Archive for the ‘Hormone Clinic’ Category

This week, reports emerged that former baseball player Alex Rodriguez and his fiance Jennifer Lopez are eyeing a bid to buy the Major Leagues Baseball (MLB) team, New York Mets. However, with Rodriguez's extensive history with using performance-enhancing drugs, should such a sale be allowed?

In an earlier report, we had written that Rodriguez had opened up to 'The Tonight Show' host Jimmy Fallon about his inclination towards launching a future bid for the Mets and also confessed how he grew up a Mets fan before winning a world series with the Yankees. "I will say this, if the opportunity came up (to buy the Mets), I would certainly look at it," he told Fallon. He also went on to say how the 1986 championship-clinching game was one the best nights of his life after the birth of his daughters.

While Rodriguez now has a thriving career as a baseball analyst, commentator and host and enjoys the limelight coming from being engaged to actor, dancer and singer Jennifer Lopez it is difficult to erase his baseball career. Even though he was once dubbed the greatest baseball player of his generation, his achievements were marred by cheating scandals.

His playing career had resulted in one World Series title, three MVP awards, 14 All-Star appearances, 696 home runs and earnings of $452M the most in the history of Major League Baseball.

The Biogenesis scandal, which resulted in Rodriguez's suspension, broke out in 2013 and was the biggest baseball performance-enhancing drugs (PED) scandal, but Rodriguez had been caught using performance-enhancing drugs much before that.

In July 2007, former outfielder and steroid-user Jose Canseco called Rodriguez a "hypocrite" and alleged that the latter was using steroids something Rodriguez vehemently denied.

In 2009, Sports Illustrated reported that Rodriguez had tested positive for two anabolic steroids, testosterone and Primobolan, during his 2003 season playing for the Texas Rangers. This was the same season in which he captured his first American League Most Valuable Player award, broke 300 career home runs (hitting 47 that year) and earned one of his 10 Silver Slugger Awards.

The same year, Rodriguez told ESPN that he had used PEDs when he first started out, stating, "When I arrived in Texas in 2001, I felt an enormous amount of pressure. I felt like I had all the weight of the world on top of me and I needed to perform, and perform at a high level every day."

In 2003, as the result of a collectively bargained union agreement, there was no penalty or punishment for a positive test during an anonymous drug survey and mandatory drug testing only began in 2004 after more than 5% of the samples taken from players in 2003 came back positive. In 2013, the New York Times alleged that Rodriguez tested positive for a banned stimulant in 2006.

It was the Biogenesis scandal that broke out the same year that catapulted the MLB, Rodriguez and other players of note to infamy. A disgruntled former employee of Biogenesis in America a health clinic briefly operating in Coral Gables, Florida, specializing in weight loss and hormone replacement therapy released records of the clinic's real business. These records showed that players such as Rodriguez, Melky Cabrera, Bartolo Coln, Ryan Braun and Nelson Cruz were getting access to PEDs, thanks to an unlicensed doctor.

Over the next two months, MLB suspended 14 players. Meanwhile, penalties for getting caught increased. First-time offenses went from 50 to 80 games, while second-time offenses went from 100 games to an entire season. Any offender caught doping is now ineligible for that year's playoffs, no matter when the infraction occurs.

For a long time, Rodriguez insisted he was innocent and even alleged that the MLB engaged in a "witch hunt" to get him out of baseball when he sued the league in 2013. Rodriguez and his team voluntarily dropped the suit in February 2014.

In 2019, Billy Corben's documentary on the scandal titled 'Screwball' released and oddly, news of Rodriguez's engagement to Lopez broke a day after the trailer for the documentary released. In an interview with Rolling Stone, Corben described the scandal as Florida f**kery distilled like freebasing Florida f**kery and crony capitalism".

Although Rodriguez has since apologized for his role in the Biogenesis scandal, Corben was suspicious of Rodriguez's image rehab. Corben told Rolling Stone, "This is the guy who was never beloved. He was booed by his own fans, for crying out loud. Without so much as a mea culpa tour, he hasnt rehabilitated his image, hes created an entirely new one that never existed before."

In August 2013, Rodriguez was suspended through the 2014 season (211 games at the time of the decision), but was allowed to play in 2013 pending his appeal of that decision. His suspension was upheld in January 2014 after being allowed to play in the 49 games between the decision and the hearing, technically reducing the suspension to 162 games. In July 2014, Rodriguez was sued by his lawyers for $380,000 in unpaid legal fees.

In November that year, it was revealed that Rodriguez had admitted to the Drug Enforcement Administration that he had used performance-enhancing drugs as early as January of the same year and Rodriguez got immunity from prosecution.

Many have also called into question MLB's handling of the Biogenesis scandal, suggesting that the MLB's actions were motivated to save face rather than to take serious action on the use of PEDs among players.

Given Rodriguez's lengthy history of association with PEDs, it stands to question whether the one-time-great baseball player ought to be given the power of owning an entire baseball team and whether the MLB would even allow it.

However, with Rodriguez's new image and with Lopez's name included in the deal, it stands to reason that the MLB would be okay with Rodriguez being one of the owners of the New York Mets, even if that may leave baseball lovers with a sour taste in their mouths.

As 'Screwball' filmmaker Corben said on the Biogenesis scandal, "When Alex was useful as a heel, he was the villain. When Bud Selig needed to salvage his own reputation as the steroid commissioner and was trying some kind of redemption and legacy-saving measures, Alex was the villain. And now that Bud Seligs gone, (current commissioner) Rob Manfred, who was responsible for this entirely botched, potentially illegal investigation of Biogenesis, ascends (within MLB) into a position of power and decides, "Oh, Alex is an ally." They let bygones be bygones now? Like after the s**tshow that they put each other through? It certainly goes to show how not legitimate MLBs concerns are about steroids and shooting up in baseball, because its obviously good for business."

Link:
Given Alex Rodriguez's history with doping scandals, should he be allowed to own New York Mets? - MEAWW

Following the announcement of the UK lockdown in March, we have all had no choice but to quickly adapt to a different way of living in order to ensure the safety of ourselves and others.

Our daily routines have been completely altered, many of our plans postponed or cancelled, and we have been unable to meet relatives and friends who we may ordinarily have seen on a regular basis. It has been tough for everyone. Unfortunately, the situation is especially difficult for the younger members of our community who are in lockdown with unsupportive families.

Research by LGBTQ youth charity, Just Like Us, suggests that LGBTQ young people may struggle more at home than cis straight young people, as they are more likely to initially confide in friends rather than a family member; the reverse is true for their non LGBTQ peers.

For so many closeted young people including some Just Like Us volunteer ambassadors moving out of home for college, university or work is an opportunity to come out and build a support network. Meeting other LGBTQ young people and moving away from home has been a life-changing experience for many of us, who kept our identities hidden from our families for many years.

The closure of universities, colleges and workplaces means that many LGBTQ young people are now separated from their chosen friends and family, and are having to re-enter unsupportive households. My co-ambassador Nicole said, Having to go from being out and living on my own, then back to being closeted in a homophobic household, has hit hard.

Anna, another ambassador, whose family is Catholic, says, I came out to my family last year after I began my second year at uni and started dating a girl. I knew they wouldnt take it well initially, but thought they would at least be able to process what Id told them by the time I came home. Now Im back home [early] they barely speak to me and when they do, they criticise me for my sinful lifestyle Being back at home with my family has definitely taken its toll on my mental health.

Our trans ambassadors face additional problems. Joel says, Im really lucky to be isolating with people who are very trans friendly and affirming, but its medical stuff thats my concern. Its causing a lot of worries around my transition. Ive recently changed from getting my Hormone Replacement Therapy (HRT) injections to gel. Im due a blood test in two weeks, but my GP isnt doing any face to face appointments so I cant have one, and if I cant have my bloods okayed at safe levels on the new HRT, my endocrinologist will probably stop it until we can prove my liver is coping.

There are other trans folk who are in similar boats. My friend has missed one injection, as he has a condition meaning he cant self-inject, and the nurse wont make an appointment to inject him at this time. Others have had their gender affirming surgeries cancelled. Theres also the fact that Gender Identity Clinics are all closed right now, so the already ridiculous wait times (currently around 26 months from referral to first appointment and 20 months between appointments for the Newcastle clinic) are only going to be longer when all this is over.

At Just Like Us, we work with LGBTQ young people in schools, many of whom are not yet out to their friends and relatives. Now that schools are closed, these kids are with their families 24/7, and if they have not yet had the chance to build a support network, this could be incredibly isolating. Many will be suppressing their identities due to the fear of being rejected by their families, and with most currently entirely dependent on their families, akt (Albert Kennedy Trust), the LGBTQ youth homelessness charity, has advised LGBTQ young people not to come out to family during the lockdown, because of the consequences of a potential negative response. In addition, the possibility that university and college courses may commence online in September will come as a huge disappointment for those who are hoping to move away from unsupportive households.

But despite this, were coming together to support one another during these difficult times, and our LGBTQ young adults are finding great ways to support themselves and one another. As an example, the Just Like Us ambassadors have set up a WhatsApp group aimed at sharing (both LGBTQ related and more general) quarantine tips, including recipes, craft ideas and self-care advice. I think we may have also broken the world record for the number of pet photos shared in one group chat, and I am completely living for it. Ive learned so much from hearing about how other ambassadors are looking after themselves during this time.

Im looking after myself by trying new hobbies, connecting with friends and not beating myself up about everything, says Sophie. Ive found that making lists with friends of stuff you guys want to do once were out of lockdown has really given me some perspective on whats important.

Just Like Us have also launched a new social media campaign, #JLUatHome, in order to support young LGBTQ people during lockdown. The campaign has consisted of a range of content so far, including messages of support to isolated LGBTQ young people, film and book recommendations, as well as the opportunity to ask Just Like Us ambassadors questions. Through this period, we are really seeing the benefits of being part of an LGBTQ community that is still connected from afar.

If you are a LGBTQ young person, we would love you to join us by listening to our latest podcast episode, which you can listen to here. This month, ambassadors Isaac, Elly and Arber will discuss more in depth what its like being LGBTQ at home. If youre an LGBTQ teenager in the UK, we also want to welcome you into our digital ambassador team which is another way to be part of this incredible community.

Finally, if youre reading this article and want to help us to help LGBTQ young people during this difficult time, you can also make a donation to Just Like Us, but only if you are in a position to do so. You can make a gift here. Thank you!

Related: Volunteering for Just Like Us gave me confidence in my identity as a young, gay, mixed race Muslim.

Related: The invisible have voices too listen to trans youth.

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School is out. Many young people are not - the impact of lockdown on LGBTQ youth - Gay Times Magazine

According to a national study conducted by The Williams Institute in Jan. 2017, West Virginia had the highest population of teens, ages 13 to 17, who identified as transgender, but according to data recently collected by Fairness West Virginia, 70 percent of transgender West Virginians said they have delayed accessing healthcare due to fear of discrimination. Following the collection of this data, Fairness West Virginia sought out to improve the livelihood of trans West Virginians by improving LGBTQ+ education in the states healthcare system.

Despite facing obstacles during the beginning of her transition, Natasha Stone, the transgender visibility coordinator for Fairness West Virginia, a statewide civil rights advocacy organization dedicated to the equal treatment of LGBTQ West Virginians, was able to find her way to medical resources, even if it meant chipping in while creating those resources.

As discussions related to transgender individuals begin to grow throughout the state, providing the community an attempt to become normalized, resources related to trans care are also beginning to grow throughout the nation. In West Virginia this process has been slow, providing limited opportunities for trans care.

While the state historically has been bombarded with various health issues over the past decades, the condition of West Virginias transgender health care system, or the lack thereof, may be one of the next issues the state must face.

Before I came on, Fairness West Virginia put a call out for information about the state of healthcare for trans people in the state of West Virginia and heard a lot of horror stories, Stone said.

The collected data set a baseline of insight centered around the experiences that trans West Virginians may face when navigating the states health care system. Stone said that among the topics researched were experiences of discrimination, necessary travel to receive care and the impact of medical costs.

According to Rebecca Denning, a board-certified child and adolescent psychologist, instances of transgender discrimination may be connected to a general misunderstanding of gender-nonconforming individuals.

Historically, training in culturally competent care has not been a standard in many healthcare programs, Denning said. We know this adversely impacts care for people of diverse backgrounds.

For Evan Wiseman, a 21-year-old trans man from Parkersburg, West Virginia, the journey to transition brought on many of those obstacles due to a lack of resources and general understanding about transgender individuals.

Starting in 2014, my parents, eldest sister and I searched all throughout the state looking for hormone therapy before I eventually started, Wiseman said. We looked everywhere but eventually accepted the fact that I would have to travel to Cleveland Clinic. All of the primary physicians in Parkersburg werent interested in helping me.

Due to the lack of resources in the state, trans individuals such as Wiseman are often times left to travel out of state in order to receive the care they need. In its surveying, Fairness West Virginia found that 36% of transgender West Virginians traveled out of state to receive care while 46% of transgender West Virginians had to travel more than one hour to receive care.

In addition to a lack of resources, Wiseman said trans West Virginians may also travel extended distances in order to receive educated, understanding care from medical professionals who are knowledgeable on how to interact with transgender individuals.

In Wisemans experience, he said any time hes received care from an emergency room, he has been treated extremely poorly.

(Doctors) in the ER will use she/her pronouns because my gender is not legally changed and theyll ask for my dead name even though I list my preferred name, Wiseman said. Often times male doctors wont even look me in the eyes and will say the bare minimum to me.

While recently receiving care for kidney stones at Ruby Memorial Hospital in Morgantown, West Virginia, Wiseman said he felt violated and not cared for after receiving care from one of the physicians.

I had a doctor who was using a scope for a vaginal procedure and, before telling me what was going on, he started the procedure, Wiseman said. When I made a sound because of the pain, he told his nurses to restrain me and told me to be quiet because its not that bad.

While medical professionals may not understand how their actions can be harmful, Denning said unfavorable medical experiences can have traumatizing effects of trans patients.

We know that when transgender patients encounter messages that their identity and gender expression are a problem, they are at a significantly increased risk for a range of poor health outcomes, Denning said. These experiences actively cause harm.

Regarding mistreatment in a medical setting, data collected by Fairness West Virginia found that 60% of transgender West Virginians said a healthcare provider intentionally misgendered them. 20% of transgender West Virginians said they had been refused care due to their gender identity and 25% of transgender West Virginians said that unrelated health issues were blamed on their gender identity.

Even still, outside of obstacles created by a lack of cultural differences and a general lack of understanding, trans individuals may still come into contact with barriers that prevent them from receiving the care that Wiseman deems life threatening.

Once Wiseman decided to look into top surgery, a medical procedure which removes breast tissue to produce a masculine appearance, he said that finding the one and only trans educated surgeon in the state was not hard, but trying to get the procedure covered by insurance was difficult.

I was supposed to get surgery heading into my senior year of high school in 2018 but my insurance said they wouldnt pay for it until I turned 18, Wiseman said. Come November 2018, I turned 18 but the insurance said they wouldnt pay for it because it was elective, despite receiving numerous letters from my therapists about how the surgery could save my life.

In order for Wiseman to eventually receive the procedure, he and his family had to pay $7,000 out of pocket.

According to Stone, in contrast to Wiseman, the cost of medical care can be debilitating to West Virginians, but can be particularly troublesome for LGBTQ citizens who historically have been shown to live in poverty.

Overall, Denning said in order to truly understand the condition of West Virginias transgender health, its important to take a look at the states overall health system.

In West Virginia we have challenges with healthcare overall, with many West Virginians struggling with access to healthcare, Denning said. When you consider that some portion of that workforce is not able to provide gender affirming care, its easy to see that accessibility is a significant barrier to care.

Joelle Gates can be contacted at [emailprotected]

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Lost in Transition: Understanding West Virginia's transgender health care system - MU The Parthenon

CUH has avoided the planned-for surge in Covid-19 cases, for now at least, but doctors concern for non-Covid patients has never diminished, writes Catherine Shanahan.

Ward staff, Cork University Hospital. Photo: Daragh Mc Sweeney/Provision

With the daily slew of statistics around the level of coronavirus infection almost relentlessly grim, some cheering news is emerging from Cork University Hospital (CUH) where just 33 staff have tested positive for Covid-19.

The number of confirmed cases among in-patients is stable at around 30, and the number in intensive care on any given day is staying constant at five or six. The hospital had planned for upwards of 100 in the ICU.

A number of outpatient clinics are resuming off-site this week, albeit on a reduced scale, among them Care of the Elderly, Rheumatology, Gastroenterology, and Respiratory Medicine.

Cancer surgery and cancer treatment is continuing, although some patients due to undergo chemotherapy are unable to do so because it weakens the immune system, which puts them at risk of Covid-19.

There are also concerns that patients who suffer minor strokes are not coming to hospital the number of stroke attendances halved in the first few weeks of the pandemic, but these figures have now begun to improve.

