Archive for the ‘Hormone Clinic’ Category

Your brain has nerve cells called neurons that can multiply within certain areas of your brain. A big factor behind this is a growth hormone called brain-derived neurotrophic factor (BDNF). "BDNF is a protein produced by brain cells that is very important to the function and survival of brain cells," Lin explains. "We used to believe that we are born with a specific number of nerve cells in the brain, and once they die, they don't grow back. We now know that is not true."

Instead, your brain has the ability to regenerate and repair itself, and BDNF is "critical" in the process, Lin says. "Studies show curcumin can increase BDNF levels, and thus support brain healing and regeneration from injury and trauma," she says.* Cognitive decline is a form of inflammation of the brain tissues, and, given that curcumin manages inflammation, it may help protect people from developing cognitive decline, Lin says.*

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What Is Curcumin? Why This Anti-Inflammatory Active Is A Game-Changer - mindbodygreen.com

(PRESS RELEASE) CHICAGO Because women have higher rates of eye diseases and eye conditions than men, Prevent Blindness, the nations oldest non-profit eye health organization, has designated April as Womens Eye Health and Safety Month. The group provides free information to the public on various eye health topics, including vision issues, possible changes in vision during pregnancy, cosmetic safety and more.

Women have a higher prevalence of many of the major vision problems, including:

The National Eye Institute states that 26 percent more women aged 12 and older have uncorrected visual impairment due to refractive error compared with men aged 12 and older. And, 14 percent more women aged 40 and older have refractive errors compared with men aged 40 and older. Additionally, women are also more likely to have autoimmune conditions, which often come with visual side effects.

According to the American Academy of Ophthalmology, for women, fluctuating hormone levels of estrogen and progesterone can affect the eyes oil glands, which can lead to dryness. Estrogen can also make the cornea less stiff with more elasticity, which can affect how light travels into the eye. The dryness and the change in refraction can cause blurry vision and can also make wearing contact lenses difficult.

Pregnancy brings an increase in hormones that may cause changes in vision. Women with pre-existing eye conditions, like glaucoma, high blood pressure or diabetes, need to alert their eye doctor that they are pregnant (or planning to become pregnant).

Lastly, women often make the majority of their familys health care decisions and are often responsible as caregivers for the health care choices of their children, partners, spouse, and aging parents. It is important to remind women to make their own vision and eye health a priority to prevent unnecessary vision loss in the future.

Prevent Blindness recommends steps that should be taken to protect vision and eye health, including:

OCuSOFT Inc., a privately-held eye and skin care company dedicated to innovation in eyelid hygiene and ocular health, is partnering once again with Prevent Blindness in support of Aprils Womens Eye Health and Safety Month.

Today, obviously there are significant challenges in maintaining overall health, said Jeff Todd, president and CEO of Prevent Blindness. We want to remind women of all ages that there are many ways to protect the gift of sight today so that it can be enjoyed for many years to come.

For more information on womens eye health, including fact sheets on eye diseases and eye protection, please visithere or call (800) 331-2020. Prevent Blindness offers a free listing of financial assistance services in English and Spanish here.

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ClearVision Optical Remains Committed to Caring for Customers During COVID-19 - InvisionMag

Dr. Ilana Sherer, 38, has a general pediatrics practice in Dublin at the Palo Alto Medical Foundation/Sutter Health with a specialty in caring for gender-nonconforming and transgender youth. Shes also a violinist with Saul Goodmans Klezmer Band. She lives with her wife and two children in Oakland.

J.: You like to say youre the best klezmer violin-playing pediatrician in the Bay Area. How did that come to happen?

Ilana Sherer: Classical violin was a huge part of my life from age 5 through high school. At a Hillel event in college, I sat next to someone in a klezmer band. There was a deep learning curve, but I played through college and then in medical school. Ive played quite a bit here but its more limited now because of my kids. I grew up in a pretty mainstream Jewish community and klezmer helped me see there were other ways to connect to Judaism. Once I entered the klezmer/Yiddish world, I thought about how this is what my grandparents spoke, and how Yiddish culture has these really strong leftist roots.

Did you always know you would be a doctor?

When I was growing up, I was often told by my parents and others Youre going to be a doctor, but I wouldnt go along with what people thought I should do. For a time I thought I might be a research scientist, but then I realized I didnt like working in a lab. There was one person there who was a medical student studying to become a pediatrician. I went along with them to a clinic and thought This is what I want to do. Everyone was right all along, but I had to figure it out myself.

When did you choose to specialize in gender-variant children?

I worked at an LGBT health center during medical school. We treated a lot of transgender people, many of whom experienced homelessness and different kinds of abuse. I saw a 20/20 episode with a transgender college student, teenager and child. The kid was doing really well, and it was an aha moment. I thought, What can we do to protect these kids, to keep them from struggling the way the adults are? When I got to UCSF for residency, I was directed to Stephen Rosenthal, who was creating the [Child and Adolescent Gender Center at UCSF Medical Center].

There are a lot of Jews working in this field, true?

Once, at the center, we were trying to schedule our next meeting and realized that everyone in the room but one person was Jewish. I see it as part of the social justice terrain and my personal responsibility as a queer person and a Jew. These are the kids who need us to support and advocate for them in the way the generation before advocated for me.

How do you explain the rise in trans or nonbinary children, and at younger ages?

Kids are now taught they can be whoever they want to be. Were breaking down this imaginary social binary that tells you what each gender should do, but were also telling kids that you are in charge of how you live your best life and your best self. Not all kids who experiment will continue identifying as transgender, but they feel comfortable exploring it. In the past, a boy wearing a dress would get teased. Now, kids have the freedom to explore how they present and dress.

With a relatively small body of research, how do you know which treatment protocols to follow?

We dont start any medical intervention until puberty. Most children who present as transgender now do so early, sometimes as early as 2 or 3, but we dont need to do anything but support and love them until puberty. Then, they can take hormone blockers, which are fully reversible.

South Dakotas state representatives introduced a law that would make it illegal for doctors to give such hormone blockers to children, but ultimately, it was defeated.

Its so heartbreaking. Doctors providing this care in climates like that are my heroes. I admire those who are sticking their necks out. I feel very protected and lucky to be in the Bay Area.

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This pediatrician helps trans kids and moonlights playing klezmer - The Jewish News of Northern California

"; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; jQuery('.imgGallery').prepend(images); jQuery('.each_image:first').show()}function navigateSliderNext(){coutner_img = parseInt(jQuery('#thecnt0').html());counter_img++;if(counter_img>total_img){counter_img=1}jQuery('#thecnt0').html(counter_img);jQuery('.each_image').hide()jQuery('.each_image[id="is'+counter_img+'"]').show()}function navigateSliderPrev(){coutner_img = parseInt(jQuery('#thecnt0').html());counter_img--;if(counter_imgAbout Dr. HE Obesity Clinic

Dr. HE Obesity Clinic in Istanbul, Turkey offers expert assessment and surgical treatment for obesity from leading bariatric surgeon, Assoc Prof Dr Hasan Erdem, and his team. With extensive pre- and post-operative counselling and a one-to-one patient-orientated approach, the clinic is committed to finding the best treatment solution for each individual case. All surgery is carried out at partner hospitals in Istanbul. Treatment options available include sleeve gastrectomy, gastric bypass and non-surgical weight loss (gastric balloon).

Assoc Prof Dr Hasan Erdem is one of Turkey's leading bariatric surgeons and has performed more than 5000 weight loss surgeries to date.

Dr Erdem qualified from the Istanbul Medical School of Istanbul University in 2002 and completed his specialist training in general surgery at Bezmialem Vakif Gureba Teaching Hospital in Istanbul. Following his national service at a government hospital, he worked as Chief Assistant in General Surgery at the Training and Research Hospital of Istanbul, where he carried out research into advanced laparoscopic and robotic surgery.

Dr Erdem established his private clinic in Istanbul in 2016. The author of a number of scientific publications in the fields of obesity, metabolic and robotic bariatric surgery, he was granted the title Associate Professor of Obesity and Metabolic Conditions in 2018.

Read what patients have to say about Dr. HE Obesity Clinic on Trustpilot

Sleeve gastrectomy or gastric sleeve, is a keyhole procedure to remove approximately 80% of the stomach, including the area where the hunger hormone, ghrelin, is produced. The resulting smaller gastric volume and loss of appetite thus leads to rapid weight loss.

Sleeve gastrectomy is suitable for people aged between 18 and 65 who have failed to lose weight by means of diet or exercise and who have a BMI of 40 or higher. It may also be considered in patients with a BMI of 35-40 who have co-morbidities such as diabetes, hypertension or sleep apnoea.

With the lowest complication risk and highest lifelong comfort compared to other methods, sleeve gastrectomy has become the favoured procedure with bariatric surgeons worldwide.

Gastric bypass offers a permanent solution to the diseases associated with obesity, particularly type 2 diabetes. It is suitable for patients who have a history of multiple unsuccessful attempts at losing weight with diet, those with excess weight that may jeopardise health, people with a BMI of 40 or higher, or people with a BMI of 35-40 with any obesity-associated co-morbidity.

Performed laparoscopically (keyhole surgery), the procedure shrinks the stomach to a small pouch and causes the food to bypass the upper portion of the small intestine. This has a dual effect: both the amount of food that can be ingested and the amount of nutrients that can be absorbed is reduced.

