krummel says.

The bigger provocation, he suspects, may be your own immune system. Like any pathogen, SARS-CoV-2 will trigger an immune attack within minutes of entering your body. This counterstrike is extraordinarily complex, involving many tactics, cells, and molecules. In a UCSF study called COMET (COVID-19 Multi-Phenotyping for Effective Therapies), Krummel and other scientists have been observing this immune warfare in more than 30 people admitted to UCSF hospitals with COVID-19 and other respiratory infections. What were doing is looking at patients blood, their genes, and the secretions from their noses and lungs, and were asking, Whats your army? Whats your response strategy?

Its pretty compelling data that maybe were not dealing with a hugely aggressive virus.Max Krummel, Ph.D.

An early analysis of COMET data, Krummel says, suggests that the immune systems of many hospitalized patients mobilize differently and more aggressively against SARS-CoV-2 than against influenza viruses, which cause the flu. Their lungs are ravaged, these data suggest, not by the virus alone but by the detritus of an immunological battle gone awry. This rogue immune response could explain why, around day 11 of a COVID-19 infection, patients often develop a severe pneumonia known as acute respiratory distress syndrome, or ARDS.

Ultimately, COMET seeks to find COVID-19 therapies that can rein in an overeager immune system in order to prevent or treat ARDS. But that feat wont be easy, saysCarolyn Calfee, M.D., MAS 09, an ARDS expert, UCSF professor of medicine, and co-leader of the study. Too much or the wrong kind of intervention, she explains, could cripple a persons immune system to the point where it cant clear an infection. Its a fine line between therapeutic and deleterious, Calfee says. Were trying to find that balance.

Typically, people who die from COVID-19 ARDS die around day 19. Reported rates of mortality have varied widely, with the highest rates being where the pandemic has hit hardest, overwhelming hospital resources and staff. At UCSF hospitals likely due to the citys early shelter-in-place orders, which prevented an initial surge of COVID-19 cases so far only 10 of 85critically ill patients have died.

The good news is that weve been doing clinical trials of best-care practices for ARDS since 1998, Matthay says. Thanks toresearch by him and others, for example, clinicians have long known which ventilator settings result in the fewest deaths and how to flip patients onto their stomachs a technique known as proning to best help them breathe. If public health measures can keep hospital admissions low so that frontline providers can make good use of the skills and knowledge they already have, we may find that we have less to fear from SARS-CoV-2 than we thought.

On the other hand, the virus behaves in ways that are still mysterious.

In April, Susan Parson, M.D., a Bay Area medical examiner, made a startling discovery. For nearly two months, officials had believed that the first people in the U.S. to die from COVID-19 had died of respiratory failure in Washington state in late February. At the time, the U.S. Centers for Disease Control and Prevention limited testing to people who had respiratory symptoms and had recently traveled to China or otherwise been exposed to the virus. Those restrictions, however, turned out to be misguided.

As a medical examiner for Californias Santa Clara County, Parson had done a routine autopsy on a 57-year-old woman named Patricia Dowd, who had died suddenly at home on February 6. In Dowds tissues, Parson found the cause of her death: SARS-CoV-2. But the virus hadnt wrecked Dowds lungs. In fact, she had only mild pneumonia. Instead, SARS-CoV-2 had ruptured her heart.

Meanwhile, epidemiologists began learning that preexisting heart disease and related conditions put people at greater risk of suffering and dying from COVID-19. Were finding that many patients who have more severe forms of the illness are obese, they are diabetic, they are hypertensive, says cardiologistNisha Parikh, M.D., a UCSF associate professor who specializes in population health research. Such risk factors, she says, are unusual. Theyre not ones that really stood out in prior epidemics.

Clinicians, too, were seeing surprising numbers of COVID-19 patients develop heart problems muscle weakness, inflammation, arrhythmias, even heart attacks. Were not used to respiratory viruses having such dire consequences on the heart in such apparently high numbers, says cardiologistGregory Marcus, M.D., MAS 08, UCSFs Endowed Professor of Atrial Fibrillation Research. Many patients whose hearts acted up also had failing lungs. But others had no other symptoms or, like Dowd, only mild ones.