Mary Horgan, consultant physician in infectious disease at CUH and president of The Royal College of Physicians of Ireland (RCPI), says good planning and fantastic public compliance with Government restrictions designed to limit the spread of the virus have fed into the hospitals success.

Ive been on the last two weekends and it was so nice to see the number of positive tests markedly reduced for those people coming into the hospital.

At the weekend, there was just one positive case of someone who presented to the hospital, and in actual fact, they were known positive, so we were just re-swabbing them to see if they had cleared it.

Dr Horgan, who has more than 30 years experience in acute medicine and infectious disease, says she has never seen anything like Covid-19.

I suppose why it is different is it doesnt affect children, yet it affects everybody else.

And while most people have no symptoms, or mild symptoms, others will get a lot sicker.

If I looked at two [ostensibly healthy] 50-year-olds, I wouldnt be able to say: You are going to do really well and you are not going to do so well.

Dr Horgan doesnt like what she has seen: Im doing this for 30 years and I can tell you after looking after patients - I would not like to get this infection.

CUH has devised two separate patient pathways for Covid and non-Covid patients.

If theres an index of suspicion, they go into the Covid pathway, where they are swabbed and isolated, and staff put on their PPE (no shortages at the moment).

Oxygen levels are monitored and once the test is back, they are treated accordingly.

Dr Horgan says most of those who are admitted require some level of breathing assistance. They usually have viral pneumonia.

Its a lack of oxygen that results from the viral pneumonia that gets a patient into trouble. The virus is gone down into their lungs.

Some patients have ended up on ventilators, including some in their 30s. Some people recover quickly, others dont.

As of the end of March, about one-third of those admitted had been discharged, Dr Horgan says.

"About 50% of those admitted are under the age of 60 and otherwise healthy.

The big question now, she said, was what the impact on the hospital system will be as restrictions are gradually lifted.

I think what we are going to be looking at in the health system is cranking up non-Covid activity again, so that we are giving care in the way we always have, as well as having a parallel life of Covid care delivery.

We have to start planning for us to increase outpatient numbers, to ensure people come into hospitals when they are getting sick, Dr Horgan says.

Her sentiments are echoed by CUH clinical lead for stroke services, Liam Healy and clinical lead for cancer services, Richard Bambury.

Dr Bambury, a consultant medical oncologist, says as of last weekend, there were 146 empty beds in the hospital.

Pre-Covid CUH was pretty much running at max capacity, so in a way this [empty beds] is welcome, but this is an unusual situation.

CUH has not made much use of private hospitals in the region some acute medical patients have been transferred to the Mater Private, but no-one so far to the Bon Secours. Dr Bambury says there are ongoing discussions.

At CUH, they have worked to make the hospital as safe as possible for cancer patients, creating a separate entrance and triage area, swabbing any suspected cases, and if they test positive we dont recommend chemotherapy.

This is because chemotherapy suppresses the immune system, which heightens the risk to cancer patients in the event of Covid-19.

The risk:benefit ratio in some situations has changed. For some, the risk might outweigh the benefits so if alternative therapy is available we are looking at that.

"Its a case-by-case decision.

Alternative treatments include the use of hormone therapy in treating prostate cancer.

Postponing treatment where it is safe to do so is another. For those on annual check-ups or who are in remission, their appointments can be postponed for a month or two until the Covid situation stabilises, Dr Bambury says.

Theres been some decrease in non-urgent activity to reduce the footfall and help with social distancing, Dr Bambury says but in saying that, in the past six weeks they have 200 new patients on radiotherapy and 50 on chemotherapy.

Rapid assessment clinics for anyone with a high suspicion of cancer are continuing.

On Ward 3B, Dr Healy, consultant geriatrician, is happy to see they are nearly back to the normal cohort of around 25-30 stroke patients, after seeing figures halve, dropping back to 10 or 15, in the early days of the pandemic.

I suppose the general message has been one should not come to hospital unless one absolutely needs to - but there are some conditions, like stroke, whereby if someones having symptoms, the only right thing to do is come in as quickly as you possibly can.

Theres a worry, he says, that people with a minor stroke may have stayed away, but theres plenty we can do for them in terms of optimising their treatment, or seeing if its something we can reverse," Dr Healy says.

Theyve had no Covid-19 staffing issues on his ward and very few patients affected by Covid-19, even though some of the early indications in this outbreak were that a higher percentage of people with the virus would have strokes.

Theres not a case that I can think of whereby weve had a stroke patient whos been disenfranchised by it or has had any kind of problems because of Covid-19, he says.

Consultant geriatrician at CUH, Paul Gallagher, is playing a role in the care of Covid patients in residential care facilities.

They have set up four teams to cover Cork and Kerry, each with senior nurses, and led by a geriatrician.

They are taking calls from care homes in the community - of which there are c100 in the region - and giving expert advice and guidance.

In some cases there are site visits to assist with care on the ground, for example at Clonakilty Community Hospital where there has been an outbreak and, tragically, a number of deaths.

Dr Gallagher says some elderly people have typical Covid symptoms, but others have atypical symptoms, such as a tummy upset, as well as fever and shortness of breath.

Within CUH itself, the number of Covid patients he sees remains stable, which has allowed us to manage it in a more planned way.

We had planned for upwards of 100 in ICU, that hasnt happened at all.

Dr Gallagher resumed his outpatient clinic for Care of the Elderly this week, albeit a scaled-down version.

The clinic is being run off-site on Model Farm Road.

At the moment, we are seeing urgent new referrals.

"Hopefully it will ramp up, but we have to be very cautious. Appointments will be staggered and time allowed between appointments to clean the rooms, for protection of patients and staff.

As CUH looks to returning to a more normal service, the medics do have certain concerns.

As Dr Gallagher points out, the fear now is of a non-Covid surge.

If people who need it dont seek treatment now, the risk is that we will be overwhelmed down the line.

The latest restrictions in operation since Friday, March 27 mandate that everyone should stay at home, only leaving to:

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Catherine Shanahan: Cautious optimism is order of the day at Cork University Hospital - Irish Examiner

At the moment, it feels like life has been put on pause... Literally. The government has advised us to stay at home to help control the spread of coronavirus. So what does this mean for women who are struggling to fall pregnant and embarking on IVF?

IVF is already a daunting, stressful and emotionally-draining process. But now, there are a whole new cohort of people with the added layer of uncertainty of whether they will ever get pregnant because treatment has been postponed indefinitely.

On 24 March, the official regulator for fertility clinics, Human Fertilisation and Embryology Authority (HFEA) announced no new treatment can begin. It means patients whod already started an IVF cycle can finish it, but all treatment after 15 April has been stopped.

On the face of it, HFEAs measures are simply complying with government social distancing advice to flatten the curve and ease the burden on the NHS which is already under huge pressure. Sounds reasonable. But that doesnt change how upsetting this is for so many who now feel helpless in their pursuit of parenthood.

We have had many calls from patients who are upset and distressed by the indefinite delay, said Dr Geeta Nargund, Medical Director at CREATE Fertility and abc IVF. Not knowing when they're able to start treatment brings with it a potentially serious mental health impact, particularly when patients know that time is of the essence and that it may impact upon their chance to become biological mothers.

Dr Nargund says that once a patient is given medication to stimulate ovaries, it can take up to two weeks to mature the eggs and prepare them for egg collection. First, she is given stimulation medication and monitored with ultrasound scans and blood tests, before an egg-collection procedure is booked in. Next, the eggs are fertilised with sperm in a lab to create embryos. Embryo/s are either transferred as fresh embryos three or five days later or frozen for later use.

Nargund says the treatment suspension has been particularly hard for women who have waited a long time for IVF or those diagnosed with a very low egg reserve, for whom time is of the essence.

Matilda*, 37, from Cheshire has a low Anti-Mullerian hormone level for her age, indicating a decreased egg reserve. Shes had two unsuccessful rounds of NHS-funded IVF, in August 2019 and January 2020. She and partner Eric*, 41, scraped together savings and borrowed from family and friends for private treatment, costing around 7,000.

At first, I was reluctant, Matilda says. If you have another round of heartbreak, you lose all that money. But you also feel, if I dont do it, will I live the rest of my life in regret?

We decided, finding all the funds, going into debt, using our life-savings, its such a huge risk. Sometimes I feel physically sick about spending that amount on a small chance and potentially ending up with nothing at all, she explains.

The clinic put Matilda on the pill and scheduled her egg collection for 17 April. But her treatment was cancelled as it had surpassed HEFAs deadline by two days. As Matildas turning 38 in a couple of months, shes concerned the delay for someone her age could mean not having a biological child.

Your chances diminish every month. This could have been my month, this could have been my cycle. Im losing that chance and its getting less likely it will ever work. If this lasts six or twelve months, Ive spent all that money and its going to be pointless, she says. Ive lived from appointment-to-appointment for close to a year, trying to keep healthy, not drinking alcohol, doing things to prepare and now theres no appointments, theres nothing. I dont know how to carry on. Im depressed and angry at just how hopeless you are as a woman in this situation.

Matilda says she will try again once the suspension lifts, but knows her chances will be slimmer.

Leanne Jones, 31, from Hampshire is having pre-implantation genetic diagnosis (PGD) IVF because her husband Kyle, 30, has a genetic disorder called PKD1 which affects life-expectancy and has a 50% chance of being hereditary..

During five years of treatment, Leannes had two cycles resulting in early miscarriages in September 2019 and February 2020. When you have a positive pregnancy test, a door opens. Youre planning the next 35 years of your life and your emotions run away with you. Then someone goes nope and shuts the door. Its grief. My emotions were like someone had died. I felt like someone had taken my right to breathe and I couldnt catch my breath at all, she explains.

As a midwife, Leanne sympathises for NHS staff, both in the face of COVID-19 and the suspension: It must be horrendous. Its hard but its the right thing.

What can you do if youre in a similar situation?

Dr Nargund suggests:

1. Use this time to make sure your body is ready for treatment. Make sure you're maintaining a healthy weight, getting regular exercise and following a balanced diet. While it may be difficult during this time, trying to stay relaxed and giving up vices such as smoking will all help to optimise your fertility status.

2. Do your research. There are multiple discussion groups and webinars being hosted that will allow you to better understand the treatment suspension and what it means for you, as well as ask questions of experts and decide on what treatment is right for you.

3. Explore getting treatment started online. Some clinics are offering virtual consultations that can be conducted over video call and using hormonal blood tests conducted at home. This will allow you to get the process moving and ensure that once the lockdown is lifted treatment can be started as soon as possible.

Help:

HFEA are updating patient guidance on their website.

The Fertility Network UK support line (0121 323 5025) is open Monday, Wednesday and Friday between 10am-4pm.

Professional Infertility Counselling Association(BICA) have a Find A Counsellor section on their website.

Professor Dr Geeta Nargund at CREATE Fertility is hosting webinars twice a week to provide information and guidance for all those considering starting treatment after the suspension.

*Matilda and Eric are fictional names

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The Impact of Suspended IVF Treatment On Women - GLAMOUR UK

DENVER, April 18, 2020 /PRNewswire/ -- In response to current media stories regarding Low T Center's commitment to meeting the needs of Colorado patients during this COVID-19 Emergency, Low T Center provides the following for immediate release.

On April 9, the Colorado Department of Public Health & Environment released its 4th Updated Public Health Order (PHO) 20-24, encouraging Critical Businesses to remain open: "Critical Businesses, as defined below, are exempt, subject to certain limitations, from this PHO and are encouraged to remain open." Part C of PHO 20-24 states, "Any business . . . engaged primarily in any of the service activities listed below, may continue to operate as normal." PHO 20-24 defines a Critical Business as "Healthcare Operations, Including: . . . clinics, and walk-in health facilities . . . Medical . . . care, including ambulatory providers . . . [and] laboratory services." On April 6, 2020, Governor Polis issued Executive Order 2020 024 stating, "I direct all Coloradans to stay at home, unless necessary to provide, support, perform, or operate Necessary Activities . . . Necessary Travel or Critical Businesses as such terms are defined in PHO 20-24 . . . " The Order provides that "Necessary Activities" include . . . "Engaging in activities . . . including, but not limited to . . . without limitation, obtaining medical supplies . . . obtaining durable medical equipment, obtaining medication, [and] visiting a healthcare professional . . . " On that same day, the Governor issued an amended Executive Order D 2020 027, prohibiting voluntary or elective surgical procedures, if same could be safely postponed for at least three months.

Low T Center is a multi-specialty medical clinic with forty-six clinic locations spanning eleven states. Low T Center is not a hospital or outpatient surgery or procedure provider. It is not a gym or supplement store. Each clinic operates a certified and licensed moderately complex CLIA/COLA medical laboratory facility, which can accommodate a variety of important medical diagnostic tests. Pursuant to recently issued Department of Homeland Security regulations, Low T Center's facilities and its healthcare team members are classified as part of the Essential Critical Infrastructure Workforce.

Low T Center physicians treat chronic health diseases and conditions, as well as acute medical issues, ranging from low testosterone, to obstructive sleep apnea (a respiratory condition), to hypertension, high cholesterol, thyroid disorders, severe allergies, cardiometabolic issues, and other conditions that make men feel bad, and if left untreated, can be life-threatening. These conditions are often correlated with a serious medical condition known as hypogonadism. Hypogonadism is a clinical syndrome that results from the body's failure to produce physiologic concentrations of the hormone Testosterone.Hypogondal men require medically necessary hormone therapy to restore normal body functions. Failure to adequately treat and monitor these conditions can lead to serious problems such as heart disease, diabetes, obesity and cancer as well as adversely effecting overall well-being and quality of life. Treatment for hypogonadism is recognized as "medically necessary" by every major insurance carrier in Colorado.

Proper treatment of chronic hypogonadism requires office visits, labs, and continued therapy.For the individuals that require this therapy, interrupting, deferring or otherwise discontinuing therapy for a period of three months would lead to severe adverse effects, and place these patients at risk. Similarly, failing to provide treatment for diabetic patients, patients suffering from respiratory disorders, and serious cardiologic issues, is simply not acceptable, and would be contrary to the treatment guidelines employed at Low T Center.Remote treatment protocols are enabled for patients whose medical conditions do not require an in-person visit to the clinic.

For many of our patients, Low T Center is the sole provider of their preventive and primary care services. As noted above, in addition to having extensive clinical and research experience in diagnosing and treating hypogonadism, Low T Center also provides vital and continuous life-saving evaluation, diagnosis, treatment, and control of a variety of chronic, serious, and potentially life-threading disorders including cardiometabolic health, obstructive sleep apnea, hypertension, cholesterol disorders, metabolic syndrome, diabetes, and other chronic men's health issues including cardiovascular risk assessment and prevention. Because of the nature of the practice, many patients require close follow-up including appropriate physical exams as well as critical laboratory services, that if delayed "for a minimum of three months" would place these patients at "undue risk to both the current [and] future health of the patient." The treatment programs for these chronic, progressive and potentially fatal conditions (if not appropriately diagnosed, managed, and treated) are evidence- and guideline-based using the most recent literature and approaches and have been developed by a protocol committee comprised of medical school faculty and Harvard-trained distinguished leaders in their respective fields.

Consistent with Executive Order D 2020 027, these important primary care assessments and treatments cannot be delayed (as with any primary care office) as there would be 1) "a threat to the patient's life," 2) "a threat of permanent dysfunction of an extremity or organ system," (e.g., chronic limb ischemia risking amputations or progression of chronic kidney disease or heart failure.) These conditions require close physical and laboratory follow-up and monitoring of both the disease as well as the response to therapy. Furthermore, there is 3) "risk of . . . progression" particularly of the target organs of hypertension, cholesterol disorders, and diabetes manifesting as preventable strokes, heart attacks, limb damage, blindness, kidney failure, and heart failure - all of which require close medical management and adjustment of medical therapy to prevent.

Executive Order D 2020 027 rightly lets "the doctor make the decision," by granting the "treating medical facility" the exclusive discretion to determine whether a three month delay or interruption in treatment would risk the health of the patient. It would be unfortunate indeed that a hypertensive Coloradan would die, because the access to the care he needed, was postponed for three months. The Governor's Order expressly recognizes this principle, by leaving the classification of "voluntary" to the patient's medical professionals.

Low T Center does not believe Governor Polis' Order prohibits Coloradans from obtaining medically necessary treatment for diabetes, hypogonadism, hypertension, hypercholesterolemia, receiving allergy antigens, obtaining medical laboratory testing, receiving treatment for thyroid disorders, obtaining continuous positive airway pressure devices for the treatment of respiratory conditions, or any of the other medically necessary services provided to patients at Low T Center healthcare facilities. The Order uses the words "without limitation" which means Low T Center's patients should have the right to visit their healthcare provider - without limitation, for these important continuing care services.By signing the Order, Governor Polis assured Coloradans that they would be able to continue to receive their medical care during this time, by expressly classifying these activities as "Necessary Activities." Low T Center physicians, nurse practitioners, and medical staff are persons involved in operating a Critical Business which are necessary to help patients with these Necessary Activities.