Most patients who undergo gastric bypass surgery successfully lose weight and maintain their excess weight loss in the long term. The role of a dietician is important in the postoperative period to ensure that patients adapt to the dietary changes required, however the rates of postoperative patient satisfaction are high in terms of the psychological and physical effects.

An intragastric balloon is a soft, expandable balloon that is inserted endoscopically into the stomach. Once placed, the balloon is filled with liquid, generating a feeling of fullness when smaller food portions are ingested. A gastric balloon may be in place for 6 or 12 months.

The gastric balloon is designed to work in conjunction with dietary and lifestyle changes. It is suitable for overweight people with a BMI over 25 who have failed to lose weight with diet or exercise, who have lost motivation or who do not want to undergo a surgical procedure.

Dr. HE Obesity Clinic welcomes patients from around the world and has dedicated patient coordination and consultation services in English, German, Bulgarian, French, Spanish, Armenian, Italian and Arabic.

For more information, call the clinics 24/7 Obesity Help Desk on 90 543 346 10 37 or fill out the online form to get a free consultation.

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Dr. HE Obesity Clinic: Weight loss clinic in Turkey - Treatment Abroad

Since 1851, normal human body temperature has been considered 98.6F (37C), established by Carl Reinhold August Wunderlich, 'the father of clinical thermometry'.

However, the German physician also observed variances in temperature depending on age and gender, and noted that normal body temperature is better described as a range.

Here's what you need to know about your body temperature, when it's considered a fever, and how to take it properly.

The human body isn't consistently one temperature, and depending on your age, the time of day, and even the activities you've been doing, it's more accurate to describe a normal body temperature range: between 97F (36.1C) and 99F (37.2C), according to Mayo Clinic.

"Temperature can vary between individuals, where some well members of a family are consistently warmer than others," says Charles Brantly, MD at Central Health. "This is not necessarily a bad thing. The normal range for the vast majority of people is between 36C and 37C."

A 2017 study of 35,488 people published in the British Medical Journal found the average body temperature to be 36.6C, slightly lower than what Wunderlich found in 1851. Moreover, a 2020 study from Stanford University School of Medicine, which assessed temperatures taken from three different databases over a 157-year period, found that the average body temperature has decreased over time a drop of 0.03C per birth decade.

The study authors indicate that the change in body temperature could be linked to improvements in human health and lifespan, as body temperature is an indication of metabolic rate. In this study, a slower metabolic rate was correlated with a longer life.

While core body temperature for men and women is roughly the same, in one study, women were found to generally have a lower skin temperature in some areas, because of their higher percentage of body fat. Brantly says that women can also have varying temperatures during their monthly menstrual cycle, and points out many other factors that can affect temperature on a day-to-day basis.

"On average children tend to be slightly warmer than adults, and those over 65 are cooler," says Brantly. "Exercise, hydration status, and clothing will all affect your day time temperature as well."

Chawapon Kidhirunkul, MD at BDMS Wellness Clinic, also says that time of day can impact your temperature. "Our temperature drops at night during sleep and increases over the day," Kidhirunkul says. "The lowest temperature is at around 4 a.m., and the highest peak at 5 p.m."

This rise in temperature is due to increased cortisol the stress hormone in the body as we go through the day. Kidhirunkul adds that another factor can be food, which usually increases temperature slightly after a meal.

High body temperature is one of the first symptoms of illness. According to Cleveland Clinic, 100.4F is considered a fever for adults, and children may feel feverish at slightly lower temperatures, depending on how you take the temperature.

A fever is an indication that your body is fighting off an infection, and is a common response to many kinds of viruses and illnesses. It's often associated with other symptoms like chills, headaches, tiredness, body aches, and sweating.

If you're feeling feverish, Brantly advises measuring your temperature and recording it several times a day, as thermometers aren't always accurate and your temperature may rise and fall throughout the day.

Fever is also a common symptom of the coronavirus. If you think you may have a fever associated with other symptoms of coronavirus, follow the CDC guidelines for taking care of yourself and preventing the spread of the virus.

There are several options when taking your temperature, such as armpit, forehead, mouth, ear, and rectal methods, according to Kidhirunkul.

The most common and easiest method of taking your temperature is in the mouth, however, Kidhirunkul says rectal temperatures are the most accurate. When it comes to a professional setting, Brantly notes that most hospitals and clinics rely on ear thermometers, though these are more expensive.

The UK's National Health Service recommends digital thermometers, which are inexpensive and easy to use. To take an oral temperature reading at home, follow these steps:

1. Put the thermometer under the tongue.

2. Close your lips around the thermometer to hold it in place.

3. The time the thermometer takes depends on the manufacturer's instructions: set a timer, or if it's digital, it may already have a timer function.

4. Once the time is up, remove the thermometer and then read it.

5. Make sure to clean the thermometer before putting it away.

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What is normal body temperature? How to know if you have a fever - Insider - INSIDER

Head to a motor racing circuit and you might be surprised to find one of the drivers sharing his experience of a bumpy fertility journey, as well as talking tyres and podium positions.

It might seem out of place, but for Toby Trice its a chance to share the tough emotional stress of in vitro fertilisation, or IVF, with a wider audience.

I had all this anger, frustration and stress, which I released through go-karting, says the 29 year old, who has been through IVF and the pain of unexplained infertility with partner Katie.

That led to me embarking on a motorsport career and I realised I could use it to start conversations about fertility and IVF. I want to send out a strong message that you can talk about what you are going through.

Uncertainty, guilt, sadness, anxiety: the emotional stress of IVF has been documented by Fertility Network UK, which found fertility problems and treatment cause high levels of distress.

IVF is not just about the four weeks of treatment, but potentially years of disappointments and hopes, explains Tim Child, medical director at Oxford Fertility and associate professor at Oxford Universitys Nuffield Department of Womens and Reproductive Health. Patients have very often been through the ringer by the time they get to IVF.

The process can be gruelling, both physically and emotionally, with no guarantees of success. While everyone is different, particular points where IVF emotional stress can spike are during internal pelvic scans to check for follicles in the ovaries, during egg collection carried out under a light general anaesthetic or intravenous sedation and on embryo transfer day.

For a heterosexual couple, the man could face anxiety about producing a sperm sample, while the woman might be apprehensive about the daily self-injecting of drugs during the IVF cycle.

Adjunctive therapies such as reflexology, acupuncture, yoga and psychotherapy can be useful around these times to help manage the stresses, says Child.

Clinic-led support groups can be a source of help and, for Kelly Da Silva, her own eight-year journey through multiple rounds of artificial insemination and IVF prompted a desire to help others.

As well as setting up her own childless support organisation and online community The Dovecote, she began working with the Care Fertility clinic where she had her treatment. The 37-year-old pioneered monthly walk-and-talk events in green spaces across the country, as well as Skype events.

Peer-to-peer support can be really cathartic, she explains. The exercise aspect also helps low mood and can be something that gets neglected.

I realised I could start conversations about fertility and IVF. I want to send out a strong message that you can talk about what you are going through

Da Silva has also set up a buddy scheme, matching those going through the same stage and type of treatment. Plus, I am buddying up men, same-sex couples and women having donor sperm or eggs, she says. Not everyone is on the same journey.

The focus on matching those on similar journeys is important, as the Human Fertilisation and Embryology Authoritys latest statistics show significant increases in same-sex partnerships and single patients among the 75,000 IVF cycles in the UK each year.

Female same-sex partnerships now make up 5.9 per cent of IVF cycles, while single patients make up 3 per cent.

Helen George, a psychotherapist specialising in fertility issues and founder of BME Voices Talk Mental Health, says counselling in an emotionally safe space can help prepare for IVF.

It also provides the opportunity to explore the lasting implications of having IVF treatment using donor eggs, sperm or surrogacy, she adds.

Its something that Gloucestershire couple Heidi and Gary Stephens advocate. While Heidi, 34, had counselling through the IVF process, Gary, 50, believes he would have benefited from the emotional help, especially as he went through surgical sperm recovery to retrieve blocked sperm.

I dont like talking about my worries, but inside it was eating me away, he says. You have to remain positive, but its such a lottery. With hindsight, I would have seen a counsellor.

While IVF treatment is filled with uncertainty, theres an area that can be controlled: nutrition. Nutritionist Dr Marilyn Glenville, a specialist in womens health, says regulating blood sugar has the biggest impact on helping women going through the rollercoaster of hormones.

The same hormone, cortisol, that manages stress also manages blood sugar, so we can end up feeling more stressed, she says.

Reducing refined sugars, such as the comforting chocolate muffin after that internal pelvic scan, and replacing it with high-quality, fresh foods, can minimise additional emotional stress. Supplements containing magnesium and B vitamins act as natural tranquillisers, says Glenville, while chromium can help tackle sugar cravings.

Meanwhile, work can prove a further painpoint, with Fertility Network UKs research finding 58 per cent of people said work affected their treatment.

Although theres currently no statutory right to time off for IVF treatment, more employers are now taking the issue seriously and creating their own policies.

Nurse Natalie Herring, 32, and her husband Ian, 36, struggled with fertility before undergoing IVF and she says being open with her employer helped.

Im very lucky as my employer has an IVF policy, which is best practice, so I was very open with my manager, she says. They were so supportive, there to listen and help me as much as they could if I needed it.

With more than 1.1 million IVF cycles now having taken place in the UK, and more than 300,000 babies born through IVF, the chances are patients are not the first in their workplace dealing with IVF.