Since March, Marcus has co-led one of the largest community surveys to better understand the spread of SARS-CoV-2 and its myriad effects. The study, dubbed COVID-19 Citizen Science, has so far enrolled more than 27,000 people; anyone with a smartphonecan participate. Marcus plans to also start collecting data from wearable devices, including Fitbits and Zio patches, which wirelessly monitor heart rhythms. There may be large numbers of people who are suffering from cardiovascular effects of COVID-19 in the absence of other symptoms, Marcus says. Im worried were missing those cases.

It stands to reason that SARS-CoV-2 affects the heart. After all, heart cells are flush with ACE2 receptors, the viruss vital port of entry. And, indeed, laboratory experiments suggest that the virus can enter and replicate in cultured human heart cells, saysBruce Conklin, M.D., a professor of medicine and an expert in heart-disease genetics at UCSF and the Gladstone Institutes.

But Conklin doesnt think SARS-CoV-2 necessarily kills heart cells outright. Rather, in the process of copying itself, the virus steals pieces of the genetic instructions that tell the heart cells how to do their job. Its hauling away and hijacking stuff thats necessary for the heart to beat, he says. He is currently testing this hypothesis using human heart cells grown in cup-sized vesselsin the lab ofTodd McDevitt, Ph.D., a bioengineer at UCSF and the Gladstone Institutes.

Its also possible, however, that an infected persons own immune system may do the majority of the damage in the heart, as it appears to do in the lungs. The heart probably gets infected by a lot of other viruses, and they dont have a lethal effect, Conklin says. What makes this one different?

Graph with three bars. Bar at left has 80 percentat top and Non-Severe at bottom. Bar in middle has 15 percentat top and Severe at bottom Bar at right has 5 percentat top and Critical at bottom. Text below graph reads: Most symptomatic cases of COVID-19 are mild. To left of graph, small circle with the letter i in the middle opens to text reading: Graph Data: Wu et al., JAMA 2020. Livingston et al., JAMA 2020. Garg et al, MMWR 2020. Stoke et al., MMWR 2020. Left of graph: illustration of a coronavirus.

Toward the end of March, as San Francisco began to warm up, Sonia got cold feet. She put on wool socks and turned up her heater. Still, her feet felt frozen. Three days later, her soles turned splotchy purple. Red dots appeared on her toes. At night, her cold feet itched and burned. Walking hurt. And she was exhausted, napping through afternoon Zoom meetings. It was so bizarre, says Sonia, a San Francisco resident. A week later, her symptoms were gone.

Yes, COVID, wroteLindy Fox, M.D., a UCSF professor of dermatology, replying to an email describing Sonias case. Sonia wasnt surprised. Anyone, like her, whos been following news of the pandemic has probably heard about COVID toes, a painful or itchy skin rash that sometimes pops up in young adults with otherwise mild or asymptomatic cases of COVID-19. It looks like what we call pernio, or chilblains, Fox says, which is a pretty common phenomenon when somebody goes out in cold weather they start to get purple or pink bumps on their fingers or toes.

Many people with rashes like Sonias dont test positive for COVID-19, Fox says, which has made some clinicians skeptical of the connection; when patients have both, its just a coincidence, they believe. But Fox doesnt think so. For one thing, the time of year is wrong, she says. Pernio usually shows up in the dead of winter. Even more compelling, dermatologists around the world are getting crazy numbers of calls about it, Fox says. In the last three weeks, Ive had somewhere between 10 and 12 patients.Normally, I have four a year.

And its not just dermatologists who are adding their observations to COVID-19s ever-expanding symptom list. Gut specialists are finding that 20 percentto 40 percentof people with the disease experience diarrhea, nausea, or vomiting before other symptoms, says gastroenterologistMichael Kattah, M.D., Ph.D., a UCSF assistant professor. If you swallow virus particles, he says, theres a good chance they will infect cells lining your stomach, small intestine, or colon. As in the lungs and heart, these cells are studded with vulnerable ACE2 portals.

Especially disconcerting, Kattah says, is how long the virus seems to persist in the gut. About 50 percentof patients with COVID-19 have virus particles in their stools, often for weeks after their nose swabs test negative, he points out. Laboratory studies show that these particles are often still alive and can infect cells in a petri dish. Whether fecal transmission occurs between people, however, is an open question. If the answer is yes, people recovering from COVID-19 may need to stay quarantined even after they feel well, and the rest of us will need to be as meticulous about bathroom hygiene as weve become about handwashing and mask-wearing.