Also, very relevant to the current COVID-19 crisis, outpatient centers like Low T Center significantly reduce the likelihood of requiring care in both Emergency Departments and acute care hospitals - where patients may have enhanced risk of both contracting SARS-CoV-2 and developing a potentially life-threatening and/or fatal complication of COVID-19.

Finally, Low T Center's protocol committee has mandated a series of workplace safety initiatives designed to implement social distancing guidelines. The clinic operational teams continue to adhere to enhanced cleaning and sterilization protocols. Sick persons or those exhibiting any COVID-19 like symptoms are prohibited from coming to work, but may work from home in some situations. Consistent with good medical practice, all team members are required to wash hands and use hand sanitizer between each patient visit in increasing frequency throughout the day. Patients are educated about covering coughs and sneezes, and recognizing signs or symptoms associated with COVID-19.

Low T Center's healthcare team members recognize their role as healers, and status as members of critical infrastructure, and are committed to remaining available to protect patients' rights, while adhering to all public health orders and directives issued in this state.

Media contact:David J. Moraine, J.D., M.A., LL.M. Chief Legal Officer, david@mailproglobal.com 469-990-3626

Continued here:
Low T Center Is Committed To Meeting The Needs Of Colorado Patients During The COVID-19 Emergency - The Grand Junction Daily Sentinel

Even if youve been staying mostly inside during the COVID-19 outbreak and laying off heavy makeup, your skin may be acting out.

Reports of increased acne and dry skin are not uncommon, even for people who previously had their skin under control.

For many people, stress can be a trigger for acne and we are certainly living in stressful times, said Dr. Julia Carroll, a Toronto-based dermatologist at Compass Dermatology.

But stress is only one culprit.

Here are some reasons why you may be experiencing acne or overly dry skin during coronavirus isolation.

Stress

Like Carroll said, the outbreak of the novel coronavirus is understandably causing a lot of people stress. From job loss to health concerns, many Canadians are experiencing a pique in anxiety.

Unfortunately, stress can wreak havoc on our skin and the stress hormone, cortisol, can lead to acne flare-ups. Theres also stress-related habits that we develop.

With so many people working from home all day in isolation, Ive had a lot of my patients confess to touching and picking at their face, Carroll said.

Its a common habit when people are stressed, bored or procrastinating.

Carroll said people should try to keep their hands off their face, which is not only important for acne, but for preventing the transmission of COVID-19.

To help lower stress levels, try to find ways to relax, like exercising, deep breathing, meditation or doing something creative.

New skincare routines

With more free time on our hands, some people are experimenting with their skincare routine, Carroll said. This can include using different and new products, like cleansers and leave-on face masks.

Many of the patients I have been seeing virtually are trying new routines while isolating and this has caused some breakouts, she said.

Others are abandoning their routine all together, which is also causing changes in the skin.

Carroll suggests people take a look at their skincare routine and make modifications accordingly. If you tend to have breakouts, she said to add products with either salicylic or glycolic acid.

This could be in the form of a cleanser or a medicated cream, she added.

For people who are wearing masks, their skin may also see a change.

Carroll said shes seeing a lot of acne-like breakouts due to the humidity in closed-off masks, like the N95 model.

Stress may also be a factor here, she said.

Others are reacting to the mask material with contact dermatitis. This could be a true allergy or just an irritation. The mask marks are another common complaint.

To treat mask irritation, Carroll suggests people use a gentle cleanser before putting on the mask and after they remove it.

Moisturizer can also be used, but she cautions against over-applying as it can affect the masks material, she said.

Lifestyle and environment

Because health officials urge people to stay at home to help curb the spread of COVID-19, many of us are not getting the same amount of fresh air we are used to.

Im seeing a lot of patients with dry skin, Carroll said. This comes from low humidity in some of our dwellings.

Theres also lifestyle changes, including diet and exercise, that many of us are experiencing.

Research shows exercise can help reduce inflammation, which can be a culprit of acne. Exercise also helps reduce stress, and might even lead to younger-looking skin, according to research out of McMaster University.

Our eating patterns may also be out of whack, and what we eat might affect our complexion.

While this varies from person to person, Carroll said, some people do have specific triggers to certain foods.

According to the Canadian Dermatology Association, if a certain kind of food seems to aggravate your acne, its best to avoid it.

There is evidence that avoiding dairy products or having a diet with a low glycemic index may reduce symptoms for some people, the association said on its website.

Treatment

If you have dry skin, Carroll suggests adding a hydrating wash to your routine, as well as moisturizers or serums with ceramides and hyaluronic acid.

If your acne does not get better with a consistent skincare routine and lifestyle changes, you might want to see a dermatologist, Carroll said.

Whatever you do, do not pop your pimples or pick at your skin. Squeezing pimples only leaves behind holes, or worse, acne scars.

Once scars are on your face, you cant do anything, Dr. Faisal Al-Mohammadi, a Mississauga, Ont.-based dermatologist and pathologist at Dermcare clinic, previously told Global News.

He said that for for some adults, laser scar removal treatments only improve scars by 40 to 50 per cent.

We will not be able to bring your skin back, he said.

Questions about COVID-19? Here are some things you need to know:

Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.

Symptoms can include fever, cough and difficulty breathing very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.

To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.

For full COVID-19 coverage from Global News, click here.

Laura.Hensley@globalnews.ca

- Global News

View post:
COVID-19: Here's how isolation might be impacting your skin - TimminsToday

When Dr Phil McGraw was 29, he had a vasectomy. At the time his wife was pregnant and he had made up his mind that he didnt want more children. Six years later, he would walk back into the clinic and demand for a reversal. Six months later, his wife was expectant.Having the procedure at such a young age was the biggest mistake I ever made.It is for this reason that doctors advice that when going for some long term family planning measures, you need to be absolutely sure. Vasectomy offers 99 per cent effectiveness and is suitable for men who are certain that they do not want any more children. According to Marie Stopes Kenya, this male sterilisation surgical procedure takes approximately 15 minutes and its failure rate is about 1 in 2,000 men. The Kenya Obstetrical and Gynecological Society reports that only one per cent of Kenyan men have undergone vasectomy despite its high effectiveness and surgical simplicity. However, since most vasectomies are performed in private facilities rather than in the public health system, the statistics could be an underestimation.It is estimated that 40 per cent of pregnancies globally are unplanned. In addition, most women are shunning hormonal contraceptives due to associated side effects. The modern man has grown more aware of the struggles their female partners go through and is more willing to take up family planning options. The options are nevertheless limited for men. Condoms, withdrawal (coitus interruptus and vasectomies are the most readily available artificial methods men can use. A man produces over 1,500 sperms per second which makes it challenging to come up with the most suitable reversible family planning method for men. But not to worry, there are options in the pipeline that will give the man more options and power over how many children he can have.WATCH OUT FOR:1. The Contraceptive gel

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Original post:
Birth control options for the man who wants to take charge - The Standard

Potbelly.Beer belly. Muffin top. Spare tire. Regardless of what you call it, excessbelly fat is frustrating.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.Policy

For most people, the appearance of excess weight around the midsection is their biggest concern. But obesity medicine specialist W. Scott Butsch, MD, says the bigger issue is the increased health risks that come with belly fat.

Abdominalfat is visceral fat, stubborn fat that surrounds the organs deep within theabdomen. Researchers have proved that excess visceral fat increases a personsrisk of metabolic diseases, including:

Dr.Butsch says belly fat affects men and women differently: Men are more likelyto havemore belly fat (orvisceral fat) than premenopausal women. But aftermenopause, women begin to gain more weight in their abdominal area.

An easy wayto gauge abdominal weight gain is to just pay attention to how your pants fitor the notch on your belt, says Dr. Butsch. If things are tight, then thatmay be an early warning sign of potential health problems.

Waistcircumference correlates to visceral fat. For men, a waist circumferenceapproaching 40 inches indicates increased risk. For women, 35 inches raises ared flag.

Patientswant to know why they cant just do sit-ups to melt away the fat, says Dr.Butsch. When you do sit-ups, youre increasing muscles in the abdomen, butthat doesnt specificallytarget the visceral fat that is around the organsdeeper in the body. Instead, Dr. Butsch recommends these strategies to trim thebelly fat:

Weight lossalone can effectively reduce visceral fat, says Dr. Butsch. By losing 10% ofyour body weight, you may lose up to 30% of your body fat.

Talk to your doctor about a weight-loss method that is right for you. While there are lots of options to choose from, Dr. Butsch recommends you avoid fasting for long periods. Prolonged fasts cause the body to hold onto the visceral fat, making it tougher to lose. If fasting is your jam, an intermittent or time-restricted fasting approach may be more effective for losing belly fat.

Exercises that increase the heart rate and make you sweat help you lose weight in general both visceral fat and the subcutaneous fat under the skin. Aerobic exercise burns overall calories and helps you reduce total body fat.

Dr. Butsch says the key to losing abdominal visceral fat seems to lie in a combination approach. He suggests trying 20 minutes of whole-body strength training plus a cardio routine to strengthen muscle cells and increase fat burn.

Fructose, or sugar, causes fat cells to mature faster, specifically in the visceral fat. A diet filled with fructose-containing sodas or drinks not only increases your calorie intake, but it impacts how the belly fat develops.

If youre feeling stressed out, especially right now that were in the middle of a pandemic, your body is likely releasing the stress hormone, cortisol, into the bloodstream. This can not only lead to weight gain, but theres also a strong link between an increase in cortisol and higher amounts of visceral fat.

Do your best tode-stress if you want to whittle your middle. Dr. Butsch states yoga,meditation, therapy and physical activity as ways to dial down your stresslevel.

Follow this link:
Want to Lose the Belly Fat? - Health Essentials from Cleveland Clinic

From weird dreams and nightmares to increased insomnia, the coronavirus pandemic has stimulated some unusual sleep issues for many people.

As a behavioral sleep researcher at theUniversity of Alabama at Birmingham, a number of patients have been asking: "Why is this happening, and what can I do to stop it?"

We do most of our dreaming during a stage of sleep called "rapid eye movement." This is when the brain grows more active and revs up the amygdala and hippocampus (regions of the brain that deal with emotions and memories).

In this time of heightened fear and distress, the brain has even more emotional demands to process. And because our brain likes order, the frontal lobes attempt to process, organize and integrate our thoughts to make sense of the chaos of REM neural signals (which is what produces those dreams).

In other words, our colorful yet strange dreams may be a reflection of the negative emotions invited by Covid-19.

Like so many others, I've also had my fair share of weird and memorable dreams since the pandemic.

In one dream, I boarded a cruise ship, dressed head to toe in bubble wrap and carrying nothing but a roll of toilet paper. In another, I slept through my shift at the telemedicine clinic and missed all my patients.

Luckily, I've been able to get those unwanted dreams under control. Here's what I've been doing to sleep better at night:

1. I wake up at the same time every day.

We tend to keep a consistent sleep schedule mostly during the weekdays. But I'm now waking up at 5:30 a.m., seven days a week.

This helps because the body rewards regularity: People who wake up at the same time experience more metabolic health, improved cognition and enhanced emotion regulation.

To keep myself accountable, I place my alarm clock across the room so that I have to get out of bed to turn it off. I've also created an enjoyable morning routine that involves coffee and gratitude journaling outside, where I can bask in the morning light.

Having something pleasant to look forward to makes waking up easier, while the natural light helps entrain my circadian rhythm.

2.I do everything I can to stay active during the day.

This can be a difficult task during a time of social distancing and quarantining. It now feels nearly impossible to get in as much physical movement as I did before the pandemic.

But it's still important to try.Vigorous, moderate or even mild cardiovascular exercise (i.e., walking or doing household chores) stimulates adenosine, which helps build sleep pressure or the body's "hunger" for sleep. And an increased sleep pressure means less likelihood of anxiety or insomnia.

However, I avoid exercising too much in the evenings.Research has shown that intense physical activity within one hour of bedtime can reduce sleep time, while also making it harder to wake up.

3. I use my bed for three things: Sleep,sex and rest (if I'm sick).

Everything else watching, reading or anxiously scrolling through my phone for news about Covid-19 happens out of the bed.

With more time spent inside, people may start adopting the habit of eating, working or binge-watching Netflix in bed. This can be disruptive to our sleep, because it trains the brain to associate the bed with daytime activities, rather than a place for resting.

Even on nights when I find myself unable to sleep, I'll get out of bed and go to another room. Keeping a dim light on, I'll do something relaxing, like guided meditation or fold the laundry. When I'm finally sleepy again, I'll return to bed.

4.I take a bath before bedtime and avoid devices.

Darkness facilitates healthy production of melatonin, a hormone that promotes drowsiness; whereas light interrupts it. So at least one hour before bedtime, I try to reduce my exposure to light-emitting devices, such as my phone, laptop and TV.

Instead, I take hot bath or shower.According to studies, our core body temperature needs to drop by about2 to 3 degrees Fahrenheit to maintain deep sleep and soaking yourself in warm water can help.

Most people think it's easier to fall asleep after a bath because your body is nice and toasty.But the opposite happens: It actually brings the heat from the core of your body to the surface, thus naturally cooling the body andpromoting a more peaceful sleep.

Christina Pierpaoli Parker is a behavioral sleep researcher and clinical psychology resident at the University of Alabama at Birmingham. She writes about sleep forPsychology Today and HealthDay, and her work has been published in the Journals of Aging & Health, Geriatric Psychiatryand The Clinical Gerontologist.

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This sleep expert also had 'weird dreams and nightmares' since Covid-19. Here's what she does now to sleep better - CNBC

Connectus Health is donating nonperishable food items, hygiene products and diapers at two of its Middle Tennessee clinics for those dealing with hardships brought about by the coronavirus pandemic. (Courtesy Connectus Health)

At Connectus, we strive to serve as a healthcare home for every single Nashvillian in need, and Second Harvests mission aligns perfectly with ours, Connectus Health Co-CEO Suzanne Hurley said in a release. We feel so lucky to have this partnership with them and do our part in alleviating food insecurity in our community.

The clinics pantries are stocked with food items, such as soup, rice, cereal and pasta, along with hygiene products, such as toothpaste, soap and deodorant.

For those wishing to pick up supplies or visit the clinics, Connectus asks that they call ahead at 615-292-9770 to ensure that a staff member is able to meet them.

Supplies are available for pick up Mon.-Thu. 8 a.m.- 5 p.m. and Friday from 8 a.m.-2 p.m. at the Vine Hill clinic, located at 601 Benton Ave., Nashville, or the clinic at Priest Lake, located at 2637 Murfreesboro Pike, Nashville.

In addition to food and hygienic products, Connectus Health is also accepting new patients for pediatrics, midwifery, primary care, behavioral health services, hormone replacement therapy and transgender care, with financial counselors available to assist with securing health insurance coverage.

More:
Connectus Health providing food, supplies to Middle Tennessee during coronavirus pandemic - Community Impact Newspaper

Even if youve been staying mostly inside during the COVID-19 outbreak and laying off heavy makeup, your skin may be acting out.

Reports of increased acne and dry skin are not uncommon, even for people who previously had their skin under control.

For many people, stress can be a trigger for acne and we are certainly living in stressful times, said Dr. Julia Carroll, a Toronto-based dermatologist at Compass Dermatology.

But stress is only one culprit.

Here are some reasons why you may be experiencing acne or overly dry skin during coronavirus isolation.

Stress

Like Carroll said, the outbreak of the novel coronavirus is understandably causing a lot of people stress. From job loss to health concerns, many Canadians are experiencing a pique in anxiety.

Unfortunately, stress can wreak havoc on our skin and the stress hormone, cortisol, can lead to acne flare-ups. Theres also stress-related habits that we develop.

With so many people working from home all day in isolation, Ive had a lot of my patients confess to touching and picking at their face, Carroll said.

Its a common habit when people are stressed, bored or procrastinating.

Carroll said people should try to keep their hands off their face, which is not only important for acne, but for preventing the transmission of COVID-19.

To help lower stress levels, try to find ways to relax, like exercising, deep breathing, meditation or doing something creative.

New skincare routines

With more free time on our hands, some people are experimenting with their skincare routine, Carroll said. This can include using different and new products, like cleansers and leave-on face masks.

Many of the patients I have been seeing virtually are trying new routines while isolating and this has caused some breakouts, she said.

Others are abandoning their routine all together, which is also causing changes in the skin.

Carroll suggests people take a look at their skincare routine and make modifications accordingly. If you tend to have breakouts, she said to add products with either salicylic or glycolic acid.

This could be in the form of a cleanser or a medicated cream, she added.

For people who are wearing masks, their skin may also see a change.

Carroll said shes seeing a lot of acne-like breakouts due to the humidity in closed-off masks, like the N95 model.

Stress may also be a factor here, she said.

Others are reacting to the mask material with contact dermatitis. This could be a true allergy or just an irritation. The mask marks are another common complaint.

To treat mask irritation, Carroll suggests people use a gentle cleanser before putting on the mask and after they remove it.