Professor Geeta Nargund, medical director at CREATE Fertility and lead consultant for reproductive medicine services at Londons St Georges Hospital, concludes: If we want people to be more open and honest about fertility issues, we need to raise awareness, educate and get the conversation started. Its time to lift the stigma and help people with emotional support.

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IVF journey: tips to manage the emotional stress - Raconteur

Does the coronavirus pandemic have you feeling anxious? Unfortunately, that might compound the problem. Stress can weaken the immune system. How about something thats been proven to reduce stress and help people fight off the cold virus: a big hug. On second thought, maybe not. Exercise can reduce stress. Of course, no gyms or yoga studio are still open. But there are a bunch of other ways to ease your worries that are cheap, relatively easy and still allow you to maintain your social distance. Here are seven of our favorites:

Chew gum

A surprising number of studies (only a few of which were funded by the Wrigley Science Institute) have shown that chewing gum reduces anxiety. For example, researchers in Japan found that test subjects asked to chew mint-flavored gum twice a day for 14 days reported lower levels of anxiety and mental fatigue compared with a control group that got just a mint.

In the words of the American Institute of Stress: There is little doubt that chewing gum can be a powerful stress buster. One has only to look at a tightly contested baseball game on TV to see how many players, coaches and managers are vigorously chewing bubble gum or something else to relieve their pent-up tension.

Say amen

Feeling lonely because youre forced to work at home or need to practice social distancing? Try talking to God.

Shane Sharp, a Northern Illinois University sociologist who has studied prayer, said many people are able to manage negative emotions through prayer.

Sharp said prayer basically is communicating with an other who can make the situation less threatening.

People, when they pray, it makes salient in their minds that God loves and cares for them, Sharp said.

If you go down on your knees, you wont be alone. Sharp said about 70% of Americans pray at least once a week.

Give thanks

Being thankful or expressing gratitude can help with relationships, stress and depression.

One method might be to keep a gratitude journal, where you regularly write down things youre grateful for.

Sarah Moe, CEO of Sleep Health Specialists in Minneapolis, suggests something even simpler.

She asks clients who have trouble getting to sleep to say aloud three things they are grateful for before they close their eyes or if they wake up in the middle of the night and have trouble falling back to sleep.

Hearing your own voice remind you all that you have to be grateful for seems to improve relaxation and reduce stress, Moe said.

Ground yourself

Its starting to get warm enough to go barefoot outside, and thats a healthy thing, according to advocates of a practice called grounding or earthing.

Biohackers and health gurus like Deepak Chopra say that giving our bodies a chance to connect to the subtle electrical charge of the Earth can help with stress, mood, pain and inflammation.

They recommend going barefoot on the concrete, soil or grass outdoors for a half-hour at a time, or using grounding devices that will give you that connection while indoors.

Yuk it up

It might not hurt to try to find the humor in the situation.

According to the Mayo Clinic, laughter can be a great form of stress relief, stimulating circulation, aiding muscle relaxation, enhancing the intake of oxygen-rich air, increasing endorphins released by your brain, even improving your immune system.

When youre short on laughs, Mayo recommends everything from comic strips to funny movies. Even laughing at not anything in particular can help.

Even if it feels forced at first, practice laughing. It does your body good, according to the Mayo Clinic.

If you want to find something funny about the pandemic, check out the YouTube videos on the creative, hands-free Wuhan shake.

Or, if youre working from home, take a break with the viral BBC dad video, described as every work-from-home parents nightmare.

Yarn bomb it

Knittings meditative, repetitive rhythm has been shown to reduce blood pressure, lower depression and anxiety and increase a sense of well-being. Manipulating soft, soothing yarn has been compared to yoga in its ability to create a relaxed state.

If you start now, youll have a head start on the Craft Yarn Councils Stitch Away Stress campaign in April.

Heavy petting

Just 10 minutes spent petting a dog or a cat has been shown to reduce levels of a major stress hormone, according to a study conducted at Washington State University.

Oh, by the way, the American Kennel Club, the World Health Organization and the Centers for Disease Control say that pets arent affected and are not a source of infection for COVID-19.

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Stressed out by coronavirus? Here are 7 simple things you can do right now to relax - Minneapolis Star Tribune

HASTINGS Innovative Womens HealthCare is the newest clinic in Hastings, focusing on womens (and sometimes mens) health care to help people live the best life.

Owned and operated by Elizabeth and Jim Hardy, the clinic is located at 223 E 14th St, Suite 50.

Elizabeth Hardy earned a Bachelor of Science in Nursing degree in 1989 and a Master of Science degree as an Advanced Practice Registered Nurse in womens health in 1998. Both degrees are from University of Nebraska Medical Center.

She has additional training with the International Society for the Study of Womens Sexual Health, is certified in bio-identical hormone pellet therapy, and is a certified sexual assault nurse examiner.

While Hardy has had many years of experience in hospitals, professional education, public heath and administration, she said her main passion has always been the care of women in obstetrics, gynecology and reproductive health clinics.

She is a member of Nebraska Nurse Practitioners and Nurse Practitioners in Womens Health.

Im excited to work with adults at Innovative Womens HealthCare, Hardy said.

The Hardys have five children and she says she enjoys family time, boating and Tri-City Storm hockey.

Hardy said Innovative Womens HealthCare provides wellness and preventive care including annual exams, education, testing, and identification of treatment options.

Services offered include menopause symptom support, hormone therapy and care for women with bladder leakage and/or symptoms associated with sexual activity. Additional services are available for men including hormone level evaluation and testing for sexually transmitted infections.

Hardy said coming to a clinic can be uncomfortable for many people.

Its hard to disclose to clinic staff your specific needs and to ask for services that might feel personal or delicate, she said.

Hardy said Innovative Womens Health is unique as its environment is designed to be inviting and to minimize discomforts.

Our staff will put you at ease and offer professional health care, Hardy said. Ultimately, individuals can expect expert guidance in achieving optimum health with traditional and unique therapies.

She said the vision of Innovative Womens HealthCare is to provide a variety of health-oriented therapies addressing mind-body-spirit needs of the individuals we serve.

Our goal is to provide individualized quality health care to women and men regardless of race, ethnicity, religion, disability, family structure, sexual orientation or income while maintaining confidentiality and dignity of those served, Hardy said.

The clinics mission, she said, is to support women in every stage of life and level of wellness. Using patient goals, internal and external resources, and individualized health strategies harmonious with individual values, adults will be assisted in reaching maximum wellness.

Our services include womens wellness evaluation, preventive measures, symptom management, and treatment of selected conditions, she said.

Annual exams. Wellness physical exams include assessment and screening tests for early identification of health problems that can be treated and prevented.

Testing. Tests include vaginal pap exams, mammograms, blood chemistry, metabolic tests, bone density, exams related to weight gain, fatigue, insomnia, incontinence, problems of a sexual nature, and tests for sexually transmitted infections.

Education. Based on individual needs, education is designed to empower adults to actively participate in their health care. The clinic provides verbal, written, blogs, and websites for nutrition, physical activity, healthy lifestyle and weight loss.

Identification of treatment options. When a problem or diagnosis is identified, the clinic will discuss options available for treatment, including pros and cons and possible referrals so patients can make the most informed decision to move forward with a plan.

Menopause and perimenopause. The years leading up to the end of reproductive cycles often include symptoms that are undesirable and uncomfortable. The clinic offers options available that can help prevent, minimize or eliminate these symptoms.

Hormone therapy. Hormones direct how body systems function. For many people, hormones are not at optimal levels which leads to low energy, sleep issues, over eating, mood changes, weight changes, low bone density, hair loss, and low sex drive. Hormones are evaluated and options are explored in order to reach optimal levels for reproductive and thyroid hormones.

Sexual issues. There are many reasons adults experience low libido or pain with sexual experiences. It may be a new symptom or a long-term issue. The clinic can identify treatable causes and discuss options to improve or eliminate symptoms.

Incontinence. Many women experience urgency or leaking of urine with coughing, sneezing or laughing. Clinic staff can help identify what is causing incontinence and offer solutions to help.

The clinic also offers bio-identical hormone replacement therapy; Votiva skin treatment with microneedling radio frequency technology for wrinkles, scarring, stretch marks and sweating; Votiva FormaV radio frequency technology for female intimacy problems and incontinence; and Arterosil.

Hardy said people should visit her clinic because it provides personalized setting different from all-to-common rushed, stressful hubbub of many health care settings.

We also offer new alternatives from the traditional treatments often not requiring prescription or surgery, she said.

They accept many insurance companies, Every Woman Matters and cash pay. Some services are cash only.

We take the preventative approach to healing problems by identifying risks and symptoms in peoples lives to plan a course of action to decrease complications, often using natural solutions to avoid medication, Hardy said. Prescription are provided only when needed. Our philosophy is to support and promote total health prevention of diseases.

She said male and female hormone testing with blood work drawn in the clinic is very popular.

We offer many options like pellet insertion to optimize hormone levels and extend treatment intervals to improve quality of life and overall health, Hardy said. The clinic setup is designed to be cozy and comfortable with chandeliers in every room. People relax and are able to share difficult stories.

The clinic sees patients from a wide area including Custer, Valley, Nuckolls, Furnas and York counties.

When it comes to their future plans, Hardy said their desire is to maintain a personal, intimate setting, yet to expand to offer services in other communities.

We have had the most outstanding patients since our opening a year ago and want to thank them for their confidence, Hardy said. We have a portal on our website (www.womenshealthnebraska.com) for sharing, messaging and making appointments.