Other specialists are also raising flags. Neurologists worry about reports of COVID-19 patients with headaches, brain fog, loss of the sense of smell, dizziness, delirium, and, in rare cases, stroke. Nephrologists worry about kidney stress and failure. Hepatologists worry about liver injuries. Ophthalmologists worry about pink eye. Pediatricians, meanwhile, worry about a peculiarCOVID-related inflammatory syndrome thats showing up in kidsand young adults.

Theres a lot of smoke. We need to figure out where the fire is coming from.Michael Wilson, M.D.

Researchers are still sorting out the causes for this constellation of effects. If you come down with a particular symptom, is it because the virus is attacking your cells? Because your immune system is overreacting? Or just because youre very sick? In any severe illness, for example, the kidneys must work extra hard to filter waste and control nutrients and fluid; if overtaxed, they may begin to fail. Similarly, cognitive problems can result from increased blood toxins due to stressed kidneys or from low oxygen due to respiratory distress. Theres a lot of smoke, saysMichael Wilson, M.D. 07, MAS 16, the Rachleff Distinguished Professor at UCSFs Weill Institute for Neurosciences. We need to figure out where the fire is coming from.

Recently, theres been speculation that some of COVID-19s seemingly disparate symptoms may stem from trouble in the blood. Blood clots, for example, are showing up in cases of COVID-19 frequently enough for clinicians to take notice. Theres something unique about the coagulation system in these patients, says nephrologistKathleen Liu, M.D. 99, Ph.D. 97, MAS 07, a UCSF professor of medicine. In caring for COVID-19 patients on dialysis machines, shes been surprised to see blood clots block dialysis tubes more than usual. Clotted tubes are common, she says, but this is extreme.

That may be because, as growing evidence suggests, SARS-CoV-2 can infect cells in the walls of blood vessels that help regulate blood flow and coagulation, or clotting. If true, this behavior could explain some of the viruss weirder (and rarer) manifestations, such as heart attacks, strokes, and even COVID toes.

Our vasculature is a contiguous system, says cardiologist Parikh. Thus injury in one area, such as blood vessels in the lungs, can set off clotting cascades that affect multiple organs. Some of that trouble likely results from inflammation triggered by the immune system, she points out, although another culprit may be the bodys RAAS, or renin-angiotensin-aldosterone system, a hormone system that controls blood pressure and fluid balance. Because RAAS involves ACE2 receptors, Parikh suspects it may become disrupted when the virus infects cells through these receptors, thus triggering coagulation and other downstream effects. Her lab is now studying this system in COVID-19 patients to better understand how SARS-CoV-2 infection affects it.

Inevitably, some ailments may turn out to be red herrings. During a pandemic, when people are flocking to hospitals with infections, clinicians will also see a rise in other health problems, simply by the rules of statistics, points outS. Andrew Josephson, M.D., the Francheschi-Mitchell Professor, chair of UCSFs neurology department, and a member of the Weill Institute for Neurosciences. If the prevalence of infection is high, then almost any condition a broken leg, if you will you might conclude is associated with COVID-19.

As clinicians, we want to get information to our medical community and to the public as quickly as possible, Josephson says, but we have to be cautious about not making too big a deal of a little blip.

As with any infection, how long a bout of COVID-19 lastsvaries from person to person. If youre ill enough to need critical care, you can expect the disease to take at least a few weeks to run its course. In some cases, symptoms persist for months. For a typical milder case, though, you should feel better within a couple weeks.

At that point, the question foremost on your mind will be: Am I immune? There are now more than a dozen antibody tests on the market, but most are unreliable,according to UCSF research. And even the best tests cant tell you whether you have enough of the right kinds of antibodies to protect you against reinfection. There is a lot of hope and belief that well have an antibody test that actually informs us of immunity, but were not quite there yet, saysChaz Langelier, M.D., Ph.D., a UCSF assistant professor of medicine who is working to improve diagnostic tools for COVID-19.

What we have in the meantime are a lot of unknowns: If you do become immune to SARS-CoV-2, when and how does that occur? Will you gain immunity from a mild or asymptomatic case, as well as a severe one? How long will that immunity last?