Moisturizer can also be used, but she cautions against over-applying as it can affect the masks material, she said.

Lifestyle and environment

Because health officials urge people to stay at home to help curb the spread of COVID-19, many of us are not getting the same amount of fresh air we are used to.

Im seeing a lot of patients with dry skin, Carroll said. This comes from low humidity in some of our dwellings.

Theres also lifestyle changes, including diet and exercise, that many of us are experiencing.

Research shows exercise can help reduce inflammation, which can be a culprit of acne. Exercise also helps reduce stress, and might even lead to younger-looking skin, according to research out of McMaster University.

Our eating patterns may also be out of whack, and what we eat might affect our complexion.

While this varies from person to person, Carroll said, some people do have specific triggers to certain foods.

According to the Canadian Dermatology Association, if a certain kind of food seems to aggravate your acne, its best to avoid it.

There is evidence that avoiding dairy products or having a diet with a low glycemic index may reduce symptoms for some people, the association said on its website.

Treatment

If you have dry skin, Carroll suggests adding a hydrating wash to your routine, as well as moisturizers or serums with ceramides and hyaluronic acid.

If your acne does not get better with a consistent skincare routine and lifestyle changes, you might want to see a dermatologist, Carroll said.

Whatever you do, do not pop your pimples or pick at your skin. Squeezing pimples only leaves behind holes, or worse, acne scars.

Once scars are on your face, you cant do anything, Dr. Faisal Al-Mohammadi, a Mississauga, Ont.-based dermatologist and pathologist at Dermcare clinic, previously told Global News.

He said that for for some adults, laser scar removal treatments only improve scars by 40 to 50 per cent.

We will not be able to bring your skin back, he said.

Questions about COVID-19? Here are some things you need to know:

Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.

Symptoms can include fever, cough and difficulty breathing very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.

To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.

For full COVID-19 coverage from Global News, click here.

Laura.Hensley@globalnews.ca

- Global News

Read more:
COVID-19: Here's how isolation might be impacting your skin - ThoroldNews.com

Its not unusual to crave a cold glass of water on a hot summer day or after youve eaten something particularly spicy. But there are multiple reasons why you may suddenly find yourself thirsty and some are more serious than others.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.Policy

One of the most common reasons youre probably thirsty is dehydration. Overheating is one of the biggest causes of dehydration. Whether youve been rigorously exercising or just resting in the sun at the beach, your body needs water to keep from overheating.

When you exercise, your muscles generate heat. To keep from burning up, your body needs to get rid of that heat. The main way the body discards heat in warm weather is through sweat. As sweat evaporates, it cools the tissues beneath. Lots of sweating reduces the bodys water level, and this loss of fluid affects normal bodily functions.

According to the American College of Sports Medicine, to avoid dehydration, active people should drink at least 16 to 20 ounces of fluid one to two hours before an outdoor activity. After that, you should consume 6 to 12 ounces of fluid every 10 to 15 minutes that you are outside. When you are finished with the activity, you should drink more. How much more? To replace what you have lost: at least another 16 to 24 ounces (2 to 3 cups).

One way to make sure you are properly hydrated is to check your urine. Matthew Goldman, MD, says, The goal is to keep the urine clear. If it starts to become yellow, then youre getting dehydrated.

Certain foods are also great at helping you stay hydrated thanks to being heavy on water content. And many have added benefits of including other essential nutrients your body needs. Vegetables such as cucumbers and celery arent just high in water content, theyre also low in calories, making for a perfect snack.

If youre looking for fruits, both watermelon and strawberries are excellent choices with 91% water content and make for great, sweet treats, especially in hot weather.

Drinking water is one of the best ways to stay hydrated but some sports drinks can also assist in replacing not just fluids but electrolytes such as sodium and potassium. But try to avoid alcohol and caffeinated beverages, such as coffee and sodas, as these fluids tend to pull water from the body and promote dehydration.

Increased urination and excessive thirst are two telltale signs of the onset of type 2 diabetes. It can also be an indicator of hyperglycemia, a condition where there is too much sugar in the blood, most often experienced by those with diabetes.

According to the CDC, Eating too much food, being less active than usual, or taking too little diabetes medicine are some common reasons for high blood glucose (aka hyperglycemia). Your blood glucose can also go up when youre sick or under stress.

Normally, the amount of sugar leaving the body through the urine is not detectable, explains Dr. Goldman. However, if someones blood sugar level is elevated enough, sugar begins to leave the bloodstream through the kidneys and enters the urine.

The glucose (sugar) molecules are small enough to leak out through the filtration system of the kidneys. As the excessive glucose molecules enter the urine, the glucose draws water with it like a sponge. As a result, the amount of urine formed and frequency of urination increases. As we lose those excess fluids, we eventually become dehydrated.

This is why patients who have elevated blood sugar levels for too long often become dried up and may end up in the emergency department or intensive care unit. Once they arrive, they often require a lot of fluids (through IV) as well as vitamins and medications to get their sugar levels under control in a safe manner.

Dehydration could also be a sign of a condition known as diabetes insipidus. According to Dr. Goldman, Antidiuretic hormone (ADH) is a hormone that allows the body to reabsorb water from urine that is forming in the kidneys. This reabsorption tends to occur most when we are becoming dehydrated, such as while we sweat.

If the body isnt producing enough ADH or the kidneys arent responding appropriately to ADH, then the body doesnt retain as much water as it may need; this may result in more frequent urination and possibly dehydration.

Patients should speak to their provider about sugar levels and what is considered a normal blood sugar level for themselves as well as what to do if these levels become abnormal, suggests Dr. Goldman.

In general, patients should avoid drinking fluids to have excessive amounts of sugar in them because this may eventually lead to uncontrolled blood sugar levels and cause the amount of urination to worsen, Dr. Goldman says.

One reason patients should take in some extra sugar is if their blood sugar level is too low. Patients should speak to their provider further about what is considered a normal as well as low sugar for themselves, he adds.

Certain medications your doctor prescribes may cause certain side-effects, including thirst.

Lithium is a medication that is widely known to possibly result in excessive urine output and therefore increased thirst, according to Dr. Goldman. Over time, it may eventually block the activity of antidiuretic hormone (ADH) in the kidneys, which leads to excess urination and thirst, he says. A number of other medications antipsychotics, antidepressants, anticonvulsants, anticholinergics and alpha agonists can cause dry mouth and, therefore, trigger thirst.

Dr. Goldman also notes that SGLT2 inhibitors (a kind of diabetes medication) as well as steroids can also cause thirst since SGLT2 inhibitors increase the release of glucose from the blood into the urine to lower blood sugar levels and steroids often raise sugar levels as a side effect.

This is why, when someone is placed on steroids (whether short or long term), they may be encouraged by their provider to monitor their blood sugar or accommodate the higher sugar levels by taking more diabetic medications.

Dr. Goldman says you should talk to your provider about these side-effects and see if there are alternative medications available.

Until you and your provider can discuss alternatives, continue taking your medication as directed.

See the original post here:
3 Reasons Why You May Be Feeling Really Thirsty - Health Essentials from Cleveland Clinic

For continuing coverage of how COVID-19 is affecting reproductive health,check out our Special Report.

Four years ago, I needed an abortion in Texas while HB2, Republicans sweeping anti-abortion law, was still in effect. I wondered if Id have to continue a pregnancy for which I wasnt ready.

It took me two weeks to access care that I needed immediately. Im struggling today knowing that as a result of the COVID-pandemic, countless others are facing similar barriers I had faced. Millions have lost their job and are without childcare, and some anti-choice government officials have used the crisis to outright ban abortiondirectly violating our rights under Roe v. Wade.

Weve known that our right to an abortion means nothing if we cant access it. Even though it feels hard right now, you should know advocates have worked for decades to ensure people always have access to abortion care, especially in times like these.

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If youre seeking abortion care during the pandemic, I want to help you learn about the same network that helped me access an abortion whenit felt impossible. Here are some tips that might help you navigate the state of abortion access during COVID-19.

How to get an abortion in a state that has deemed abortion nonessential

If youre seeking an abortion in a state thats attempting to or have already restricted access during the pandemic, youve probably experienced a delay in your appointment at least once. But if you have the capacity, you should call clinicsincluding thosein surrounding areasfrequently for updates because circumstances can change day to day.

Some clinics may be scheduling appointments for the future, and if legal action changes abortion access, scheduling an appointment allows the clinic to contact you to tell you about appointment availability. Providers are working closely with advocates to ensure access to abortion care continues, and theyre one of the first to know when services can resume.

Clinics can also connect people with resources for out-of-state abortion care. Providers are already prepared with this information for people over the legal limit to have an abortion in certain states, and who are forced to travel to one of the statesthat provide later abortions.

If youre considering traveling, youre not alone. Fund Texas Choice, a practical support organization providing Texans with travel assistance, told Rewire.News last month that pregnant people with varying gestational ages have reached out for assistance to go out of state since Texas Gov. Greg Abbott (R) banned abortion under COVID-19. The Brigid Alliance, a practical support organization that helps people traveling to clinics providing second- and third-trimester abortions, told Rewire.Newsthat the organization has recently helped people with pregnancies of earlier gestations, as well as families who are forced to travel together as a result of a lack of childcare.

Because of shelter-in-place orders, some state officials are preventing drivers from crossing state lines and subjecting non-residents to 14-day quarantines, which could increase the logistical costs pregnant people face. Some methods of transportation have been affected too. But the Brigid Alliance says it hasnt encountered drivers being turned away when crossing state lines, and the organization is letting folks flying to New Mexico know that in order to be exempt from the state quarantine, they can only travel between the clinic and hotel where theyre staying.

Brigid Allianceis also seeing the impacts that are surging for those providing and needing practical support.

Bus lines have closed down, airlines have spontaneously canceled flights, hotels have closed down entirely or reduced capacitywe had to move people from hotel to hotel in the middle of a three- to four-day process [to get an abortion], and were hearing from partners that there are some Greyhound lines that are doing temperature checks, Odile Schalit, executive director of the Brigid Alliance, said.

Schalit wants people to know support is available for those seeking care amid the ever-changing landscape of abortion access.

While the obstacles to your health care may appear numerous today, please know that there is a network of good people, volunteers, and resources that exist to support you. Tap into our network and, as much as possible, your own, Schalit said. Take your time, break down your plan and needs, and take stock of your unique physical and emotional safety and comfort. For many, accessing abortion care now means having to travel out of your home town, city, and state. While this may seem impossible, we and many others are here to help you construct safe plans for getting to your care.

If youre thinking about traveling out of state for abortion access, consider going to one of the 23 states that dont have a mandatory waiting period to limit the number of times you have to visita clinic before the procedure.

How to get an abortion if you need help paying for an abortion, traveling to a clinic, or other logistical support

Abortion funds and practical support organizations help alleviate the high costs associated with paying for an abortion and traveling in or out of state. Funds generally help with the cost of an abortion, while practical support organizations cover travel-related costs; some do both. Below are some organizations that may be able to help you access the care you need:

To find other local abortion funds and practical support organizations in your area, visit the National Network of Abortion Funds to search for groups by state.

You can also ask abortion clinics to screen you for financial assistance. Unlike assistance from abortion funds and practical support organizations, in-clinic funding can be income-based, but you arent required to show proof of how much money you earn.

How to get an abortion in a state that allows telemedicine

Eighteen states prohibit the use of telemedicine for abortion care. If you live in one of the states that allow it, medical abortions can be obtained up to ten weeks into pregnancy through video conference with an abortion provider.

While U.S. Food and Drug Administration (FDA) restrictions prevent the medication from being mailed to your home, patients can avoid traveling long distances to an abortion clinic while protecting their health during the pandemic by visiting a nearby health center to receive the medication under guidance of a doctor.

TelAbortion, however, can send the medication to your home if youre eligible. TelAbortion is a study run by reproductive and maternal health research group Gynuity, and the evaluation is offered over the internetso you can access it on your own phone or computer. But the FDA requires people participating in the study to visit a health clinic in order to have an ultrasound or pelvic exam, according to Dr. Elizabeth Raymond, senior medical associate for Gynuity Health Projects.

You will need video conference access in one of the 13 states participating in the study, and have a mailing address in the state where the medication can be sent.

If a person encounters barriers in accessing an ultrasound or pelvic examespecially barriers compounded by the COVID-19 pandemicthey can call a TelAbortion site, as the provider may be able to accommodate their situation.

If youre eligible for a TelAbortion, youll be sent a package containing the necessary medications and an instruction sheet by mail. Afterward, the TelAbortion provider follows up with study participants to ensure the abortion was successful, and to address any side effects and complications. According to their data, the TelAbortion model is just as effective as an in-person abortion.

In the past two months, Gynuity expanded its TelAbortion study to include Maryland and Illinois, and the hope is to continue to expand during the pandemic,as telemedicine abortion care will be critical. In the past few weeks, Gynuity has had a significant increase in traffic to the TelAbortion site.

Weve been doing this study since 2016, [and] now its right there [and] ready, Raymond said. Its gratifying to be able to help in this crisis.

What you need to know about self-managed abortion

Self-managed has proven to be extremely safea 0.3 percent risk of major complications, according to an analysis byAdvancing New Standards in Reproductive Health. Interest in it is also rising.

Self-managed abortion canincludeusing mifepristone and misoprostol, or misoprostol alone, to end a pregnancy. Mifepristone blocks the hormone essential to advancing pregnancy, whereas misoprostol empties the uterus.

Plan C provides a report card on online retailers that offer the medications, resources about how the process works, and the legal risks surrounding it.Some states have laws that could be used against people ending their own pregnanciesat least 21 people have been arrested since 2005, Jill E. Adams, executive director of If/When/How: Lawyering for Reproductive Justice, told Rewire.News.

In states without such laws, Adams said some have faced charges as a result of prosecutors misapplying parts of the criminal codes that were never intended for people ending their own pregnancies. In most cases, the judge determines the law doesnt apply, but at that point, people have already been arrested, lost their job, and face public scrutiny as a result of private records being released.

The risk is highest for populations and communities under surveillance and on the receiving end of disproportionate state violencecommunities of color, especially Black and African American people, immigrants, and trans and gender nonconforming people, are all more at risk of criminalization, and [theyre] also more likely to need self-managed abortion due to barriers to clinic-based care and bans on coverage, Adams said.

Mandatory reporters, like health-care professionals, can also feel obligated to report people should they seek follow-up care from a doctor, even though Adams said the American Congress of Obstetrics and Gynecology and the American Medical Association recommends against it.

No state requires mandatory reporting for suspected or confirmed self-managed abortion, including when the person is a minor, Adams said. If people do report, they are likely violating patient privacy laws.

When seeking follow-up care, people arent legally required to disclose their situation to a doctor. If/When/How: Lawyering for Reproductive Justices legal helpline offers information on a persons rights when talking to law enforcement officialsor doctors involving self-managed abortion. According to the website, no one has been arrested for buying abortion pills online.

The right to abortionself-managed or provider-directedstill exists throughout the United States, Adams said. But laws have been misused and power abused in unjustly criminalizing people for ending their own pregnancies.

The helpline offers free, confidential legal information topeople concerned with being investigated or arrested for self-managing an abortion, as well as legal advice from an attorney when necessary.

But Adams said if there were ever a time to eliminate the sources of criminalization, that time is now. Their legal helpline has received double the number of inquiries they usually get.Local, state, and federal officials should make it clear that no one will be arrested, charged, or detained for ending their pregnancy, or for helping someone else end their pregnancyand not just during the pandemic, but always, Adams said.

If you need an abortion without parental consent

In the 37 states that have forced parental involvement laws for young people seeking abortion care, teenagers are forced to go through the overwhelming process of obtaining a judicial bypass, or permission from a judge to have an abortion. As a result of the pandemic, shelter-in-place orders and school closures prevent teens from discreetly leaving home to go to court, or even obtaining resources that may be able to support them.

Other things to know when seeking abortion care during COVID-19

Be aware that crisis pregnancy centers (CPCs), or anti-choice clinics, are still operating, but they dont provide abortion care. Even if they offer to talk to you about your options, they wont refer you to an abortion clinic or provide the necessary resources to obtain one. Reach out to any of the aforementioned organizations for information about the next steps.

The Online Abortion Resource Squad, a group of volunteers who respond to abortion-related questions on Reddit with compassionate, accurate answers, developed a resource site in response to the confusion and uncertainty around abortion during this health crisis.The site offers up-to-date information on clinic operations in states that have deemed abortion as nonessential health care, as well as connecting with local resources for financial and logistical assistance, and locating clinics in your state and nearby states.

Go here to read the rest:
How to Get an Abortion During the COVID-19 Pandemic - Rewire.News

People with hypothyroidism who choose desiccated thyroid extract (DTE) over levothyroxine alone perceive that it works better but patients may not be aware of the risks, new research suggests.

Those were among the findings from qualitative analyses of nearly 700 online posts from three popular online hypothyroidism forums, which found that 75% of patients felt they fared better on DTE than the standard therapy of levothyroxine (LT4).