The clinics phone number is (402) 834-3973 and it has a Facebook page.

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Innovative Womens HealthCare serves clients in several counties - Grand Island Independent

"But I wasn't sure how rooted in research it was or if it was going to be safe to do," Kemptar said. "I didn't want to start down the path that would lead me to ruin."

So Kemptar, who lives and teaches in Esko, started looking up places that offered voice coaching in the area and the first call she made was to the University of Minnesota Duluth's Robert F. Pierce Speech-Language-Hearing Clinic.

"Just total dumb luck," Kemptar said. "It turns out it was the best program I could have possibly found."

For about 10 years, the UMD Speech Clinic has offered free and individualized transgender voice therapy. This past fall the clinic started offering group sessions as well for anyone who wants to work on developing their desired voice alongside others experiencing something similar.

Kemptar attended those group sessions every week.

"The really great thing about it was that it was a way for trans people to get together. Which is really rare," Kemptar said. "For people that are first starting to transition, especially male to female, it's really hard to go out in public. It's a lot more noticeable."

Ashley Weber, the clinical instructor speech language pathologist, said she hasn't heard of anywhere else in the state offering a group-based version of transgender voice therapy.

"The fact that we're offering a group network was a really big deal," Weber said. "We've found big success within the group of having peers that can support each other and give each other feedback."

Speech-language pathologist Ashley Weber demonstrates how a computerized speech lab is used to help people re-training their voices to match their gender identity at UMDs speech clinic. (Steve Kuchera / skuchera@duluthnews.com)

The UMD clinic has received calls from people in the Twin Cities wanting to drive up for the group session. Weber said the University of Minnesota Twin Cities, which offers individualized services, is in the process of figuring out how to formulate group-based services too.

The clinic has seen up to five individuals in the group setting which currently meets every Wednesday evening and welcomes more participants.

"Everybody's at a different stage," Weber said. "The ages range within the group so everybody brings a different experience into it, and a lot of humor, which I love."

Most of the clients at the clinic are people transitioning from male to female. Weber said that's because once people transitioning from female to male start taking testosterone, the hormone is able to lower the pitch of their voice for them. Estrogen, however, doesn't have much of an effect on vocal quality.

During the 6-12 month process in which clients meet twice a week for individualized training, Weber and student clinicians work with individuals on gradually increasing vocal pitch, both for authenticity and safety reasons. If done too fast, people can experience vocal abuse and loss of voice, which only deepens vocal pitch.

Some clients even work on language and how they use description.

"Since expression is a huge part of our culture ... being mis-gendered through your expressions can be really damaging," Weber said. "We just want to offer individuals that voice and make sure we're affirming their gender identity."

Because insurance can be finicky when it comes to covering outpatient services, Weber said voice therapy can be a barrier for individuals already dealing with hefty medical expenses. At UMD, the clinic is able to provide the services for free largely through grants and donations.

Clients use a voice journal to track different aspects of their voice as well as their goals and progress. The journal also outlines exercises to do at home.

A voice journal used by people training their voices to match their gender identity includes exercises to perform at home. (Steve Kuchera / skuchera@duluthnews.com)

"These clients have been some of the hardest working clients I've ever had," Weber said. "They really have to fight for what they're doing."

While going through the training last year, Kemptar said she warmed her voice up every morning like she was taught.

"Because it's all muscles," Kemptar said. "You're just exercising your muscles. They're going to get tired, but you have to build them up to be able to get where you want."

Before starting voice therapy, Kemptar said she often found herself not using her voice because she feared it was her "giveaway."

"I felt like it was kind of a tell that I was trans," Kemptar said. "It was interfering with my enjoyment of life. So that was my motivating factor, even if it was going to be dangerous I was willing to take that risk. I am lucky that I found a healthier alternative."

One of the most rewarding parts of undergoing the voice therapy, Kemptar said, was when she listened to her final voice recording and compared it to the first one.

"It was like night and day," Kemptar said. "There were times I was in tears because she'd play back my voice, and I'm like, 'That's me?'"

Although she's done with the training, Kemptar still checks in with herself to make sure her voice is where she wants it to be.

Since the clinic started offering transgender voice therapy about a decade ago, approximately 10-15 people have gone through the training, according to a clinic secretary. Most of those clients are from more recent years.

According to Essentia spokesperson Louie St. George III, Essentia Health also has a voice therapist who offers transgender voice therapy services.

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UMD speech clinic now offers group-based trans voice therapy - Duluth News Tribune

Fatal blood clots, suicidal behavior, lowered IQs, brittle bones andsterility are just a few of the potential side effects of puberty blockersthat the transgender industry doesnt want talked about.

By Celeste McGovern, September 18, 2019

Thousands of children attending affirmative gender health clinicsglobally, including in the United States and the United Kingdom, are beinggiven powerful puberty-blocking drugs with a litany of serious side effects including death according to Food and Drug Administration data.

And the National Health Service (NHS) in England is currentlyinvestigating issues surrounding use of the drugs since it registered a 4,500%increase last fall in the number of youths seeking treatments to alter theirbiological sex in the previous nine years.

The drugs, sometimes referred to as chemical castrators because theyare used to treat sex offenders, are increasingly used as a first-linetreatment for gender-confused children as young as 10 years old when they arereferred to counseling.

Frequently on their first consultation, children and teens areimplanted with hormone-blocker-releasing rods or taught to self-inject thedrugs to pause their adolescence and prevent developmental changes, likegrowth of breasts and facial hair while they decide on which sex they wouldlike to identify.

The practice recently gained the endorsement of the Endocrine Societyand the American Academy of Pediatrics, but the Food and Drug Administrationhas not licensed the drugs for transgender medicine due to lack of supportiveevidence. They are approved for treating prostate cancer and uterine pain inadults. The agency has recorded more than 41,000 adverse events reported withtheir use between 2013 and June 30, 2019.

More than 26,000 of the events associated with the two hormoneblockers, Leuprolide acetate and triptorelin (which includes Lupron and similardrugs used by clinics), were classified by the federal agency as serious,including 6,370 deaths. The drugs, which dramatically lower testosterone andestrogen levels in the body, are linked to life-threatening blood clots andother complaints, include brittle bones and joint pain.

Inducing Disease

The recent increase in the number of gender dysphoric youths seekingdrug treatments is particularly alarming to experts who see the drugs effectsas too risky to prescribe in their current form if at all.

Michael Laidlaw, an endocrinologist from Rocklin, California, testifiedbefore the British House of Lords on the issue of transgender health care inMay. Laidlaw told the Register, These drugs actually induce a known disease inpreviously hormonally healthy children.

Puberty blockers, he explained, interfere with normal signals betweenthe brain and the sex organs, thereby creating a disease state calledhypogonadotropic hypogonadism in youths. Its a serious condition thatendocrinologists would normally diagnose and treat because it interferes withdevelopment, but in [gender dysphoria] cases theyre inducing this diseasestate, Laidlaw said.

Because the drugs are relatively new, their long-term effects have yetto be fully determined, but one 2018 study of long-term risks of pubertyblockers from researchers at Boston Childrens Hospital found that while sideeffects of the drugs are advertised to resolve three-six months after stoppingtreatment, in actuality, the majority of subjects reported long-term sideeffects while almost one-third reported irreversible side effects thatpersisted for years after discontinuing treatment.

In addition to experts, those who have experienced the drugs effectsare also raising the alarm.

On social-media platforms, women describe crippling long-term sideeffects after taking the drugs as children. One woman on a Facebook page calledBAN Lupron said she was given Lupron for years as a young child to stoppremature puberty, and now, as a 24-year-old mother of two, I have [a]herniated disc in my lower lumbar, S-I Joint dysfunction, [a] shredded meniscusin my right knee shoulder pain tendonitis in my left foot, extreme toothdecay and minimal teeth left, TMJ [jaw pain].

A 25-year-old said on the page that she suffers from osteoporosis and acracked spine, while a 26-year-old indicated the need for a total hipreplacement.

Youths who take puberty blockers complain of similar side effects andof menopausal symptoms, including hot flashes, insomnia, fatigue, rapid weightgain and depleted bone density.

I stubbed my toe; it broke. I fell over; my wrist broke. Same with myelbow, an anonymous teen, who was prescribed the drugs by the Tavistock NHSgender center, told the Times newspaper of London.

They promise you that your breasts will disappear, that your voicewill be deeper, that I would look and sound more like a boy. For me, that wasthe best thing that could have happened, the teen said about her attitude atthe time, but she came to call taking the drugs the worst decision Ive evermade.

Evolving Guidelines

These and similar complaints have come to the attention of some membersof the medical community, who urge some kind of government oversight.

Yes, there can be poor or improper treatments by some; thus,governments as well as medical organizations should investigate reports ofpatient/family complaints in this regard, Michigan State Universitypediatrician Donald Greydanus told the Register. Greydanus is one of eightauthors of a paper, published in the August issue of the journal Disease-a-Month,overviewing care of teens who identify as transgender.

Greydanus is not necessarily opposed to the use of castration drugs,but he acknowledges that prudence must still play a role in how they areadministered especially since the drugs have a sketchy safety record.

Adolescents with gender dysphoria should not be started on pubertyblockers until at least early adolescence, he said. Sex-affirming hormonetherapy using high levels of hormones of the opposite sex may start soonafter, and surgery by age 18, generally, but he said, These guidelinescontinue to evolve and to be debated!