The answers will have huge implications for social distancing and masking and for getting the economy back up and running, saysMichael Peluso, M.D., a clinical fellow who came to UCSF three years ago to help fight HIV. Now hes co-leadinga new study called LIINC(Long-term Impact of Infection with Novel Coronavirus), which is enrolling people who have been infected with SARS-CoV-2 and will follow them for two years. Besides illuminating changes in immunity over time, LIINC is investigating chronic effects of infection on the immune system, lungs, heart, brain, blood, and other parts of the body.

I hope people will recover and immunity will be protective and long-lasting, and that will be that, Peluso says.

Its what we all hope. We hope we will beat an infection swiftly or, better yet, avoid the virus until there is a vaccine. We hope that if we do fall gravely ill, we will be cared for by the best providers and tended to by people we love. The reality, as we already know, is more complicated. And even if COVID-19 doesnt batter our bodies, the pandemic will surely leave scars on our psyches, our livelihoods, our institutions, and our health that we are only beginning to fathom. In truth, we dont know how our cards will fall, as individuals or as a people. Only time and data will tell.

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We thought it was just a respiratory virus. We were wrong. - University of California

The objective of androgen deprivation therapy (ADT) in men with prostate cancer is to maintain very low levels of testosterone so that the hormone does not promote tumor growth. But a new analysis found that drugs commonly used to achieve this are administered later than the recommended 28-day regimen, and this late dosing was associated with ineffective suppression of testosterone.

"Evidence suggests achieving and sustaining T levels <20 mg/dL with ADT is desirable and correlates with improved disease-specific survival in patients with advanced prostate cancer," lead author David Crawford, MD, professor of urology, University of California, San Diego, and colleagues point out.

They looked at administration schedules for luteinizing hormone-releasing hormone (LHRH) agonists and found that they were frequently (84%) administered later than the recommended schedule of every 28 days. Nearly half of the late testosterone values for the extended month were greater than 20 ng/dl, and mean testosterone was almost double the castration level, they report.

"Considering the presumed clinical benefits of maintaining effective T suppression throughout the course of ADT, clinicians should administer treatments within approved dosing instructions, monitor T levels, and consider prescribing treatments with proven efficacy through the dosing interval to maintain T below castration levels," they emphasize.

The analysis was published in the Journal of Urology and was presented during the virtual American Urological Association 2020 annual meeting.

The study was done before the current pandemic, which canceled the in-person gathering of AUA 2020. Now, in the COVID-19 era, the interval between when men are scheduled for their next injection and when they actually get it may well be growing longer. Crawford says he recently saw one patient who waited 3 months before getting his next "monthly" injection.

For the review, Crawford and colleagues examined electronic health records (EHRs) and associated insurance claims for a total of 85,030 injections to evaluate the frequency of late dosing.

When the pivotal registration trials for LHRH agonist were done, a 1-month injection of an LHRH formulation was defined as every 28 days, and not 30 or 31 days as per calendar months.

The current analyses were done using 2 definitions of a month: a 28-day month with late dosing defined as injections given after day 28, and an "extended" month with late dosing defined as injections given after day 32, for products that are dosed once-monthly. The analyses also looked at products that are dosed once every 3-months, once every 4 months, and once every 6 months.

The team also evaluated how often testosterone exceeded the castration level of 20 ng/dL, as well as mean T levels and frequency of T tests and prostate specific antigen (PSA) tests taken by physicians prior to administering the injection.

Results showed that 84% of the 28-day dosing interval and 27% of the extended-month dosing administrations were late.

Furthermore, "when LHRH agonist dosing was late, both the proportion of T tests with T >20 ng/dL and mean T were higher compared to when the dosing was early or on-time," Crawford and colleagues point out.

For example, 43% of T values exceeded 20 ng/dL when injections were late compared to only 21% of T values when injections were given early or on time.

Furthermore, mean T values were 21 ng/dL when injections were given early or on time, but they rose to a mean of 79 ng/dL when injections were late.

Physicians were also far less likely to measure T levels at the time of administering the injections when compared to measuring PSA levels, the team found. T levels were assessed only 13% of the time, whereas PSA levels were assessed 83% of the time while administering LHRH injections.