The results were to be presented at the Endocrine Society's annual meeting in late March, but the meeting was canceled because of the COVID-19 pandemic. They were subsequently published online April 3 in Medicina by Freddy J.K. Toloza, MD, a postdoctoral research fellow at the University of Arkansas for Medical Sciences, Little Rock, and a research collaborator at the Mayo Clinic, Rochester, Minnesota, and colleagues.

Made from desiccated pig thyroid glands, DTE is not approved by the US Food and Drug Administration because it pre-dates the agency, but it was grandfathered in and is sold legally by prescription under the names Nature Thyroid, Thyroid USP, and Armour Thyroid.

DTE is currently used by an estimated 10% to 29% of patients with hypothyroidism, despite concerns about the risk for hyperthyroidism-associated side effects.

"Current [American Thyroid Association] guidelines strongly suggest the use of levothyroxine over DTE as thyroid replacement therapy. We agree with this recommendation given concerns about DTE's side effects," Toloza told Medscape Medical News.

"Nevertheless, additional research should be conducted to understand if this recommendation applies to all hypothyroid patients," he added, and for those patients who are taking DTE, more research is required to determine who is at risk of side effects and methods to prevent these.

Toloza said that patients with hypothyroidism who take DTE frequently described a lack of individualized treatments and a feeling of not been listened to as issues influencing their choice.

"These findings reinforce the need for patient-centered approaches in current clinical practices. Clinicians need to carefully listen to their patients and consider their individual needs and the context of every patient," he noted.

Asked to comment, endocrinologist Rachel Pessah-Pollack, MD, of New York University Langone Health, told Medscape Medical News, "Animal-derived desiccated thyroid hormone contains both T4 and T3. We typically do not recommend using this because it can vary in concentration, meaning that the actual preparation is not physiologic."

Pessah-Pollack,a coauthor of the 2012 joint clinical practice guidelines on hypothyroidism by the American Thyroid Association and American Association of Clinical Endocrinologists, added that one of the major concerns about using DTE is the risk for iatrogenic hyperthyroidism, potentially leading to atrial fibrillation and fractures.

"That is one of the main factors that drive many professional societies to really use caution regarding DTE. That's also why major societies recommend against using DTE...based on the evidence to date," she said.

The whole issue of "combination therapy" in hypothyroidism is contentious, however. Physicians can also prescribe a "combination" of synthetic levothyroxine (LT4) and triiodothyronine (LT3) treatment; this, along with use of DTE products, has been a subject of debate for many years.

The current (2014) American Thyroid Association guidelines do not specifically rule out use of synthetic LT4/LT3 therapy, rather they "recommend only against theroutineuse of combination therapy." And although they don't expressly endorse use of DTE, they removed a statement saying it "should not be used."

"There is definitely a select group of patients who do better on combined T4/T3 treatment, and we're still trying to delineate who that population is," Pessah-Pollack told Medscape Medical News.

"As long as these patients are closely monitored and aware of the risk of hyperthyroidism and have their levels followed to ensure that they're not hyperthyroid, in select cases this is appropriate."

"But, first-line is ensuring that a good evaluation occurs...Clearly this helps us understand that we do need more studies in this area well-designed, blinded studies to really help us get to the bottom of this controversy."

Toloza and colleagues analyzed 673 posts from three online forums, WebMD (Medscape's parent company), PatientsLikeMe, and Drugs.com, selected from an initial 1235 posts because they included more complete information.

About half (51%, n = 257) of patients had primary hypothyroidism/Hashimoto's thyroiditis, 25% (n = 126) had postsurgical hypothyroidism, and 16% (n = 81) had postablation hypothyroidism. Among the 172 posts in which DTE dose information was available, the mean dose was 84.1 mg/day. Treatment duration ranged widely, from 2 weeks to 45 years.

Among the posts describing the source of the DTE prescription, the initial interest was driven mainly by the patient in 54% (n = 88), while 46% (n = 74) said that a clinician drove their interest in trying DTE. (The type of clinician was not reported.)

Among posts mentioning thesource of DTE, local pharmacies were the most common (63%, n = 75), followed by pharmacies outside the United States (31%, n = 37), and online (6%, n = 7).

Previous thyroid treatments were mentioned in 300 posts, of which 93% mentioned LT4 monotherapy.

Among the reasons for changing to DTE were no improvement in clinical symptoms (47%, n = 75), development of side effects (24%, n = 38), no change in overall well-being (22%, n = 36), and no changes in laboratory workup (7%, n = 12).

Perceived benefits of DTE included improvement in clinical symptoms (56%, n = 155), change in overall well-being (34%, n = 94), possibility of reaching previous health status (7%, n = 19), and low cost compared with previous treatment (3%, n = 8).

Specific symptoms reported to have improved included fatigue (28%, n = 43), weight gain (17%, n = 26), and neurocognitive symptoms (5%, n = 8). The average time to notice benefits with DTE was about 30 daysbut ranged widely from 2 days to 4 months.

The majority of posts (77%, n = 99) stated that DTE was more effective than their previous therapy, while 13% (n = 17) described it as equally effective and 10% (n = 13) said it was less effective.

Side effects of DTE were described by 20% (n = 136), including weight loss (15%), fatigue (11%), palpitations (11%), heat intolerance (11%), sleep disturbances (10%), high blood pressure (7%), and hair loss (5%).

A qualitative analysis of the posts yielded five major themes: experience with previous therapies before starting DTE, perceived effectiveness and benefits of DTE, DTE side effects, need for individualized therapy for hypothyroidism, and barriers to obtaining DTE.

One patient posted: "Synthroid [levothyroxine] did not help...and gives me bad side effects...my endocrinologist blamed all side effects on everything except the Synthroid."

Another wrote, "It [Armour] changed my life...I'm glad I found a medication that makes me feel normal again...all have improved; moods, skin (no itching), no headaches, goiter is down."

Others cited the lower cost of Armour compared with Synthroid.

However, some expressed negative experiences with DTE, such as, "My doctor expected that this medication would help me with brain fog, energy, and tiredness. I experienced the opposite."

And some couldn't obtain it. One wrote, "Doctors think they know how u feel and do not even tell you about Armour. I asked my doctor and was told there was not enough studies on it to show its effectiveness."

Pessah-Pollack pointed out that the study data don't address whether patients' initially prescribed levothyroxine doses were optimal, and noted that sometimes changes are needed, such as during pregnancy, following weight gain, or if the patient is taking other certain medications.

"It's unclear from patient-reported symptoms whether or not they actually had an evaluation of their thyroid levels to ensure that their dose of thyroid hormone was correct before switching over to T4/T3 replacement...There are many factors that need to be taken into account before we decide that the medication itself isn't working."

What's sorely needed, she said, are "well-designed, blinded studies that look at this controversy."

"Here, we don't know why patients are feeling better...We need to do additional work including validated symptom questionnaires and comparing thyroid levels of patients who are on Armour thyroid with those on levothyroxine monotherapy."

Toloza agrees:"It is not possible to say that DTE is working better for the user due to the limitations and the nature of the data used in our study."

"However, our findings are in-line with previously published research, which has shown that a subset of patients may prefer DTE to levothyroxine and have higher satisfaction with this treatment. Nevertheless, the reason behind this is still not well understood," and it should be further investigated.

Pessah-Pollack has reported being an advisor for Boehringer Ingelheim-Eli Lilly and Radius Health, and a moderator for Sanofi.

Medicina. Published online April 3, 2020. Abstract

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Read more from the original source:
Patients Say Desiccated Thyroid Better Than Standard Therapy - Medscape

Study group

The study group was differentiated by several sociodemographic factors, most importantly age of the participants, as it ranged from 45 to 65years. Obviously, it was due to the inclusion criteria adopted in this study, which referred not to the chronological age, but to the time which lapsed since the last menstrual period, and also due to quite large time span (between 2 and 10years of the menopause) accepted for the study. Participants of this study went through menopause between the age of 40 and 60. This is consistent with population studies concerning Poland [26] and other highly developed countries [27, 28].

The diversity concerning the place of living provides, according to some authors, the possibility of identifying beneficial as well as adverse aspects of living in urban and rural areas [29, 30]. It is worth emphasizing that the differences between these areas are becoming less and less noticeable. In this study the number rural residents was significant (40.4%). The vast majority of the respondents (75.5%) declared to have completed secondary education. Study groups in similar studies conducted by other authors also comprised women with similar educational background [31], however some other authors noted a higher percentage of participants with basic vocational education [32]. According to broad population studies, middle aged women are characterized by a lower level of education than the study group in the presented material [33].

Hormone replacement therapy was used by 10.6% of respondents at the time of the study. In the light of reports from literature, this percentage should be considered as relatively low, because, as some authors claim, climacteric syndrome symptoms appear in 75% of perimenopausal women, and 25% of them require treatment [34]. Hormone replacement therapy is effective in relieving menopausal symptoms, i.e. hot flushes, night sweats, dyspareunia, sexual dysfunction and insomnia, as well as in the prevention of osteoporosis [34, 35]. However, there are some contraindications to the use of this therapy [36].

In the presented material, an attempt was made to define the concept of being healthy as understood by the postmenopausal women. The obtained results proved that the respondents perceived health primarily as a feature (to have all parts of the body functioning well and not to feel any physical discomfort) and/or condition (to experience happiness most of the time). These results are similar to the results obtained in other studies which were carried out on groups of elderly people [37, 38]. There are also studies showing that health is perceived as a feature also by younger people, i.e. over 40years of age [39], and by chronic patients [40].

The analysis of the presented results showed that the definition of health was related to the self-assessment of health. The study proved that women with low self-assessment of their health more frequently understood health instrumentally. Interestingly, these participants selected the statements which defined health as a feature of a body (to take medications only occasionally, not be sick or only suffer from flu, cold or indigestion, not need to make appointments with a doctor and/or hardly ever go to the doctor). On the other hand, those who assessed their own health better were more likely to choose claims that corresponded to the definition values of the result (to eat properly) or purpose (to accept oneself, to know your capabilities and deficiencies). In his study, Juczyski noted that low self-assessment of health was associated with attaching greater importance to the physical criteria of health [25]. Moreover, there are differences in the way health is understood in the case of loss of health or the occurrence of chronic illness [3]. Thus, health self-assessment is gaining popularity in the field of epidemiological research where is employed to assess the health condition of entire populations [41]. Additionally, some authors notice a correlation between health self-assessment and the results of laboratory tests and the prevalence of various civilization diseases [42]. In this study self-assessment of health proved to be surprisingly high. It was rated as good by more than half of the respondents, even though they were undergoingcontinuous treatment for various chronic diseases. The literature review shows that hypertension, coronary heart disease and atherosclerosis are the main medical problems in the postmenopausal period [43, 44].

The overall rate of health behaviours of the women in the studied group was average (M=86.18, SD=13.08). The results proved to be comparable with the normalized results of Juczyski (M=85.98, SD=12.70) who observed that the postmenopausal women exhibit more behaviours that have a positive effect on health than younger women. Juczyski claims that the only exception to this observation are the younger women who are affected by some chronic diseases [25]. Recent years indicate a fairly constant tendency among older women to improve their health behaviours. According to some authors, seniors may even show above-average results [45]. However, the study by Kurowska and Kierzenkowska [32] shows the opposite trend women over 60 have worse results in the area of pro-health behaviours. The results of the present study indicate that prevailing pro-health activities encompass prophylactic behaviours. Postmenopausal women should be under a regular care of a gynaecological clinic, just like younger women, and the frequency and type of appointments should be agreed individually, depending on the needs [46]. Nevertheless, gynaecological check-ups should take place at least once a year [14].

Our study revealed that slightly more than a half of the respondents regularly had a prophylactic gynaecological examination, and only 32.0% of them did so in line with the above-mentioned recommendations. In addition, the study confirmed that some women (11.7%) had never had a prophylactic gynaecological examination performed. It is probable they would never see a doctor without a serious reason, which could be considered a risky behaviour once they reached the postmenopausal period. According to literature, the frequency of women reporting for gynaecological examinations decreases with age, and women between 41 and 60 report to the gynaecologist less frequently than every 20months [47]. This situation should be considered as both worrying and requiring improvement. This study shows that in many cases (37.3%) the only reason for making an appointment with a gynaecologist was the appearance of disturbing symptoms. Such appointments do not have a prophylactic character. Some authors claim that such appointments are perceived by many women as a compulsion or an indispensable duty. They feel exempt from this duty if there are no disturbing symptoms [14]. Sometimes even when symptoms do show up (including the climacteric syndrome), it does not increase the regularity of gynaecological check-ups [48]. Breast self-examination is the first step in the secondary prophylactics of breast cancer. It is a simple, inexpensive, fast and non-invasive examination and all women should be encouraged to be more actively responsible for their own health [49]. It is the self-examination of breast that increases the number of early detections of breast cancers and therefore women should be encouraged to perform this self-check on a regular basis [14]. Our study indicated that 72.4% of women perform breast self-examination, although only a few (13.8%) did it regularly on a monthly basis. Similar trend was observed by other researchers [50]. One of the possible manifestations of womens concerns for their own health is taking advantage of free prophylactic examinations. According to the National Health Fund (NFZ), in 2015 only one in five women took part in the Population-Based Breast Cancer Early Detection Program, and in 2018 nearly two times more women participated. The Population-Based Cervical Cancer Screening Program attracted even fewer women-9.34 and 17.89%, respectively [51]. Our study indicated that 72.4% of the respondents declared undergoing regular mammography examinations and 69.4% confirmed they undergo regular smear tests of the cervix. However, it is not known to what extent this was a participation in a population-based screening programme. Perhaps some of them decided to undergo these examinations on their own initiative, i.e. without an invitation. What is more, some women sign up for test in private clinics. Anyway, the attendance rate is still unsatisfactory [52]. The reasons for such low attendance rate may be numerous and include a lack of faith in their effectiveness, ignoring the problem of cancer, the fear of pain and nudity associated with the examination, as well as fear of detecting the disease [53].

As regards health behaviours concerning positive mental attitude (PMA), the following categories were taken into account: avoidance of upsetting and depressing situations, avoidance of excessive emotions and tensions, and social life. The analysed material showed quite high psychometric properties of this factor (M=3.60; SD=0.70), which can be considered beneficial for the mental health of postmenopausal women. This is good news, as in this age group the incidence of various mental disorders, especially depression and anxiety, is generally on the increase [9]. These women, when compared to younger women, feel more negative emotions, such as anxiety, sadness and exhaustion [49].

Proper eating habits (PEH) are the third important health criterion and a number of factors were taken into account including the frequency of consumption of fruit, vegetables and wholegrain bread, and decrease in the consumption of animal fats, sugar, salt and heavily salted foods. The literature emphasizes the importance of following the principles of healthy nutrition and proper diet in the prophylaxis of diseases typical for the postmenopausal period (metabolic syndrome, ischemic heart disease, diabetes, malignant tumors, osteoporosis and depressive disorders) [14, 54].

It is worth noting that Juczyski [25] presented an identical distribution of results for all categories of health behaviours in his study. It is undeniable, however, that the results obtained by the authors of this study as well as the results obtained by other authors show that women are not sufficiently concerned about their own health. The average results which were obtained in reference to health-related behaviours cannot be considered satisfactory, due to the fact that women in this period are more susceptible to various psychophysical disorders [9, 14, 55, 56].

Choosing pro-health behaviours is usually characteristic of people who are satisfied with their health [57]. In the presented material higher self-assessment of health was significantly associated with a higher general indicator of health-related behaviours. In addition, in both age groups women who regularly performed prophylactic gynaecological examinations obtained higher score of the general indicator of health-related behaviours, proper eating habits (PEH), prophylactic behaviours (PBs) and health activities (HA). Moreover, women over 55years of age, who achieved higher scores in prophylactic behaviours (PBs) had mammography screening and preformed self-examination of breasts more regularly.

The obtained results concerning the concept of health, health self-assessment and the type of health behaviours undertaken by postmenopausal women may be further used in broadly defined health promotion programs, including new prophylactic programs. Most of these programs are aimed at convincing women that the proposed health-related behaviours will not only improve their lives but also they will be beneficial for their families and society. However, the programs need to be constantly improved and adapted to changing needs.

This study has several important limitations that may affect the obtained results. First and foremost, the selection of the study sample using convenience sampling methodology. Next, the broad age range of women included in the study. Therefore, for the purpose of statistical analysis, the study group was divided into two age groups. This way it was possible to show in more detail any possible differences in health behaviours and in the undertaken prophylactic activities. Another limitation is connected with the inclusion of women who had reported that they were undergoing continuous treatment for chronic diseases at the time of the study, which could have modified their health behaviours. However, due to the age of the participants, it is difficult, if at all possible, to include only women without any ongoing health problems. Therefore, to minimize this limitation, a statistical analysis was performed to check any potential differences in health behaviours presented by women in these two groups (with and without chronic diseases). The analysis showed that there is no statistically significant difference between these women in terms of health behaviours. It has to be noted that the claim of an undergoing treatment for a chronic disease was made subjectively by the participants. Their health history was not examined to objectify the results, neither were their former health behaviours investigated. Therefore, it was impossible to compare and analyse any changes, which could have occurred in this regard. It would be advisable to carry out such analyses in the future using a mix-method methodology, supplementing the collected material with qualitative research, which would allow for a more in-depth analysis of the issue.