Greydanus added that proper informed consent should let all partiesknow the drugs risks before they are given.

All drugs have side effects, he told the Register, and some can beworse in some patients versus others.

However, Laidlaw called the hormone-blocking drugs untested andunsafe for adolescent children. He referred to them as development blockersbecause their results are systemic and block normal brain development and ahost of other body functions as well as sexual maturation.

Development is so stunted, he said. If you take these long-term, youwind up with an adult with child-like sex organs. If they are taken at a veryearly stage, they wont develop sperm. Permanent infertility is a possibleoutcome for those who use the drugs, he said.

Puberty is a time of tremendous growth and not just in the gonads, hesaid, noting that bone formation is also taking place at this time. They arelengthening as well as strengthening.

The effects of the drugs on bone density are well-documented, Laidlawsaid. By the end of two years the bone density of the girls [taking pubertyblockers] is down in the lowest 3%.

Mental-Health Concerns

According to guidelines from the World Professional Association forTransgender Health, children must be screened for underlying mental issues. Yeta Freedom of Information request filed by Oxford sociologist Michael Biggsrevealed that nearly one-third of the children treated at one clinic in Britainhad been diagnosed with autism spectrum disorder.

Besides putting patients with pre-existing mental conditions at risk,the drugs also seem to be having a deleterious effect on young patientsdeveloping mental capacities, studies have shown.

Puberty is also a time of tremendous brain changes, when gray matterbecomes denser which may explain why puberty blockers have been found tolower IQ.

One 2016 study found that girls treated with puberty blockers had aneight-point lower IQ score than controls who did not receive the treatment.This was similar to the seven-point IQ drop from 100 to 93 reported among 25girls who took puberty blockers for two years for early puberty and a nine-pointIQ drop in a study of a 12-year-old boy 28 months after taking the blockers.

Proponents of the drugs claim the effects are reversible, but we dontknow what will happen in all the cases, Laidlaw said.

But the mental damage may be even more serious than a drop in IQ forpatients.

Concerns about the impact of puberty-blocking drugs on the mentalhealth of youths were raised in England when Biggs uncovered the unpublishedresults of a study by the Tavistock and Portman NHS Trusts Gender Identity DevelopmentService (GIDS).

Although the results for using puberty blockers had been reported tothe public as positive, Biggs found that for all but one yardstick (that ofparents perspective) the outcomes were negative and that a significantincrease was found in the number of drug-treated youths who agreed with thestatement: I deliberately try to hurt or kill self.

Transgender Censorship

But even scientific evidence pointing to the risks of castration drugsdoesnt seem to matter to the cultural gatekeepers who wish to seetransgenderism normalized in society.

Demand for the drugs as puberty blockers has skyrocketed withgovernment-sponsored and cultural transgender programming, including televisionshows like I Am Jazz, an American reality TV following Florida teen JazzJennings, who was born male but took hormones and was surgically castrated toappear female. And the market for the drug has a potential to expand further,as gender science is extending to transgender preschool children.

With such positive reinforcement of transgenderism in culture,criticism of treatment for gender dysphoria is increasingly banned as harmfuland transphobic. The same tendency toward censorship also surfaced recentlyin state legislation. Last month, North Carolina became the 18th state to banthe use of taxpayer dollars for any conversion therapy practices that seek tohelp transgender children overcome their confusion without drugs and surgery.

Experts in the field are also not immune to such censorship. Laidlawtold the Register that as an endocrinologist, he tweeted on July 21 about thedangers of puberty blockers but his tweet was deleted by Twitter last month,and he has been unable to post on the platform since.

Likewise, when Biggs revealed the unpublished GIDS report to theBritish press, the Oxford professors Twitter account was reportedly suspendedfor transphobic statements.

Catholic Teaching

Aside from the medical risks involved with castration drugs, theprinciple driving their promotion flies in the face of Catholic teaching onhuman sexuality.

Pope Francis addressed the issue of transgenderism in his 2015encyclical Laudato Si (Care for Our Common Home), citing the words of hispredecessor, Benedict XVI, that man too has a nature that he must respect andthat he cannot manipulate at will.

Man, Benedict said in his September 2011 address to the GermanParliament, does not create himself. He is intellect and will, but he is alsonature, and his will is rightly ordered if he respects his nature, listens toit and accepts himself for who he is, as one who did not create himself.

[V]aluing ones own body in its femininity or masculinity is necessary if I am going to be able to recognize myself in an encounter with someone who is different, Pope Francis added. In this way we can joyfully accept the specific gifts of another man or woman, the work of God the Creator, and find mutual enrichment.

__________________________________________

Celeste McGovern writes from Nova Scotia, Canada.

https://www.ncregister.com/daily-news/fda-thousands-of-deaths-associated-with-drugs-given-to-trans-children

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FDA: Thousands of Deaths Associated With Drugs Given to 'Trans' Children - Catholic Citizens of Illinois

16 March 2020

The spread of a novel coronavirus (SARS-CoV-2), which causes the disease COVID-19, presents UK fertility clinics and patients with a unique set of challenges. Some of this is because we simply don't know enough about the effects of the infection on fertility, fertility treatment and early pregnancy. Early data, summarised in the Royal College of Obstetricians and Gynaecologists guidance, are reassuring, but the number of reported cases is still small.

Clinics could face logistical challenges if large numbers of staff are unable to work due to quarantine requirements, or if elective work in hospitals is shut down to make space for emergencies. Should this prospect impact the advice we give patients? The UK Government, at the time of writing, has held back from the more radical social distancing measures implemented in other countries. This leaves clinics with a dilemma of whether to continue to offer fertility treatment to unaffected patients, or to go beyond current Government advice and suspend services.

Patients' anxieties are understandable and those who wish to delay their treatment should be accommodated. It makes sense for anyone who meets the criteria for self-isolation (which are also evolving as we write) to be advised not to start treatment and indeed to stop active treatment if already commenced.

Some would go further and say that all elective fertility treatment should be delayed. The European Society forHuman Reproduction and Embryology advises that all fertility patients should 'avoid becoming pregnant at this time'. A Twitter poll targeting reproductive medicine clinicians found 45.5 percent support for delaying frozen embryo replacement in patients in areas with a high COVID-19 burden.

The question then arises, for how long should treatment be delayed? It is reported that the UK will see the peak of infections three months from now, with a tail persisting into the autumn and a potential second peak after this. If we were to delay all fertility treatment, UK clinics may struggle with the capacity to cope with demand when treatments re-start. One could easily envisage a delay of six months, which may well harm the chances of conception for some patients. Hence the need for advice to be tailored to each individual patient's situation. Delaying treatment, in effect closing clinics, would have other impacts including financial strain (particularly for smaller stand-alone clinics) and loss of morale among the more vulnerable fertility patients.

Furthermore, Chinese researchers have identified that testicular Leydig cells and seminiferous tubules express the angiotensin-converting enzyme 2 (ACE2) receptor, which is used by the virus to gain entry into cells. This short discussion paper has not been peer-reviewed and there is no evidence to suggest that the virus is found in the testes, as reported in BioNews 1039. However, this paper does alert to the need for further research into whether male fertility may be affected by COVID-19, so that patients can be adequately counselled.

The fact is that this is a fast-moving situation, with facts and knowledge changing daily. This makes it hard for professional bodies to issue meaningful guidance to practitioners and patients. The American Society for Reproductive Medicine even calls its guidance 'suggestions', showing the tentative nature of such advice. As far as UK clinics are concerned, unless restriction of movement is introduced, it is reasonable to continue treatment for those who are well and wish to continue. However, centres must be prepared to terminate or complete treatment (including through cycle cancellation, oocyte or embryo freezing) and cease initiating new treatments as and when 'lock-down' commences.

Clinicians have in their toolbox measures, which can be taken proactively, to reduce the risk to patients who find themselves in a situation where treatment has to stop. A patient may develop symptoms, or fall into a risk group, for COVID-19 after having started ovarian stimulation. Patients on a g onadotropin-releasing hormone (GnRH) antagonist regime could be managed by stopping follicle-stimulating hormone (FSH) administration and continuing antagonist administration until the patient's ovarian response has settled. Data from small case studies indicate that GnRH antagonist continuation after the trigger of final oocyte maturation is effective in reducing the risk of ovarian hyperstimulation syndrome (OHSS). Where concern exists about a high ovarian reserve, consideration should be given to co-treatment with letrozole, keeping oestradiol levels low and reducing concern about the risk of OHSS.

The key is anticipation of problems, both clinical and organisational. All centres should have a contingency plan in place that describes a stepwise reduction in their activities. This allows prioritisation down to a minimal activity if needed. It is unlikely that any licensed fertility clinic can shut down completely; work goes on behind the scenes, in particular around the maintenance of storage banks. There are practical considerations for this maintaining tanks for example but also the regulatory issues around consent expiry and data management. Urgent medical issues will still arise, and it may be appropriate to maintain a fertility preservation service for cancer patients. This prioritisation must take into account national and local pandemic policies, as well as recognition of likely reduced levels of staffing due to illness and isolation. Mitigation policies may include replacing consultations with phone- or video-calls and making sure there is a good communication policy for patients who have treatment-related problems.

We must also bear in mind the anxiety that is generated by how this pandemic is playing out. In our connected world, news, including fake news, travels faster than the virus. It is hard to escape the sense of a storm looming or a tidal wave about to break. In some countries, of course, the storm is now raging and the tide has overwhelmed even well-resourced health systems.