"All of the package inserts say clinicians should measure T periodically when men are on these drugs, yet urologists don't do it most of the time. They are more interested in PSA because that is what the patient wants to know," Crawford commented in an interview with Medscape Medical News.

The thinking is that "so as long as the PSA is fine, everything else is fine too," he added.

That, however, is not necessarily the case.

As Crawford and his colleagues explain, rising PSA levels can reflect disease progression to castrate-resistant prostate cancer but they may also simply reflect late ADT dosing or other technical issues such as inappropriate dosing for a patient's body weight.

With a number of new therapies now available for castrate-resistant prostate cancer, it's important that physicians ensure that T levels remain below castration levels in order to not wrongly diagnose a man with castrate resistance disease as subsequent changes in management could be entirely inappropriate.

More of an issue, Crawford suggests, is that every time a patient receives an injection of an LHRH agonist, not only do his T levels flare, but so does his PSA.

Crawford suspects that levels of follicle-stimulating hormone (FSH) are also going up in response to LHRH agonist injections.

"We know that hormone therapy is associated with a lot of side effects but the big one for us right now is cardiovascular, so you may be doing the patient a significant disservice by allowing these 'mini-flares' to occur with late injections," Crawford said.

As to why men are receiving their injections beyond recommended intervals, Crawford feels that many urologists are not taking the timing of dosing as seriously as they should.

"There may also be scheduling issues and patient compliance issues as well," he acknowledged.

Disturbingly, however, if a man does show up in a timely way for his next injection, "insurance companies may refuse to reimburse him unless he comes back on days 30 or 31," Crawford observed.

For men who are concerned about COVID-19 and reluctant to attend the clinic for the next injection, there are ways to deliver healthcare that can facilitate timely dosing.

For example, some big urology clinics are having men drive up to their parking lots and receive their next injection in the car, by appointment only of course. Some centers are trying out at home administration.

The other solution to the late dosing problem is to prescribe longer-acting depot formulations so men need less frequent infections.

"It is simply not acceptable to be giving drugs out of their indication and time frame for which they were approved, so people need to take this more seriously," Crawford said.

"We need to administer these drugs on time," he emphasized.

"We need to monitor T levels because some patients will still experience escapes even if they are getting the drug on time," Crawford explained, "and we now have evidence that when patients do have these T failures, this is reflected in rising PSA levels and that may be an indication of disease progression, which we clearly don't want to happen."

The study was funded by Tolmar. Crawford reports receiving fees from Tolmar and Ferring. The other study authors have disclosed no relevant financial relationships.

The American Urologist Association (AUA) 2020 Annual Meeting: Abstract MP37-18.

J Urol. Published online April 1, 2020. Abstract

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ADT for Prostate Cancer: Concern That Injections Often Given Late - Medscape

Audrey Fenske has always been a night owl. But even by her standards, the past few months have wreaked havoc on her sleep patterns.

Since March, when the COVID-19 pandemic upended most daily routines, Fenske, a program assistant with the Duke Career Center, has up woken up on many nights around 3 a.m., unable to fall back asleep.

Im a chronic over-thinker and over-worrier, Fenske said. So in the past when Ive woken up in the night, my thoughts tend to go to things Im worried bout. Id probably exaggerate things in my mind. But now there are so many serious things going on in the world, its much more stressful.

For many, the stress and anxiety brought on by the COVID-19 pandemic has made it harder to get a good nights sleep. While some data shows that Americans may be gettingslightly more sleep, likely due to the lack of a morning commute, other studies show that these uncertain times have increased insomnia in some populations byaround 20 percent.

Duke Clinical Psychologist Meg Danforth, who leads theDuke Behavioral Sleep MedicineClinic, said shes seen a spike in people seeking treatment for chronic insomnia, which is defined as an inability to fall, or stay, asleep, since the pandemic began.

It is a basic survival mechanism to not sleep well when were in danger, thats evolution, said Danforth, who pointed out the brain often unconsciously equates nighttime with danger. In a very real way, with COVID-19, were all in danger. So its really natural to not be sleeping well.

The Centers for Disease Control and Prevention recommends that adults getaround seven hoursof sleep per night. In addition to leaving you fatigued, irritable and unable to focus during the day, chronic insomnia can leave you at greater risk for developing depression and anxiety.