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Perception of health, health behaviours and the use of prophylactic examinations in postmenopausal women - BMC Blogs Network

When Dr Phil McGraw was 29, he had a vasectomy. At the time his wife was pregnant and he had made up his mind that he didnt want more children. Six years later, he would walk back into the clinic and demand for a reversal. Six months later, his wife was expectant.Having the procedure at such a young age was the biggest mistake I ever made.It is for this reason that doctors advice that when going for some long term family planning measures, you need to be absolutely sure. Vasectomy offers 99 per cent effectiveness and is suitable for men who are certain that they do not want any more children. According to Marie Stopes Kenya, this male sterilisation surgical procedure takes approximately 15 minutes and its failure rate is about 1 in 2,000 men. The Kenya Obstetrical and Gynecological Society reports that only one per cent of Kenyan men have undergone vasectomy despite its high effectiveness and surgical simplicity. However, since most vasectomies are performed in private facilities rather than in the public health system, the statistics could be an underestimation.It is estimated that 40 per cent of pregnancies globally are unplanned. In addition, most women are shunning hormonal contraceptives due to associated side effects. The modern man has grown more aware of the struggles their female partners go through and is more willing to take up family planning options. The options are nevertheless limited for men. Condoms, withdrawal (coitus interruptus and vasectomies are the most readily available artificial methods men can use. A man produces over 1,500 sperms per second which makes it challenging to come up with the most suitable reversible family planning method for men. But not to worry, there are options in the pipeline that will give the man more options and power over how many children he can have.WATCH OUT FOR:1. The Contraceptive gel

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Outlook on the Thyroid Hormone Disorder Drug Market to 2025 by Application, E - News by aeresearch

The coronavirus pandemic has caused strain and hardship in so many ways and for so many peoplebut one demonstrable effect is that it has made the vulnerable more vulnerable. If it was already difficult to be an LGBTQ youth whose parents or caretakers dont understand or accept their sexuality/gender identity, that stress is magnified during a time when we, as a society, have been advised to stay indoors. The situation can effectively trap these people between the forces of a global pandemic outside and virulent bigotry inside.

The New York-based Ali Forney Center (AFC) continues to serve homeless LGBTQ youth, even during a global pandemic, providing housing, mental health support, meals, and a transitional living program that teaches youth to live independently. Though the AFC has been impacted by covid-19 in several ways, it is largely meeting the increased demands, according to executive director Alex Roque, who talked to Jezebel last week about the AFCs operation in the midst of a crisis. The organizations drop-in center, which serves new clients with no place to go, remains open (though it has moved to the organizations Bea Arthur Residence in Manhattans East Village). Theres been an increased demandin part because many of their former clients who were in college have been sent home, which means needing to return to one of the 18 AFC facilities around the city. Despite this, AFC has managed to increase its meal budget and spending for its recentlyout-of-work clients. (An info sheet sent out by AFCs communications department says that 90 percent of the organizations housed clients have lost their jobs as a result of the pandemic). Further, salaries of AFCs essential workers have increased by almost 50 percent. We really felt strongly that we needed to recognize how critical and how valued our essential workers are, Roque told me.

In our conversation, Roque explained how AFC has managed to do it, and how it is managing in general. Our interview has been edited and condensed.

JEZEBEL: Overall, how as the Ali Forney Center been managing during this pandemic?

ALEX ROQUE: AFC is in a unique because we are an essential services provider thats caring for a largely disenfranchised, uncared for population of young people who are rejected by their families because of their LGBTQ identity. Around the country and across the world, people have been asked to stay home and to shelter in place and find safety in their homes, and comfort in their families. Our young people dont have any of that, so its kind of a punctuation to what their realities are that even in these dark days and awful circumstances, they have nowhere to go.

Things are pausing. Pollution is down. Wild animals are running free. Critical care hospitalizationlike, heart attacks and strokeshave also declined significantly, according to the New York Times. I thought that maybe homophobia and transphobia would also just take a little pause. That hasnt been the case. Were seeing an increase in young people in our care and a demand for our work. A lot of it has to do with young people who were in our care before who went off to college and then were sent back because of shut-downs and we were their home before college. Some of it has been with young people who left their homes at younger ages because of homophobia and transphobia and were employed and have lost their jobs and now have no family to rely on. And another part of it is that a number of youth services providers have shut down in the city. A number of the shelters have shut down as a result of staffing issues, a number of community spaces and things like that have closed their doors. Thats increased the demand for our work. But theres this understanding that covid-19 is disproportionately affecting communities of color, disproportionately affecting communities struggling with poverty and lacking access to care. Its true for our young people. Among the most marginalized communities, our young people are still marginalized. Among LGBT youth, our young people are homeless LGBT youth.

Are you able to provide the same services that you were providing pre-coronavirus?

The drop-in center was moved to the Bea Arthur Residence at the recommendation of our medical provider. We have an onsite medical clinic and when covid started, we retained our medical provider to advise us on how to operate following CDC protocol. The CDC protocol was that there should be no more than 10 people congregating in a space. Thats difficult for us to do at the drop-in center, especially because we had on average anywhere between 60 and 80 young people coming there a day. We moved to a smaller facility where we can structure it more: housing referrals, offering meals, and offering crisis intervention for young people at Bea Arthur, and then more importantly, making sure were getting them into a stable bed as we work through this. Initially, it was a big increase and then when the new protocols came into place on March 23 about stay at home and 10 people or less, we moved it to Bea Arthur. A bulk of our services that were drop-in related were moved online. About 70 percent of our counseling, mental health, psychotherapy, medical, and educational services moved online. Were offering those online to young people and were still doing a structured drop-in program.

So, if someone is sheltering in place with a homophobic or transphobic parent, they still can leave and come to you?

Correct. They can come and access a meal, they can come and access support, and they can come and access solutions to housing options. We have 18 sites throughout New York City, and so we have beds at all those sites, except for the drop-in center. So if a young person is unstably housed, they can come to us, have the crisis de-escalation, have the intervention they can offer, and then have a housing referral to our program, which is preferred, or to another program that we work with.

What is the process in place for someone who comes in and has been potentially exposed to covid, and could expose other people? Is there any sort of quarantine?

Young people across all of our sites are assessed twice a day for their symptoms: temperature and a health check-in. Similarly, for clients that were intaking, were following a protocol. Outside of covid, when a young person would come into our care, they would have a medical evaluation and a check-in. Part of that evaluation now also includes covid, but also assessing them on their experiences and other health issues. We do have an isolation option at each of our housing sites. We have an isolation protocol at all of our sites so were not rejecting anyone from housing regardless of their exposure. Were working with the citys Department of Youth and Community Development on running a hotel to service isolation. If a young person is needing isolation, instead of isolating at our site, they will be picked up by a transportation service that will bring them to the hotel. At the hotel, they will be given a room. There will be 24-hour staff on site, like there is in our housing sites, and there will also be medical staff on sitea nurse and a medical doctor providing care.

You have increased demandare you able to meet it? Is it stretching your resources?

The increased demand has been largely from clients who were accessing care in other places, like meals and group activities and access to employment or employment help. Right now, were facing a lot of applications for unemployment. There are young people that we work with that are facing immigration issues, legal services. Young people are very resilient and resourceful, so typically wed piece together different resources throughout the city they could go to. And now because all of those have closed, weve had to increase our access to meals, consultation, mental health services and therapy, medical care, and also just access to a person. Were one of the few providers that are providing access to in-person care. So its an increase in volume, but not to the extent that we have to bring in a new staff team for that. We have the staff in place.

Youve been able to manage this extra demand?

We have.

Was it a challenge to get the youth on board with sheltering in place?

Yeah. Its been a challenge for most people around the world and our young people are no different. We definitely have struggled and had to rethink our work. We started having conversations with young people that went: What can we do to keep you here? We heard some really awesome things. When we really had to start to enforce the stay at home order, which came about a week after we started the covid response, they had some great ideas. They wanted more groups online, they wanted to be able to see their friends and they needed technology for that. They wanted to have pizza parties and ice cream socials and taco nights. They all wanted their own Hulu accounts. We had experiences with young people who lost employment and young people who didnt have conventional employment and needed help getting money because they still want to buy their own things.

We came up with a way of offering incentives. If you are covid compliant, you get a weekly stipend for staying at home and following those protocols. The reality is this is what families are dealing with across the country. I have a five-year-old and Im having these conversations about staying at home and why were here and why he cant see his friends. I think any supportive or loving environment is going to creatively brainstorm around that. So now we do Zoom dates with our friends and are playing more video games and he has all the junk food he wants, which he never has before. Were embracing it. Were all in this together and were going to do everything we can to keep you happy and support that. Whats different for us than a traditional family is that we are dealing largely with young people who are traumatized by their family rejection, who are dealing with some really, really awful backgrounds related to living on the streets and what theyve had to do to survive. This is retraumatizing, so were also infusing this approach to being creative during covid with a host of mental health services, a host of direct care and support groups and activities that are clinically based to help cope.

Youve increased spendingwhere did that money come from?

Fortunately, a number of agencies have come together to help. The city is offering help for their programs. We have city, state, and federal programs. Our meal program is largely unfunded. We serve over 220,000 meals a year and thats a largely unfunded program so weve had to shoulder that ourselves. Weve been able to petition to get more funding in those areas. Weve also reached out to our community, thats helping. We reached out to restaurants that sent food. We reached out to other partners who are meal providers. A lot of that has been helpful in getting food to our clients. The reason the number went up so much is because in our transitional living program, which is a graduating part of our work, the people in that program learn to buy their own groceries, the learn to cook for themselves, theyre required to have a job or being in school. And with them losing their jobs, weve had to increase our food expense, which is already difficult to meet. Weve been reaching out and securing meals. Were okay this week. Its kind of like Groundhog Day in many ways: Okay, here we go again. How are we finding meals this week? But were getting through it.

It sounds like youre doing well, all things considered.

Were very fortunate. Were a very young and scrappy organization thats also very mighty and driven by an incredible staff team. Many have the lived experiences of many of our clients, many come from communities that represent our clients, and many understand this calling, that we are these young peoples family. We are their comfort. We are their safety. Theres a lot of unity and compassion in the work and its something that were very proud of. Were stable. We have over 200 employees, and at any given time the average has been 30 staff members out because of covid, either because theyre at higher risk or because theyve had covid. The number of staff members whove had covid is much, much lower but its been rotating. Staff will be out for a two-week period and then theyll come back around and someone else is out. What struck me is the commitment of our team to being there. Our call-outs having to fill slots hasnt been out of the ordinary. Its been what we typically see, and we thought we were going to see a big decline in staff being able to show up for work. Weve been very fortunate and as a result weve been reaching out to providers and offering help because so many of them are not as fortunate as we are.

With staff members out and new clients coming in, are you secure in your ability to keep everyone safe from infection?

Weve had no shortage of young people who have been symptomatic and who have been put in isolation. We havent had outbreaks. Were following the protocols closely, were following the isolation closely, were following the cleaning. Were making sure the young person is cared for in a way that theyre not exposing [anyone else]that theres ventilation, theres a number of protocols in place. Were a month in, knock on wood, and we havent had an outbreak. Whats also to our benefit is that were in small, home-like environments and we have the same staff working our sites mostly, so its kind of like a family.

Can you give me a sense of what the increasing of staff salaries has looked like, in terms of a percentage?

Theres been a 44 percent or almost 50 percent increase in our pay for this period. We really felt strongly that we needed to recognize how critical and how valued our essential workers are, and thats 90 percent of our staff team is essential workers, frontline workers. So weve increased that in appreciation and support and recognizing that they are doing the extraordinary. At any given time, we have over 70 to 85 people on site, on staff, working around the clock. Theyre showing up for our young people and we really needed to recognize that. Theres so much gratitude across the board, and there is that moment of unity and this abundance of love that were feeling and a call to humanity right now. It definitely feels that way.

Do you have a sense of the morale among the youth?

Its gone up and down. Initially, there was a shock in seeing other programs close, in watching this starting to happen. There was a big moment of fear. Theres some restlessness right now. For some young people, theres been an increase in depression. This is isolating. The homeless population is largely isolated from the world and we work really hard so that people dont have that isolation. We mitigate and disrupt these feelings of isolation and now were re-isolated. Were doing meditation and yoga.

Has there been any change in your trans youths access to hormones?

During Week 2, after the stay at home order and we started to move our services to teleservices, we introduced a protocol to address hormone replacement therapy. We have a transgender housing site that has 18 young TG and T individuals. Our medical provider offers a guided live session with a staff person and a young person, so theres two people helping a young person with the administration of HRT.

What can people do who want to help?

Visit our website. It doesnt have to be money. Money is obviously needed, its helping us make the decisions for the purchases we need, but obviously thats not available to everyone and some people want to help in a different way. We have set up an [Amazon] wishlist, which allows you to understand the unique needs of an individual young person and also we have a way to sign up to engage in other ways. You can interact with a young person in a safe and secure way, or if you want to write a card, if you want to host a yoga session or talk about meditation or your job. Were open to connecting. At the core of our work is demonstrating to young people that theres nothing wrong with them, that there are people in our world who care about them, who value them, and who wish nothing but the best for them in spite of what their parents contend. So connecting with people is so important.

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How One Center for Vulnerable LGBTQ+ Youth Is Helping Its Clients During the Pandemic - Jezebel

The majority of the time, periods arrive like clockwork. But sometimes, periods are late or skipped entirely.

There are all sorts of reasons for a missed period. Pregnancy tops the list, of course. But other factors including taking some medications, hormonal issues, and menopause can also delay your period.

In fact, stress is a common reason for a period that doesn't arrive on schedule.

"A woman's menstrual cycle can be a great barometer for her stress level both acute stress and chronic stress," says Lisa Valle, DO, OB/GYN at Providence Saint John's Health Center.

Stress leads to an increase in cortisol, known as the stress hormone. As this hormone increases, it "can wreak havoc on the menstrual cycle by altering the normal hormonal patterns that allow for ovulation and menstruation to occur," says Valle.

Hormones play an essential role in the menstrual cycle, so it's not surprising that an increase in the cortisol hormone has an impact.

Here's how your cycle typically progresses: Hormones are released by the hypothalamus and pituitary gland, which in turn cause a response in the ovaries. "It is a fine, delicate balance between your hormones estrogen and progesterone that determines your menstrual flow," Valle says. Stress upends these hormonal patterns.

"This can result in a missed period, delayed bleeding, breakthrough bleeding, or an early period depending on when the stress occurs during the cycle," Valle says.

According to Cleveland Clinic, amenorrhea is the absence of a monthly period. This can occur as a result of issues with the ovaries, reproductive organs, or hormones and stress is a known cause.

In a study that examined the connection between menstrual problems and stress, female students who had high perceived stress were four times more likely to experience amenorrhea. Other studies have found a similar connection between stress and irregular menstruation.

Stress can also lead to a longer cycle, a condition known as oligomenorrhea, says Briana Livingston, MD, OB/GYN at MemorialCare Medical Group. A late or skipped period can be a cause of additional stress, notes Livingston, especially if you're not trying to get pregnant.

From your body's perspective, the type of stress you're experiencing doesn't matter. "Any type of stress can affect your period. This can be emotional, mental or physical," says Valle.

If you are stressed, Livingston advises trying meditation, exercising regularly, and discussing problems with loved ones or a mental health professional. The good news is that once your stress passes, your period should go back to normal.

"When major stress in your life resolves, your period will almost always resume its regular schedule without any long lasting effects on your cycle or your fertility," says Livingston.

Like stress, depression can also have an effect on hormones. Depression is one of the factors that can lead to amenorrhea, according to the Cleveland Clinic. The two conditions are often linked people with chronic stress in their life have a higher risk of developing depression, notes the Mayo Clinic.

There's another consideration when it comes to depression and your period: Some antidepressant medications including SSRIs can increase the levels of a hormone called prolactin, according to a March 2015 review published in The Journal of Clinical Endocrinology & Metabolism. This can delay your period or skip it entirely.

Plus, people experiencing depression often shift their eating habits and experience a loss of appetite. Not eating sufficiently, and having a low body weight, are potential causes of amenorrhea, per the U.S. Department of Health and Human Services.

If your period is irregular or doesn't occur at all for more than three months, you should talk to your gynecologist, Livingston says.

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Can stress delay your period? Yes, and it's a common reason - Insider - INSIDER

A man who spent 11 years living as a trans woman has trained as a counsellor to help people accept their gender, after detransitioning back to being male.

Brian Belovitch, 63, decided to transition to a woman when he was 19 years old, having treatment including hormone therapy and breast implants.