Fittingly for the first pandemic of the social media age, there have been extensive informal discussions on these issues among clinicians across many social media platforms. US colleagues have collated a number of measures, gleaned from social media, that clinics should consider in their response to this challenge.

Things are moving apace, and we must respond in a safe and effective way, but without panic. The British Fertility Society and the Association of Reproductive Clinical Scientists are committed to providing guidance to UK clinics as the situation evolves.

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Keep calm and... stop? Fertility treatment in a pandemic - BioNews

20 March 2020

The British Fertility Society (BFS) and the Association of Reproductive Clinical Scientists (ARCS) have announced new guidelines for fertility patients during the coronavirus pandemic.

Summary

UK COVID-19 epidemic continues to escalate.

Whilst pregnant women can be generally reassured they are asked to consider themselves a vulnerable group.

It is expected that UK licenced fertility centres will now be working to suspend treatments.

UK fertility centres must establish the requirements to maintain a minimum service, which may include non-elective fertility preservation.

Centres are expected to keep communication open with patients for advice and reassurance.

Centres are expected to minimise their impact on National Health Service (NHS) resources.

Background

A novel coronavirus infection that can cause serious disease (COVID-19) in a minority of affected people has taken on pandemic proportions, leading to extraordinary measures being introduced across the world.

The situation with respect to the number of affected persons and UK government advice on measures to increase social distancing is evolving. As of 18 March 2020: 56,221 people have been tested in the UK of whom 2662 tested positive for coronavirus, and 104 have died as a result of the illness. The government has advised against non-essential social contact and non-essential travel. Self-isolation has been advised for anyone with symptoms of coronavirus along with their household. The NHS has imposed restrictions on elective surgical and outpatient work, other than in situations where this is needed for the treatment of cancer or the purpose of saving life. The NHS has put in place plans for using medical and nursing staff from different areas in the most efficient way to deal with anticipated patients. This includes block-buying capacity in private hospitals. The aims of these measures are to free-up the maximum possible inpatient and critical care capacity, to prepare for anticipated large numbers of COVID-19 patients who will need respiratory support and to support staff and maximise their availability.

This guidance builds on the initial response from BFS and ARCS to this unprecedented challenge to the UK health system and the health of the population. It is designed to help all UK fertility clinics, regardless of their setting, to prioritise and organise their activities during the outbreak, whilst complying with their clinical, ethical, regulatory and social duties. Few UK licenced clinics will be able to close down completely, since virtually all will have embryos and gametes in storage banks which must be properly maintained in accordance with the law. Centres are advised to plan a flexible local policy which allows for prioritisation and a number of eventualities. Policies must take into account local conditions, breadth of work undertaken and clinic resources (including financial resilience). The overriding priority is for centres to act in a socially responsible manner.

Policies to take into account include the national strategy led by the chief scientific advisor and chief medical officer. Hospital-based clinics will be influenced by their own trust pandemic strategy which is likely to mirror national plans. Clinic groups may develop an overarching strategy, whilst individual centres will need to consider local prevailing conditions.

In developing their local policies, clinics must take into account their duty to abide by regulations arising from the Human Fertilisation and Embryology Act 2008, and laid out by the Human Fertilisation and Embryology Authority (HFEA) in its Code of Practice. HFEA guidance to clinics is available and updated as required. In all this, clinicians retain an ethical responsibility of beneficence and non-maleficence to their patients. A wider social responsibility of promoting public health and preventing harm from infection exists for all citizens, but especially health care providers. All clinics, whether in the state or private sector, should be mindful of their wider responsibilities, including the need to promote social distancing and to consider the potential effects of their work on local NHS services, which are likely to be stretched to an unprecedented extent.

At the time of writing, it is not thought that the infection causes miscarriage or fetal abnormality, and pregnant women do not appear to be at increased susceptibility to the infection or to developing complications. However, in the Prime Minister's bulletin on 16 March 2020, it was made clear that pregnant women were considered a vulnerable group, because this is a new infection and data on effects in pregnancy is limited. Further, there is concern for the potential care commitment required for any pregnant women with symptoms. The question arises whether the benefit of continuing to treat our infertile population may be outweighed by the additional concerns. It is reasonable that women who have risk factors for severe illness if infected, for instance those with diabetes or underlying respiratory disease or immunosuppression, should be advised against conceiving during the outbreak.

Fertility patients with symptoms of COVID 19

Pregnancy should be avoided in women who display symptoms of COVID-19. Patients who are in the stimulation phase of their treatment, but have not yet received the trigger, should be advised treatment cancellation. In such a situation, stopping follicle stimulating hormone (FSH) while continuing with gonadotropin-releasing hormone (GnRH) antagonist (or agonist as the case may be) is likely to protect against ovarian hyperstimulation syndrome (OHSS). Patients should be counselled against unprotected intercourse to avoid the risk of multiple pregnancy.

Patients who have received human chorionic gonadotropin (hCG) or GnRH agonist trigger may proceed to egg collection and freeze-all, if appropriate facilities are available and after a multi-disciplinary assessment of risk.

Patients who develop symptoms after oocyte collection should not have an embryo transfer.

Embryo transfer, or intra-uterine insemination should not be carried out in women with suspected or diagnosed COVID-19.

Stopping treatment programmes

For the reasons above, it is expected that, as the UK epidemic is now proceeding, all centres will stop initiating new fertility treatments, including in vitro fertilisation (IVF), frozen embryo transfer, surgical sperm retrieval, insemination and ovulation induction. This is also in keeping with recommendations from other professional bodies in the field of fertility treatment (Ref 4 and 5). When such a decision is made, it is reasonable for clinics to complete treatment that has already commenced in patients who remain well and where the centre's resources allow this to be done safely. However, clinics should be mindful both of their duty to minimise spread and of the impact of any complications on the NHS. Moderate or severe OHSS, which is often managed in an NHS emergency care setting, has been reported in 3.1 to 8 percent of stimulated treatment cycles. The risk of OHSS is reduced by the use of GnRH agonist trigger and freeze-all. It is mandatory therefore to consider these measures in women currently in the process of treatment.

Fertility preservation

Where resources allow, it is appropriate to continue non-elective fertility preservation, for example sperm and oocyte or embryo storage for cancer patients, provided they show no symptoms of infection. It should be borne in mind that these patients may be immunocompromised, and shared decision-making involving the patient, oncologist and fertility specialist is key. Fertility preservation should only be carried out in patients who remain well during treatment, and provided sufficient resources are available to do this safely. Local arrangements will be needed to allow these procedures to take place.

Outpatient clinics and diagnostic work

As part of social distancing, it is reasonable to advise that all face-to-face work should pause, other than in emergency situations, and where delay would be detrimental to the prospects of patients. Where possible, clinics should facilitate telephone or video consultations. If patients are attending for face-to-face encounters, care should be taken to stagger appointment times to prevent large groups of people congregating in waiting areas. Group sessions and support group meetings should not go ahead while social distancing is in place. Staff who can work from home should be facilitated to do so where appropriate, by provision of remote access to electronic case records as confidentiality restrictions allow.

Patient support and communication

Clinics should be aware of the potential emotional impact of the disruption of treatment services on their patients, occurring on a backdrop of anxiety about the effects of the virus itself. Measures should be put in place to keep patients informed of changes to the service and the reasons for these. Patients are likely to have concerns about the effect of delay on their chances of success and eligibility for NHS funding. It is likely that the ongoing uncertainty about the length of delay will compound these worries. All members of the clinical team have a role to play in supporting patients, with a special emphasis on the role of trained counsellors. It is recommended that usual facilities for answering phone call queries be enhanced to account for increased demand around short notice changes in service provision. Clinic websites and apps have a role in keeping patients informed and allaying anxieties in a difficult time.

Issues concerning funding and eligibility

Clinics should establish liaison with commissioners of NHS services to clarify their position on funding of treatment cycles that are cancelled, and the eligibility of patients who reach age thresholds without receiving treatment, due to the coronavirus outbreak. Significant numbers are likely to be affected, and it is likely that individual Exceptional Funding requests will not be appropriate for the circumstances we recommend that commissioners make timely decisions to guarantee treatment in the future for all currently eligible fertility patients negatively affected by the COVID-19 pandemic, to minimise distress and facilitate pathways once treatment resumes.

Staffing

Centres should work to identify the minimum number of staff that are necessary to maintain urgent services such as fertility preservation for oncology patients. It is likely in NHS settings that a large proportion of medical and nursing staff will need to be redeployed to other areas, however measures should be taken to try to ensure that staff with the requisite skills and training to deliver urgent treatments are available at all times. If sufficient staff are not available due to illness, then centres should seek support through their reciprocal support agreements with other centres or networks.

Sufficient scientific staff should be in place to maintain and ensure the ongoing safety of gamete and embryo storage banks. To guard against the risk posed by significant numbers of scientific staff becoming ill and forced to self-isolate, centres should ensure that sufficient scientific staff are available and are cross-trained to deliver all key tasks including ongoing quality control and maintenance.

Appropriate levels of staffing should be determined by the person responsible, taking advice from nursing, medical and scientific professional leads within the centre. It is incumbent upon public relations (PR) to ensure that services are reduced in keeping with available levels.

Diagnostic services

Where assisted conception centres undertake diagnostic activities, such as semen analysis or post-vasectomy testing and these involve attendance at the clinic, these should be suspended in order to minimise social contact.