So if youre having trouble with sleep, here are a few things to consider.

For people facing sleep problems, Danforth recommends embracing three slight behavioral changes.

Avoid what she calls social jetlag, which is the effect irregular schedules can have on your internal clock.

Social jetlag happens when you keep different schedules on different days, especially on work days and days off, Danforth said. That creates a physical state thats really similar to jetlag, because your body clock is trying to tell time but it cant.

You can help your body establish a defined internal rhythm by keeping bedtimes, wake-up times, meals and exercise on a somewhat consistent schedule. Danforth pointed out that each of these activities sends signals to the brain, which regulates the bodys internal clock and can cue the release of melatonin, a hormone that can relax the body and help you get to sleep.

Secondly, Danforth said its important to protect the connection between your bed and sleep. By spending too much time watching television, staring at your phone or doing work in bed, you can send mixed signals to your body about the purpose of being in bed.

You want to make sure that your bed and bedroom creates a consistent cue for sleep, Danforth said. That means dont go to bed unless you feel like you can fall asleep quickly. If you go to bed before youre sleepy, youre just setting yourself up for failure.

Finally, try to install a buffer zone of at least 30 minutes before bedtime, during which you avoid things like bright or excessive light, worrying about work or watching intense television shows. If you can use the time to calm your mind and body, it can create better conditions for sleep.

Between pandemic worries, work stress and angst about the latest news headlines, theres no shortage of sources for negative emotions. And when youre trying to go to sleep, these factors stand in the way.

Thats why its important to begin the bedtime routine by finding a way to fill your mind with positive thoughts.

Positive emotions undo the stress response, said Carrie Adair, assistant director for theDuke Center for Healthcare Safety and Quality.If youre lying in bed and thinking about all the stressors you have coming at you tomorrow, your heart rate goes up, your respiration increases. But when we experience positive emotions, it actually relaxes all of those processes.

Adair and her colleagues study the science of stress and provideresources, includingone toolto improve sleep,for increasing resilience and reducing the risk of burnout. She said trouble sleeping is one of the first things brought up by people who are struggling with stress. Likewise, improved sleep is often the first sign that peoples ability to deal with stress is improving.

A tool thats proven useful for people looking reach a more positive mental space at the end of the day is 3 Good Things.

Developed as part of a study and now available to anyone over the age of 18, the3 Good Thingsprogram spans 15 days and asks participants to list three pleasant experiences from that day. With text message reminders and a short questionnaire, the requirements to take part are low. But Adair said the effect of spending mental energy dwelling on happy moments can be great.

Asking you to reflect on events that you might not have taken much notice of during the day can help reduce the effect of stress, Adair said. If you do it within two hours of sleep onset, that actually gives you better likelihood of better sleep and longer sleep.

According Danforth, most sleep problems only last a short time and often disappear when the stressful situation that brought them on clears up. But chronic insomnia occurs when someone has frequent trouble falling asleep or staying asleep for a period of longer than three months.

Why that matters is that once chronic insomnia takes root, it often lasts longer than the external stressors that may have caused it.

With COVID-19, were now four-plus months into this, Danforth said. So if people started sleeping poorly back in March, and theyre still sleeping poorly in July, all of a sudden, they become at more risk for having that sleep problem stick around even once, God willing, we come out on the other side of this.

When facing chronic insomnia, experts recommend seeking treatment. Duke has multiple places that treat sleep problems, including theDuke Sleep Disorders Clinic, which uses a nightlong evaluation to diagnose sleep apnea.

TheDuke Behavioral Sleep Medicine Clinic, part ofDuke Psychiatry and Behavioral Sciences, uses Cognitive Behavioral Therapy for Insomnia (CBT-i), an eight-week program - which is available via telemedicine that addresses the underlying causes of a sleep disorder.

Danforth also recommends the freeCBT-I Coach mobile app, which was developed for military veterans. Available forAppleandAndroiddevices it can help create healthy sleeping habits.

If youre having sleep problems in the short run, it will probably get better, Danforth said. But if youre having chronic sleep problems, remember that it is treatable.

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Is there something youd like for us to cover? Send ideas, shout-outs and photographshereor writeworking@duke.edu.

Read more from the original source:
3 Ways to Improve Your Sleep During COVID-19 - Duke Today