Brian, of Brooklyn, New York, said he felt uncomfortable in his own skin at the time.

I was so uncomfortable as an effeminate, chubby gay boy I thought it would be easier just to be female. Looking back now, I realise I never felt like a woman.

Brian continued: It was more that my gender had always been in question and the idea that something wasnt quite right was forced on me.

It was like, Well, if people think Im a girl, Ill be a girl.'

Brian is speaking out about his extraordinary life, which has seen him battle addiction as he tried to fathom who he really was, just as a British woman has been given the go-ahead to pursue legal action against an NHS gender clinic, saying they should have challenged her more ardently before allowing her to transition from female to male.

Known as a detransitioner a trans person who has reverted back to the sex they were assigned at birth Brian believes we are seeing the tip of the iceberg when it comes people making the decision to change gender in this way.

He said: Youd be shocked by how many people are already coming out in the community to talk about this.

I think people have this idea that transitioning is a great fix all and end up doing it for the wrong reasons.

People like myself have a duty to speak out and be vocal its the only way to stop the same mistakes being made again.

Brian certainly enjoyed a colourful existence after transitioning living as the showgirl Natalia Tish Gervais, through the late 70s and early 80s and performing in legendary New York nightspots like Dancetaria, the Limelight Club and Studio 54, made famous by artist Andy Warhol.

But beneath the glamorous surface was a seedy underbelly that saw Brian, who is now happily married to horticulturist Jim Russell, 61, develop crippling drug and alcohol addictions.

Hitting rock bottom in the 1980s and seeking therapy, in 1986 Brian decided he was fundamentally unhappy in his own skin and decided to transition back to being male.

It was such a relief, he said. I finally felt at peace in myself for the first time.

It felt like my world had become a lot simpler by the decision and I could finally live the life I wanted to.

Brian became confused about his gender as a child, when he remembers strangers mistaking him for a girl to his mothers chagrin.

One of my first memories is being out shopping with my mother and a group of women gathering around and saying, Oh how cute, how sweet. Where does she get those curls and thick eyelashes from?' he said.

My mum didnt deal with it very well and pulled me away shouting that I was a boy.

He continued: My father, Isadore, who passed away when he was 80, would say, Why are you walking that way? Stop shaking your a** like that.'

Targeted by his peers throughout his childhood and into his teenage years, Brian says he was lucky to have survived the experience.

Kids would follow me home and throw rocks at me, he recalled.

He continued: I was scared for my life and I was even more scared my father would hear what they were calling me.

You have to remember this was the 60s. It was pre-Stonewall a series of demonstrations that spearheaded gay liberation and there were only the rumblings of the gay rights movement.

Exploring the local gay scene aged 16 brought Brian some solace, especially when he made a like-minded friend in Paul Bricker, then 17, who tragically passed away from an aneurysm, aged just 27.

Describing Paul as his mentor, Brian said: We were like two peas in a pod from the night we met.

He took me home that night it wasnt sexual and he taught me everything I know. He was like a mentor to me.

Soon after, Brian moved in with Paul and his mother, Gloria Walker, now 93.

In the bohemian household, he could be open about his sexuality and he and Paul began dabbling in the world of drag.

By todays standards, I was what would be called a gender non-conformist, meaning that I trod the line between what is seen as male and female, Brian explained.

It was a mixed bag. We called it scare drag, because we were scaring the straight people that couldnt put us into one of their boxes.

Outgrowing his hometown of Providence, Rhode Island, USA, Brian moved to New York City with $100 (80) in his pocket and started performing with drag queens to earn an extra buck, alongside working in a thrift store.

Taken under the wing of a group of trans women, Brian was still struggling with his own gender identity and began to question if transitioning from male to female might be the answer to his problems.

So, less than a year after arriving in New York, aged just 19, he was given the name of a no questions asked doctor who could help him to transition.

I turned up at this doctors office no questions asked and handed over $10 (8), he recalled.

It was pretty much, Come in, drop your pants, Ill stick you with a needle.'

Describing how the hormone therapy worked very effectively, within a matter of months Brian developed small breasts, had a softened appearance and his voice sounded more feminine.

Changing his name legally that year, Brian officially became Natalia going on to spend the next 11 years living as Tish.

In 1979, four years into his hormone therapy and still not feeling like his authentic self, Brian took the next step in his transition, spending $500 (405) having silicone breast implants fitted.

It felt like the right thing to do at the time, he said. In hindsight, it wasnt very well thought out, but none of my decisions were back then.

He continued: I would just react to the situations around me. I was never 100 per cent committed to being female there was always this niggling question.

I was never assessed. They didnt really do that kind of thing back then.

I just saw the breast implants as another quick fix.

Although struggling personally, Brians professional life as Tish went from strength to strength.

Working seven nights a week, he would run the gauntlet of New Yorks hottest clubs, performing as a big, busty showgirl.

At the height of the 80s, I was a club personality, Brian said. I had a band and would do a live show with a mix of comedy and musical numbers.

He continued: I met some famous faces and was hanging out at VIP parties it was a very exciting time to be alive.

Living both as a man and then as a woman also gave Brian a rare insight into the way society treats people based on their gender.

Discussing the downside of life as a woman, he said: The worst part of living as female was the endless exploitation by men.

He continued: The misogyny and attitude that because I looked like a beautiful, sexy woman, I couldnt possibly have a thought in my head.

And men were constantly trying to have sex with me.

Also, it took much longer to get ready to go out leaving time for hair, make-up etc.

But life as a member of the gentler sex also had benefits, according to Brian.

He continued: The best thing about living as a female was the power of beauty in itself.

I used it to my best advantage and believe I got as far as I did because of my looks.

He continued: I had a lot of fun with make-up and costumes and experiencing life fully in the role of a woman gave me a unique perspective. I know what its like to be a man and a woman in a way in which not many people can understand.

But the party scene and life as a showgirl eventually took its toll on Brians physical and mental health and, in 1986, he hit an all time low.

I was relying on drugs and alcohol to get through each day, he said.

He continued: I was broke, had spent all my money and ended up living on a friends couch.

Putting his life back together, with the help of friends, he kicked his alcohol and drug addiction.

But being stone cold sober meant he could no longer ignore what was staring him in the face that he was not happy living as Tish.

I was as sober as a judge and that really was the beginning of the end for Tish, Brian said.

I always wanted to be my authentic, true self and I realised I wasnt.

After having therapy in which he discussed gender issues and what constitutes a male and a female identity, Brian felt his only option was to revert back to the gender he was assigned at birth.

I was beautiful and young, but I wasnt happy as that person, he said. I was at a crossroads. I knew I had to have surgery on my genitalia or go back to being Brian.

There was no question which path to take. Times had changed a lot since Id made the transition and there were more gay men embracing their effeminate side.

I was in the gym one day and saw a fellow who reminded me of myself before I transitioned.

He continued: He was very effeminate, but he was muscly and buff and I thought that could be me.

So, Brian decided after much consideration, to make the transition back to being male, stopping his hormone therapy and cutting off his shoulder-length hair.

Then, six months later, in February 1987, he spent $750 (609) having his silicone implants removed.

I felt a great sense of relief after the operation, he said. I woke up crying not from the pain but because it felt like a huge burden had been lifted.

Visiting the gym up to five times a week, Brian slowly built up his muscles and, with his hormone replacement out of the window, he started growing more body hair and his shape filled out.

He also came out for the third time.

Ive come out as gay, Ive come out as a trans woman and now I was coming out as a detransitioner, he said.

People would come up to me in the street and say, Hi Tish, and Id have to tell them, No its Brian now.

The whole thing just clicked this was who I was always meant to be.

Saying goodbye to Tish meant leaving the glitz and glamour of the New York drag scene, after which Brian established himself as a successful photography agent and editor.

But, after the economic crash of 2008, he decided to re-train again as a counsellor, specialising in drug and alcohol addiction.

Describing his second time around at being Brian as the the best years of his life, recently he has become alarmed about the amount of trans people following in his footsteps, by reverting back to the gender they were assigned at birth.

Hoping to shine a light on the issue, Brian released his autobiography, Trans Figured: My Journey from Boy to Girl to Woman to Man, in 2018.

He said: I wanted to break the stigma of people who have detransitioned and to provide some insight to anyone struggling with gender confusion.

I hoped to add my voice to the ever expanding understanding of gender and identity.

Nurses and others - employed by the NHS and any other part of health and care - we have never needed them more.

So lets show them some love, and create a living map of gratitude from every corner of Britain.

By dropping a heart on this map, youre saying you appreciate the efforts undertaken daily in the NHS.

Now, Brian who met his husband while walking his Jack Russell Terrier, Bricker, 18 years ago and married in 2013 is hoping to specialise in gender identity counselling, to help other detransitioners with their journey.

He concluded: We need to make sure people are definitely happy with the idea of transitioning and properly inform them of the pros and cons.

I want to help people do that. Im the perfect man for the job.

He concluded: Just look at the life Ive lived Im a self-proclaimed expert.

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Brian lived as trans woman Natalia for 11 years before 'detransitioning' back to male - Cambridgeshire Live - Cambridgeshire Live

The approval of the humanized monoclonal antibody trastuzumab in 1998 changed the trajectory of treatment and subsequent outcomes for patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer and is now the standard of care in the neoadjuvant, adjuvant, and metastatic settings. However, as with most biologic drugs, trastuzumab comes with a relatively high price tag compared with traditional cytotoxic chemotherapy and contributes to healthcare budgets. Three engineered products related to trastuzumab2 antibody-drug conjugates, ado-trastuzumab emtansine and fam-trastuzumab deruxtecan-nxki, as well as the subcutaneous trastuzumab/hyaluronidasehave since been approved and have expanded the treatment options for this patient population. The approval of 5 trastuzumab biosimilars as of the end of 2019 holds the promise of considerable cost savings, but challenges to integrating their use into patient care must be addressed. Barriers to their use, including physician uncertainty to switch patients from the reference drug to the therapeutic biosimilar and patients lack of understanding about biosimilars, are common in the United States. It is also important that all stakeholders, including managed care professionals, pharmacists, and practice administrators, understand how to incorporate trastuzumab biosimilars into formulary discussions, clinical care plans and processes, and educational initiatives for healthcare providers and patients.Introduction

An estimated 268,600 new cases of invasive breast cancer were diagnosed in women in 2019, making it the most common cancer in women in the United States. Although approximately 42,260 women died from the disease that year, the overall death rate from breast cancer has fallen by 40%, from 33.2 per 100,000 in 1989 to 20.0 per 100,000 in 2016.1 This is due not only to earlier diagnosis through screening but also to the emergence of agents with new mechanisms of action and more targeted therapies that address the presence or absence of 3 key molecular markers in breast cancer: estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2). These molecular markers are the basis for classifying breast cancer into 3 subtypesHER2-positive, hormone receptor-positive (ER+ and/or PR+), or triple-negativeand for determining the appropriate initial treatment approach in early-stage disease.2 Genomic and molecular testing is now standard practice in patients with advanced-stage breast cancer in order to determine the most appropriate targeted therapies based on hormone and HER2 status as well as PIK3CA, BRCA1, BRCA2, and PD-L1 biomarker status.3

An estimated 15% to 20% of women with newly diagnosed breast cancer have tumors that overexpress HER2. These tumors tend to be more aggressive, more likely to invade lymph nodes, and more likely to recur and metastasize than other subtypes. They have also been historically associated with shorter patient survival compared with hormone receptorpositive breast cancer.2,4 However, with the 1998 approval of trastuzumab, a humanized monoclonal antibody (mAb) that targets the extracellular domain of the HER2 protein, the trajectory of HER2-positive breast cancer shifted dramatically. Based on substantially improved outcomes in multiple clinical trials, including significant survival benefits across all stages of the disease, trastuzumab-based regimens are considered the gold standard of treatment for women with HER2-positive breast cancer.2,3

Trastuzumab

Cochrane Database of SystematicReviews found that trastuzumab-based regimens in early breast cancer (EBC) improved overall survival (OS) by 33% (hazard ratio [HR], 0.66; 95% CI, 0.57-0.77; P<.00001) and disease-free survival (DFS) by 40% (HR, 0.60; 95% CI, 0.50-0.71; P <.00001),5 and in the metastatic setting improved OS by 18% (HR, 0.82; 95% CI, 0.71-0.94; P = .004) and progression-free survival by almost 40% (HR, 0.61; 95% CI, 0.54-0.70; P <.00001).6

Dosage and Administration

Trastuzumab has a variety of dosing regimens, with the dose, combination of agents, and duration depending on its use in the neoadjuvant, adjuvant, or metastatic setting. Trastuzumab is administered via intravenous (IV) infusion and requires a loading dose followed by a maintenance dose. The National Comprehensive Cancer Network (NCCN) lists 10 potential regimens in the preoperative and adjuvant settings.3

The NCCN guidelines list 4 potential trastuzumab-containing regimens for metastatic treatment in premenopausal women with trastuzumab in combination with an antiestrogen, either as monotherapy or in combination with lapatinib. For postmenopausal women, the preferred regimens are pertuzumab, trastuzumab, and docetaxel (category 1) or pertuzumab, trastuzumab, and paclitaxel. Several other regimens are also recommended.3 The NCCN notes that an FDA-approved biosimilar is an appropriate substitute for trastuzumab in all settings.3

Safety

Overall, trastuzumab is well tolerated and does not require any supportive care medications before or after administration. The most common adverse effects (AEs) affecting at least 5% of women in the adjuvant setting are headache, diarrhea, nausea, and chills (most grade 2 in severity), whereas fever, chills, headache, infection, congestive heart failure, insomnia, cough, and rash were the most common AEs affecting at least 10% in the metastatic breast cancer (MBC) setting.7,8

Trastuzumab labeling carries a black box warning of the risk of cardiomyopathy. In the pivotal phase 3 clinical trial published by Slamon and colleagues, combining trastuzumab with anthracyclines caused cardiac dysfunction and heart failure in up to 27% of patients with metastatic disease compared with 7% in the anthracycline monotherapy group.9 Since then, large observational studies have also identified higher rates of cardiotoxicity in women receiving trastuzumab compared with anthracycline alone.10,11 This led to a change in clinical trial design to give the 2 drugs sequentially rather than concurrently, which demonstrated a much lower rate of cardiovascular effects.12 Whether the cardiovascular changes are reversible when trastuzumab is discontinued remains a key question.12

Trastuzumab/hyaluronidase-oysk

Trastuzumab/hyaluronidase-oysk received FDA approval in February 2019. The product uses a patented drug delivery technology to facilitate subcutaneous (SC) administration, with recombinant human hyaluronidase (also called rHuPH20) acting as a temporary spreading factor. It degrades hyaluronan, a large glycosaminoglycan that otherwise limits SC administration of large volumes of fluid.13 Although delivered SC, this product is not self-administered and must be administered by healthcare professionals in an outpatient setting.

Trastuzumab/hyaluronidase-oysk was compared with trastuzumab IV in the open-label, phase 3, noninferiority HannaH (Enhanced Treatment with Neoadjuvant Herceptin) trial. Eligible patients received 8 cycles of chemotherapy with either fixed-dose SC trastuzumab/hyaluronidase-oysk (600 mg) or IV trastuzumab (loading dose, 8 mg/kg; maintenance dose, 6 mg/kg) every 3 weeks in the neoadjuvant setting. Patients received an additional 10 cycles of SC trastuzumab/hyaluronidase-oysk or IV trastuzumab (according to their initial randomization) for 1 year following surgery.14

Rates of grade 3 or higher AEs were similar in the 2 groups, with neutropenia, leukopenia, and febrile neutropenia most common. However, 21% of patients in the SC group versus 12% of patients in the IV group had serious AEs, primarily infections and infestations (8.1% vs 4.4%).15 With 6 years of follow-up in the 591 women in the intention-to-treat population, the event-free survival rate of 65% (HR, 0.98; 95% CI, 0.74-1.29) with an 84% OS (HR, 0.94; 95% CI, 0.61-1.45) were similar between the SC and IV study groups.

The faster administration time provides a much improved experience for patients as demonstrated in the PrefHER and MetaspHer studies. Results of the multicenter, crossover PrefHER trial, which randomized 240 women undergoing neoadjuvant or adjuvant treatment for HER-positive breast cancer to 4 cycles each of IV trastuzumab or SC trastuzumab/hyaluronidase-oysk, found that 91.5% of women preferred the SC formulation primarily because they spent less time in the clinic.16 Similar results were seen in the MetaspHer study, which randomized 113 women to 3 cycles of trastuzumab/hyaluronidase-oysk SC or trastuzumab IV, followed by 3 cycles of the IV formulation.17 Several studies have been conducted outside the United States attesting to the cost-savings potential of an SC delivery approach for healthcare systems; the savings are accrued from less preparation and delivery time as well as direct medical cost savings.18-24 However, with the quickly evolving biosimilars market, the cost-savings potential of an SC delivery approach is not yet known in the United States.