Where diagnostic services are part of NHS pathology (or other) departments, the above also applies and staff may be asked to redeploy during the epidemic.

Resuming services

Whilst every effort must be made to reduce services over coming weeks and months, it is necessary to think forwards towards a resumption of services. Maintaining contact with patients whose treatment has been disrupted or deferred is important, and consideration should be given to prioritisation when services are able to recommence. The timing of this will be dependent on ongoing Government advice, resumption of NHS normal working practices as well as centres' own staffing and other resources.

The BFS and ARCS continue to monitor the ongoing pandemic and advice from national authorities. Further guidance will follow as appropriate, with the ultimate aim of resuming normal services as soon as possible.

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Guidance for the care of fertility patients during the coronavirus COVID-19 pandemic - BioNews

Dr. Drew Pinsky stopped by"Salon Talks" recently to talk about a new thriller called "Final Kill," in which he plays a therapist. Many will know Pinsky from his nationally syndicated radio show "Loveline," which ran from 1984 to 2016, and his many TV shows focusing on sex and addiction, as well as reality shows like "Teen Mom" and "Celebrity Rehab."He also hosts the advice-driven podcasts,"Dr. Drew After Dark" and "The Adam and Dr. Drew Show."

"Medicine saved my life, quite literally," he told me. "I woke up every day of my training thinking, 'I love doing this,'feeling like it was so important what I was doing." Pinskybegan his radio career as a medical student during the AIDS epidemic of the1980s. "No one was talking about it, particularly not to young people," he remembers. "That's what motivated me to get on the air. I thought I was doing community service for the first 10 years of going on the radio."

The desire to help people led Pinsky to get additional degrees. He originally trained as aninternal medicine doctor, then later moonlighted at a psychiatric hospital and became a specialist in addiction. "I have noticed that I start to gravitate towards the big problem of the time," Pinsky said. "Right now, to me, it's homelessness. I'm deeply involved in big problems. Childhood trauma has been a massive issue for the last 30 years, so I got involved in that, and then drugs and alcohol became the problem, so I spent 20 years running a drug and alcohol treatment center."

Calling Los Angelesan "open-air asylum" for homeless people, within which diseases can spread rapidly, Pinsky expressed concerns about transmission of COVID-19, in a way no pandemic has been in many years. Pinsky alsosays he is working on a new book directed at young people, which he hopes will address a key important issue in sex and relationships.

To hear more from Pinskyon playing a real and pretend doctor on TV, and why he thinks millennials reject addiction treatment methods that have worked for previous generations, watch my "Salon Talks" episode with Dr. Drew here, or read a Q&A of our conversation below.

The following transcript has been lightly edited for clarity and length.

Is true that you love to sing opera or did at one time?

I did. Some people will know I was on "The Masked Singer" a couple months ago.

How'd that go?

Not so great. It turns out that in the intervening year,I've lost a little bit and I have all kinds of problems with my vocal cords, but I got through that show, which was the goal.

What happened? Polyps?

A hemorrhage andreflux and all kinds of good stuff. They wanted to do a bunch of laser, which I don't have time to do because I spend my life talking. The way I got the hemorrhage is I knew I was about to do that show. I thought, I better to do some singing. So I was down both at Stonewall and The Monster in the Village, and I started, I really pushed it. And also, my mid-range was gone. I thought, oh Jesus, something's wrong. It was.

But did they love it at Stonewall Inn? That's the famous gay club here in New York.

Yeah, and The Monster is another great gay club that has a pianist there. Onthe weekends, they do a lot of cabaret, karaoke stuff.

What is your favorite thing to sing?

Musical stuff. It's so easy for me, and you don't want to hear this whole story, but when I got into "The Masked Singer" I put the costume on and all of a sudden I realize it's a rock eagle. I have to sing rock songs, and had to change everything. It was a big mess and I got through it. Then I got kicked off so it's fine.

You're glad that you stayed in medicine?

Yes. Medicine saved my life quite literally. I mean I woke up every day in my training thinking, oh God, I love doing this. I felt like it was so important what I was doing and I was deep in the AIDS epidemic back in the '80s, and that's what got me on radio. I wanted to talk about it, and I realized no one was talking to it, particularly not to young people about it. I was like, are you kidding? We've got to talk about this. That's what motivated me to get on the air. I thought I was doing community service for the first 10 years I was doing it. It was a one night a week thing. I was talking about medical topics, a lot of HIV and safe sex talk back then, and suddenly became a huge part of my life.

It was a taboo topic at the time and people had so many misconceptions.

It was weird. Because yes, there were loads of misconceptions, but no one was talking to young people. Literally, I was 24 years old and I was thinking, oh my God, I know what 18- to 20-year-olds are up to, we got to tell them about this. That was considered outrageous. Why would you talk to them? They're not having sex. And I thought, oh my God, we've got a problem. I was there, I was elbows deep in it. And if you weren't there administering, you're not here now. You know what I mean? You forget how horrible that was. I get chills.It was the most tragic, saddest chapters. Wonderful people are lost. They're just not here to tell the story, so really the rest of us got to kind of tell it.

Do you have fun playing a therapist in films and on TV? What kind of allowances can you make there, as opposed to working with your real patients?

What people don't understand about reality shows we put together, that was real work. That was me and my team doing what we do, period. And how they put it together and edit it, and what you see is a little distorted because people would say things like where's the treatment? It's like, yeah, no kidding. It's just the drama is all you're seeing, okay, that happens in treatment. The reality shows we did, I just took my team and we just did the work. We always do.

On this movie ["Final Kill"], I find it interesting. It's kind of like Tony Soprano, right? I'm treating a criminal essentially, or maniac, and I'm trying to understand why he's so messed up. Why is he such a disturbed patient? That's an interesting challenge to put yourself in that spot and then try to imagine what that would be like. I enjoyed it.

Yes, tell us more about your role in "Final Kill."

Think Tony Soprano and his therapist. I'm trying to get him to take medication mostly. And then you find out as the viewer why he's so stressed out. He has a pretty, pretty violent life. Pretty violent, messed-up challenge ahead of him.

How many takes did you have to do to keep a straight face with Ed Morrone screaming in your face and being so crazy?

A bunch. And he was even supposed to be crazier in the script, and I said, look, if you got crazy like that, I would call law enforcement. That's what I would do in that situation. They were like, okay, we're changing it.

In one scene, the character Mickey has a long stretch where he berates therapists, including you, in saying that you're using people and giving them medication for all sorts of purposes, including one that he thinks makes him not perform as well in bed. In your real life treatment of patients, how much of your real advice about sex is based in talk therapy versus necessary medication?

Idon't do a lot of day in, day out sex treatment in my clinic work. On the radio, many, many years of helping with that area. It ends up being talk, but I'm gravely concerned about psychotropic medications and their effect on our sexual functioning. And they can affect any stage of the sexual arousal and detumescent cycle. Doctors don't pay enough [attention]. I'm worried about hormones and their effect on that too. I'm worried about lack of hormones. On some of my streaming shows and podcasts, I will focus on those issues because people need to be informed. The doctors don't have the time, and aren't spending the time to educate them. And when a woman is put on a hormonal contraceptive, they should be given a ton of education.

I can't tell you how often it's vaginal dryness and decreased libido and no orgasm function. It's from these high-dose progesterones. By the same token, we were kidding about peri-menopause, but women are treated for depression when they should be treated for hormonal imbalances, and they leave out testosterone always. That's sexist in my opinion, because that's the "male hormone" no, it's not. It's kind of a big topic for me, proper assessment and proper education, and time spent doing that, not available as medicine is practiced today.

That's probably the case in a lot of silos of medicine, right? There's too many patients, too much of a load.

Everything is funneled up to the doctors and we don't have time to do what we'd like to do, which is build a relationship and spend time educating you. That goes to paraprofessionals and physician extenders. That's sad. It really bothers me.

We're both parents. What kind of advice do you have on raising teens today?

The biggest problem right now is screens. I think within 20 years we will think of screens the way we think of tobacco now. Screens are the source of a lot of really serious distress for young people. It's bad enough dealing with it normally without the screens. But the screens have added a layer where it's 24/7, it's raining down on them all the time. There's no escaping whatever they're trying to escape. There's mistakes that we all make during adolescence that now exist forever. There are literally crimes they could commit unknowingly. In many states, just sexting or requesting a sext, both are felonies and can affect these kids the rest of their life. And there's just a whole layer to the experience that. I have friends that are therapists and mental health professionals that just focus in this area, and they only give their kids 30 minutes a day on the screen. I don't know how you do that. It's almost impossible.

All right, so you and Adam Corolla and "Loveline." I remember those early days on MTV, which of course evolved from radio and the awkward questions in calls. What madeyou want discuss sex and addiction on air?

I'm an internist by training. I do internal medicine and that's why I was doing AIDS patients. I was struggling with that epidemic. I was there when we brought out the first AZT, and I was in the middle of all that. Then I ended up moonlighting in a psychiatric hospital and got very involved dealing with psychiatric patients, both medically and through the addiction. And what I noticed is, is eyes start to gravitate towards whatever the big problem at the time is. Like right now, to me it's homelessness. I'm deeply involved in that problem. And at the time, it was HIV and AIDS. Then that translated to sex and relationships, trauma, childhood trauma has been a massive issue for the last 30 years.