It remains unknown if trastuzumab/hyaluronidase-oysk SC delivery will pose a threat to uptake of the biosimilars, all of which are administered by IV.25 This version of trastuzumab does increase the potential for reducing the cost of trastuzumab IV therapy by adding more market competition. In evaluating costs, stakeholders must consider the complete episode of care; these include differences in drug administration costs and in revenue potential between the 2 different routes in practice settings.

The phase 3 PERSEPHONE trial was designed to investigate the hypothesis, demonstrated in other studies, that 6-month adjuvant trastuzumab treatment is noninferior to 12-month delivery.26 The open-label, noninferiority trial randomized 4089 patients with HER2-positive EBC to either 6-month or 12-month trastuzumab delivered every 3 weeks IV or SC in combination with chemotherapy. Switching from the IV to the SC route was allowed at the prescribers discretion. Eighty-two percent of the trastuzumab cycles were given IV and 18% were given SC. The 6-month cohorts met the primary end point of DFS noninferiority to 12 months of treatment, with increased adherence and fewer cardiac and other serious AEs in the 6-month group.26 A cost analysis estimated an average savings of $12,800 for 6 months of trastuzumab versus 12 months, regardless of administration route, for a 100% cost-effective approach with no decrease in quality of life.27 If such a change were adopted as a standard of practice with biosimilars, the cost savings could be even more significant.

Economic Issues Related to Trastuzumab

As with most biologics, the cost of trastuzumab started high and has continued to climb, even as other biologics with similar mechanisms of action entered the market.28 One potential reason for this price increase is that there has not been competition in the marketplace prior to the advent of trastuzumab biosimilar, SC trastuzumab/hyaludronidase-oysk, and antibodydrug conjugate approvals. Trastuzumab has consistently ranked in the top 20 drugs for sales revenue in the United States, with sales of $2.87 billion in 2018.29

Although trastuzumabs high price does not limit access for patients with the need for lifesaving treatment in the United States due to coverage of the therapy by Medicare Part B as well as Medicaid plans, there are significant financial impacts to organizationsincluding practices and health systemsand to patients due to out-of-pocket costs. The cost-effectiveness of trastuzumab with or without concurrent or consecutive therapies in the neoadjuvant, adjuvant, and metastatic setting has been extensively studied, but results vary depending on the setting, breast cancer stage, and treatment regimen.30-33 In a survey of 45 US oncologists, one-third cited high out-of-pocket costs for patients as a barrier to prescribing trastuzumab in the early and curative stages, and 10% reported at least 1 instance of delaying or canceling treatment because of reimbursement issues. Reimbursement issues also played a role in 60% of instances in which physicians did not prescribe the drug in the metastatic setting.34 In the same survey, one-third of physicians reported that they would increase the use of HER2-positive antibody therapy if a lower-cost biosimilar version of trastuzumab were available.34

Ado-trastuzumab emtansine, fam-trastuzumab deruxtecan-nxki, and Other AntibodyDrugConjugates

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Integrating Trastuzumab Biosimilars and HER2-Directed Therapies into HER2-Positive Breast Cancer Management - AJMC.com Managed Markets Network

You might find yourself struggling to sleep during the current COVID-19 outbreak, as stress, uncertainty and changes in our usual routine make it more difficult to relax at night and drop off.

Here, we round up some expert advice on how you can try to maintain a regular sleep pattern and get a more restful nights shut-eye.

Try to stick to the same bedtime and wake-up time

Waking up and starting your day at the same time every day is the most important way to stabilize your body clock, says Professor Greg Murray, at Swinburne University of Technology, Australia. He advises sticking to consistent sleep and wake times which fit your natural rhythm. If you are a night owl, it is okay to stay up a little later and get up a little later, just make sure these bedtimes and wake up times are the same every day, he says.

Dr. Elizabeth Cozine, a Mayo Clinic family medicine physician, agrees, Try to go to bed at the same time every night, maybe sleeping in a little bit later than you normally would because youre not rushing to get to the office. And see if you can try to get somewhere between seven and nine hours of sleep, which is what most adults need, and make that a regular part of your day.

Avoid napping

Professor Murray also advises trying not to nap during daylight hours, as it can make it hard to fall asleep at night. If you must nap, he says to restrict your sleep to just 30 minutes.

Get some sunlight during the day

Professor Kevin Morgan, who is a sleep expert at the University of Loughborough, United Kingdom, says that staying indoors means we do not soak up enough sunlight, and this can affect our sleep patterns and our need to nap during the day. To help synchronize our body clock, we should try to get enough sunlight during the day, particularly in the morning, to let our body know its daytime. He recommends exercising outdoors, if you can, or at least just walking to the grocery store or sitting in the garden.

Read also: Why you should still get sunlight even during self-quarantine

And avoid bright light in the evening

In the evening, Professor Murray says we should avoid bright light, as this suppresses the production of the hormone melatonin, which makes us feel sleepy. This also includes avoiding the blue light from computer screens and smartphones, so try to read a book or take a bath instead of watching TV to help you relax.

Avoid alcohol and caffeine

Be careful how much caffeine you have every day, says Professor Morgan, who adds that working from home, or just being at home, offers more opportunities for tea and coffee breaks. Caffeine suppresses the chemical adenosine which contributes to sleepiness and promotes sleep. He also advises limiting your alcohol intake, as although it can help you fall asleep it can also cause you to wake up early, as well as affect the quality of your sleep so you actually feel more tired the next day.

Try to relax

Psychiatry professor Adam Abba-Aji at the University of Alberta, Canada, says that if you are feeling anxious during the COVID-19 outbreak, usually the first sign of it will be a lack of sleep. It becomes difficult to switch our brains off, he said. Where theres a lack of sleep, people sometimes resort to alcohol or some other sedatives. Instead, Abba-Aji suggests trying to relax and switch off with some yoga before you head to bed.

Try meditation

You might not have tried meditation before, but Dr. Cozine says there is a lot of evidence to suggest it can improve sleep, as well as help ease stress and anxiety. Ive found that it helps me turn off those hamster wheels of thoughts that are rolling in my brain, and it also helps me to get ready for the next step, she says. Im not talking about sitting Zen, cross-legged for three hours thinking about I dont know like a desert or something. Im talking about maybe five minutes where you just reset.

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How to sleep better during the COVID-19 outbreak - The Jakarta Post - Jakarta Post

Its never easy to be living with a cancer diagnosis, but for the millions of Americans being treated for cancer right now, these are particularly trying times.

Cancer can compromise the immune system sometimes the cancer itself does this, and sometimes it's the therapies used to treat it. And what we know so far from data reported during the COVID-19 pandemic is that, not surprisingly, people with cancer are at higher-than-average risk of infection with the virus and severe consequences if infected.

For instance, an article published February 2020 in the journal theLancet Oncology reported that in China, patients with a cancer diagnosis, patients being treated with chemotherapy, and patients with lung cancer were more likely to end up on a ventilator or die with a COVID-19 infection compared with healthy people.

It was undoubtedly data like this that prompted the publication of a March 2020 article in the journal Annals of Internal Medicine, which stressed the importance of delaying cancer therapy when possible during the pandemic.

Its a good article, and it's the right recommendation.

Delaying therapy may have two benefits: It will keep vulnerable patients out of hospitals and treatment facilities, where theyre more likely to become infected, and it may relieve patients of the potentially immune-dampening effects of therapy at a time when everyone needs an optimally functioning immune system.

The million-dollar question, for patients and doctors, is what delaying treatment might mean, ultimately, for patients' survival.

RELATED: How Will COVID-19 Affect Cancer Research?

In normal times we generally encourage people not to delay. I used to tell my patients that unless you have a good reason for delay, start treatment as soon as possible.

But urging patients not to delay was often just a way of being consistent. If a treatment program that produced good results for postoperative chemotherapy for breast cancer when started four weeks after surgery has been tested and proved to work, for instance, its best to do it that way so all patients are treated alike, and so that we can predict the benefit a patient might get out of it. This then takes the issue of scheduling out as a variable.

Truthfully, four weeks was not necessarily selected because we know its the best time to start treatment; eight weeks might have worked as well or better. These kinds of variables are usually not put under stringent tests.

Have we allowed delays of treatment in the past? Sure. Sometimes a patient may have wanted to wait until after a daughters wedding, or a special trip they had planned. Depending on the type of cancer, and the stage, we tried to accommodate them.

The truth is, we dont have good data on what delays mean, because its not something weve had to consider on a grand scale.

Right now, though, we have to weigh the risk of patients getting and succumbing to COVID-19 against the risk of delaying a work-up and treatment. In most cases, delaying treatment is the less risky path. It's confusing when oncologists tell patients this, and probably scary. But the truth is, many cancers take years to develop, and in most cases, a few months' delay is probably not that risky, especially compared with the risk of getting COVID-19.

RELATED: 6 Dangerous COVID-19 Home Remedies to Avoid

Theres no one-size-fits-all template when deciding who needs immediate treatment and who can delay. Each case really should be addressed individually.

One of the most critical factors that will go into the decision is the age of the patient. Age is a critical factor in defining risk of dying from COVID-19. In most data reported, the case fatality rates are highest in patients over 70 and especially high in those over 80. Many in this age group also have a co-morbid (more than one) health condition, which puts them at increased risk.

If two patients have the same stage of the same cancer, but one is 75 with emphysema and the other is 55, their different risks if they get COVID-19 will affect the decision about treatment. The bottom line is that, when age is a factor, its in everyones best interest to keep high-risk older patients out of hospitals and clinics for a while. Most likely, older patients are going to be advised to wait.

Some cancers are an easier call than others. Prostate cancer, which tends to occur in older men, falls into this category. Low and even intermediate risk patients with prostate cancer are often offered the option of watch and wait even in normal times, so they can wait three more months for sure.

Even high-risk patients with prostate cancer can be offered hormone deprivation therapy to tide them over.

But some cancers grow rapidly, like acute leukemias and aggressive lymphomas, and many times they are the ones we can cure with aggressive treatment. In those cases, delay may well be detrimental, and arrangements need to be made to provide care in a way that minimizes, as much as possible, the risk of contracting COVID-19.

At Yale, where I am a professor, our oncologists have reorganized our outpatient facilities so that those who must go ahead can do so as safely as possible. We moved an outpatient cancer clinic to a facility 15 miles away from the main hospital, which is treating COVID-19 patients. From what I hear, other centers that have the option to repurpose clinics are doing the same thing.

And while most centers have stopped initiating new clinical trials and have stopped accruing new patients to ongoing studies, patients already participating in studies will continue to get treatment.

Of course, the usual precautions (use of protective gear like masks and, for doctors, face shields) still need to be taken for those undergoing chemo in this environment, because we know some apparently well individuals are unknowingly harboring the COVID-19 virus.

Being keeping people being treated for cancer away from the center of the action, by distancing them from the main hospital, can only help protect them right now.

It goes almost without saying that all these are decisions that oncologists need to share with their patients.

We are in an unusual time for cancer patients. Two major things have happened to them their cancer, and a pandemic washing over their community. The latter is moving very fast. The former, in many cases, more slowly.

For most patients, its best to delay treatment if your doctor thinks its possible, and let the pandemic wave crash by. This will reduce the risk for most patients of getting COVID-19 and also make a safer, less-crowded space for cancer patients who dont have the option of delaying treatment.

The 21stCentury Cures Act passed by Congress in 2016 urged the U.S. Food and Drug Administration (FDA) and the entire medical field to make better use of real-world data to make decisions in drug development. Were seeing that put into practice now with the use of hydroxychloroquine in patients infected with COVID-19. Perhaps, if we are clever enough, we can glean some useful data and insight on the impact of delaying cancer treatment when this pandemic ends.

RELATED: Cancer and COVID-19: What You Need to Know to Protect Yourself

Read more from the original source:
Should You Delay Cancer Treatments During the COVID-19 Pandemic? - Everyday Health

Posted April 11, 2020 06:04:01

It's a secret of unspoken heartache doing the rounds in rural Australia.

Regional folk may be happy to spout volumes about the fertility of their livestock, but find it much harder to talk about their own battles to conceive.

Raine Holcombe is a tough-as-nails contract musterer, raised on a crocodile farm in the Northern Territory.

She's able to stare down just about any rogue animal and withstand the toughest of conditions alongside her husband, Potter Holcombe.

The couple envisioned growing old wrangling their cattle and kids in the rugged landscape they love.

"Ever since I was a little girl playing with dolls and looking after our friends' young siblings, I've always loved children and dreamed of having our own family," Ms Holcombe said.

After they got married, Mr and Ms Holcombe faced a flood of questions from well-meaning but sometimes insensitive friends, who didn't grasp the silent battle the couple was waging.

"In the first 12 months you sort of brush it aside, and then the next 12 months was the harder part," Mr Holcombe said.

"If you're on social media, there'll be a birth announcement sometimes there's six in a week [and] that really gets you down, but at the same time you have to be happy for them and thankful they've had better luck and good fortune," Mrs Holcombe said.

It's been a gruelling process.

The couple have had two egg collections and seven embryo transfers.

The logistics of fertility treatment are 10 times harder from a remote cattle station.

"Our local closest IVF clinic is Darwin and because we travel around for work, it's up to six hours [travel], sometimes further," Ms Holcombe said.

"We can't really go to the local clinics that are close by because we need the blood results the next day or a couple of days later and those remote clinics take a week or longer to get the results."

Much of the treatment also puts the Holcombes substantially out of pocket.

"There are some payments that come from Medicare for your egg collection surgeries, there's nothing available for your embryo transfers, and there's no subsidies for travel if you live remotely," Ms Holcombe said.

All of the couple's IVF attempts have failed, and in a cruel blow, they have only recently learned that the $100,000 process was never going to work.

Undiagnosed for years has been a rare genetic condition. Both Raine and Potter carry the same DQ alpha gene, which causes an embryo to self-abort.

It has forced them to explore a different path at a clinic in Melbourne, 4,500 kilometres away from where they work.

It's their last hope and the only treatment option left.

The process involves mixing Potter and Raine's blood to create a serum, which will ideally give them up to six months to try more IVF.

If that doesn't work, it's back to the drawing board.

According to the Fertility Society of Australia, difficulty conceiving is a nationwide trend.

It estimates one in seven couples will experience some form of infertility within one year of trying.

This is partly due to the rising age of women and their declining fertility, as well as more diagnoses of fertility conditions, like endometriosis and polycystic ovary syndrome.

This is made all the more difficult by scarcity of clinics in regional Australia.

Doctors like Nicky Purser know only too well the barriers facing remote couples, particularly when it comes to hormone and fertility tests.

"Sometimes the woman might need blood tests every two or three days, and if you are 300 or 400 kilometres from a blood collecting centre and you've got to do a 600- or 800-kilometre round trip every two or three days, that's just an enormous thing to have to undertake," she said.

For testing in Darwin or Adelaide, the couple would have to spend two or three weeks in town, a trip many find logistically impossible.

"For a lot of people in IVF generally, often it is all too hard and [they] give up, besides all the extra issues that happen in the bush," Dr Purser said.

Healthcare delivery across all areas of medicine is no doubt harder in the bush, but fertility experts say addressing limited ultrasound availability, reducing sluggish turnaround times on blood tests at remote clinics, and increasing access to financial assistance could make it easier.

"The issue about blood tests and ultrasounds with a population like we have, it's not something that's going to be solved easily," Dr Purser said.

"It's always going to be a big source of sadness for people. I don't think that's really going to change."

Kimberley Mackay and her husband Angus welcomed their third baby in January.

Umbearra, their sprawling cattle station on the South Australian and Northern Territory border, is a kids' paradise, with poddy calves, motorbikes and endless plains to explore.

But while their herd of cattle boasts some impressive fertility rates, their own journey was taxing.

"A lot of people can't relate, so it was quite awkward with the people you were talking with and we did feel quite alone and isolated, especially living out here where you don't see too many people," Ms Mackay said.

She was diagnosed with polycystic ovary syndrome and fertility help was a 13-hour drive away in Adelaide.

She began treatment with a fertility drug, Clomid, which forces egg production and enabled her to fall pregnant with their first child, Ollie.

Their second attempt was more heartbreaking.

The couple went through six cycles of Clomid and then three rounds of IVF, resulting in a pregnancy that didn't last.

But they persisted, and 37,000 kilometres and four rounds of IVF later, they had Millie and considered their family of four complete.

It was a complete surprise when they found Ms Mackay was pregnant with their third child, naturally-conceived Aubrey, last year.

"We didn't believe it," Ms Mackay said.

"It was a miracle baby, really.

"We were told it wasn't going to happen. Sometimes you get lucky."

Watch this story on ABC TV's Landline on Sunday at 12:30pm or on iview.

Topics:health,fertility-and-infertility,reproduction-and-contraception,rural,rural-women,healthcare-facilities,healthcare-clinic,nt,australia,melbourne-3000,alice-springs-0870

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The long, lonely journey of infertility in the bush can involve a six-hour drive for one blood test - ABC News