I got involved in that and the treatment of trauma, then drugs and alcohol became the problem. And so I spent 20 years running a drug and alcohol treatment center. I finished that up, started thinking about other things. And now I've been involved with the homelessness epidemic. And this corona[virus]thing has been sort of a sidebar. And by the way, if the homeless start getting corona, in Los Angeles, we're going to have a big damn problem. It's an open-air asylum. These are open-air asylums with people rotting in our streets, dying three a day in LA County. If three a day were dying of corona, people would be running down the street with their hair on fire. Because they're homeless, dying three a day and drug addicted, everyone goes, oh well. This is unconscionable.

It sounds like you tend to focus your energy on where the problem is.

Yeah, that's where I tend to go and because I've had this crazy broad experience in medicine where I did general medicine and infectious diseases and then I did a whole lot with psychiatry and drug and alcohol, I have kind of a broad experience that young physicians don't have. They don't get that training. I'm trying to use as much of it, give as much of it back as I can.

This is one of my little policies since I got involved in media. I was like, these guys know how to create media that people listen to and I'm just going to inject myself into it. That's always been my policy. If you need to go somewhere crazy, you go, I'll try to make it meaningful at the end.

And inject the medicine.

Yeah, inject some of my message. "Teen Mom" is another model of that. When they came to me with "Teen Mom," I was like, this is going to work. This is going to affect teen pregnancy in this country. I know it. Whenever you have a dramatic story with a relatable source that helps young people, attracts young people's eyes and so they could see what happens if you make certain choices, my job is just to explicate and they'll get it.

How do you yourself mitigate stress?

I noticed early on in my work at a psychiatric hospital that certain personality types and addicts were having their way with me. They could really manipulate me and get me to do, respond in the middle of the night and try to help them and do all these crazy things that always ended up in catastrophes. So I went into therapy for a long time and it's just essential. Doing your own work is just a key part of being effective in all cases. You have to be able to just be present on behalf of the patient and not let your s**t get in the way of it.

How do you define yourself in the field? Years ago the New York Times called you Gen X's answer to Dr. Ruth, with an AIDS-era pro-safe sex message.

That was then. Now again, I have this broad medical and psychiatric experience, and I'm just trying to use the media to do good. That's it. I'm a medical professional with lots of extraordinary experience, and I'm trying to inject myself into the media in places where people are watching, to try to shape things. My naive little idea back in the beginning was, oh my God radio has been such a negative influence on people's sexual behaviors and drug and alcohol and they've been encouraging all this stuff. I wonder if I climbed into that vehicle, if I could move the battleship in a better direction. That kind of idea has been with me ever since, like just shaping the culture. I may not be able to get every case we're dealing with, but there'll be somebody listening and that will kind of move things in a healthier direction, which these days is hard, hard, hard, hard.

Do you get a sort of a sense of the zeitgeist, if you will, about what people, at least in the world of addiction and sexual challenges, are looking for these days, especially with the internet?

I'm very, very concerned about the impact of pornography. We don't even know what it's doing to our brain development and I'm concerned it's doing something. Obviously it does a lot of things to our attitudes and our feelings about men and women, and what's appropriate behaviors and whatnot. And the drug and alcohol issue is completely out of control right now. We have just been through this opiate crisis and we're mostly getting the prescription opiates under control, but fentanyl is still massively a problem. Meth, massively a problem.

A publication [coming out] in a few days that shows that mutual aid societies, free services, are as effective or more than professionally managed services when abstinence is your goal. More effective than professionally managed services, and it's free. That should not be under attack, ever. Now there's an evidence basis for it, and it's been under attack and people reject it, in particular young people reject it. That's been one of the challenges lately, is they just won't engage the way previous generations have.

Why do you think that is?

I don't know. We can't figure it out. None of us can figure it out. It's literally like, "Hey, that's not for me. It's not something I can relate to." And it has something to do with the spiritual piece. Like the idea is anathema to them. It's not the God thing so much as . . . millennials really don't perceive hierarchies.

They either don't perceive them or don't like them. And lot of these communities have hierarchies. They're old timers, or people that have long periods of time there. And you're supposed to look to them for guidance and help. Alot of the millennials are just like, I don't even know what you're talking about. That was just some old person.

We're talking about narcotics anonymous, NA?

Any of the 12-steps.

What about moderation therapy?

It doesn't work, but really what you're talking about is harm avoidance, right? If you got opioid addiction, or any addiction, we would not be doing moderation therapy, we'd be waiting for abstinence. But there are people for whom that is appropriate, and for whom nothing better is likely to work. Harm avoidance and replacement therapies of all kinds need to be used, but they need to be deployed appropriately. One of the problems in my field is, we don't know which cases to select for which treatments. There tends to be enthusiasm one way or the other rather than good science. And my thing is, I use replacement where we should be using it, use abstinence where we should be, and let the science direct us, and that's it.

Visit link:
Dr. Drew is worried about the "impact of pornography" and reveals his COVID-19 fears - Salon

Definite Wellness is bringing a whole new meaning of health to residents of Tullahoma and surrounding areas. Owner Candi Kinney has been a nurse practitioner for three years. She graduated from MTSU and was previously an RN for 3 years.

When I was a nurse, I worked at a hospital. I did not like the concept that patients would come in really sick and all we would do was put a Band-Aid on them and send them home fast. I did not like the fact that some patients were so chronically ill, so I decided wellness care was a better fit for me, Kinney said. I want to make it to where patients can come in here, address the issues they have going on and we stop it from getting to that point where it becomes chronic.

The office, located inside of the Coker building, houses two exam rooms, an office, and a main room with a front desk and chair where intravenous (IV) therapy is administered.

Kinney offers eight total signature IVs including the energizer, the glow, the fighter, the quencher, the athlete, the classic, the Candi cocktail and the morning after.

People can also come in and create their own IV by looking at the menu and all that I have to offer, she said. IV add-ons include B12, Calcium, Zinc, Mag-nesium, Vitamin C, B-Complex and Glutathione for an extra charge.

She also offers injections including B-12, lipo shots, Toradol, Vitamin D and Zofran.

Benefits of wellness care

I am all about things that make and keep you well. When you come in and get a B-12 or Vitamin D shot, that is going to keep you well because when either one of those is low, it can cause a lot of problems. That is what got me started with wellness care, Kinney said.

What got me started in IVs was the interest that people have in them today. This trend is huge out west. There are IV bars everywhere and I thought This is really good for recovery, athletes, dehydration and more. It is so interesting that this is something I can do, Kinney said. I signed up for an IV hydration class and decided to start offering it.

I had a man call me the other day who was so sick and asked if I could come to his house and give him an IV. I went to his house and gave him two bags of IV fluids and he texted me the next day telling me how much better he felt, Kinney said. It is also good for athletes, especially those who are into CrossFit or running marathons. Coming here is a good way to prepare your body for that and it is also a great way to recover from them. It is replenishing.

One of my friends came in and told me that she was so stressed out and wiped and needed some help, so I gave her an IV. A few hours ago, she said she felt fantastic, she added.

These IVs are not just for running marathons. There are a lot of benefits if you are big on working out. I am a former football player, so every spring I start working out again. I was very skeptical of the IV trend, Kinneys husband and business partner Eugene said. I was telling Candi how sore I was from a workout and asked her if she had anything to help me. She gave me an IV called the athlete. After I got it, I felt okay but was not that impressed. However, the next morning I was so surprised to be up and ready to go workout again.

Athlete Jordan Sheffield receiving intravenous (IV) therapy to feel replenished.

As a person who has struggled with weight my whole life, I do not believe in easy, quick fast out there diets. I can put anyone on a low-calorie diet and give them HCG shots and they will lose weight, but it will not be sustainable, Kinney said. My patients need to have a sustainable lifestyle. I advocate a whole food diet, 30 minutes of exercise and 60 ounces of water per day. If you do that in conjunction with what I offer, it is going to get you to your goal weight. However, it is up to you to maintain it.

With weight loss, I do a couple of different things. I offer three different weight loss programs, Kinney said. I distribute phentermine here in the clinic so it is like a one-stop shop.

The first option, Tier 1, is a 12-week program that includes one visit each month with Kinney, a 30-day supply of phentermine if qualified, six bi-weekly fat-burning lipo shots and one Slim IV each month, totaling at $600.

Tier 2 is a 12-week program that includes one visit each month with Kinney, a 30-day supply of phentermine if qualified and six bi-weekly fat-burning lipo shots, totaling at $285.

Tier 3 is an a la carte program that includes monthly visits with Kinney as well as a 30-day supply of phentermine if qualified, totaling at $50.

I have had four patients now that have hit their goal weight, Kinney said. One reached hers in only four months and another met her goal weight in two to three months.

You are allowed to take phentermine for six months and then you are required to take a break. I have other medications such as Topamax because it is an appetite suppressant that you can take that for a whole year, she said.

I usually do not treat patients under the age of 18, Kinney said. If you are 16 or older and you come in with a parent, I can treat you.

Kinney has a large menu of signature IVs, wellness shots and injections.

When a customer comes in, they are instructed to fill out paperwork and Kinney reviews the forms with them. If there is no conflicting medical history or a contraindication, Kinney administers the IV the same day. There is no additional charge for coming in to receive an IV. A customer will only be charged for how much the IV costs. She also does sport, D.O.T. physicals and walk-in sick visits that do require a $75 fee.

I treat simple things like ear infections, UTIs, sore throat, flu and strep for much cheaper than an urgent care visit would be, she said.

Kinney also offers bioidentical hormone replacement therapy. This is typically for middle-aged people for replacements of estrogen, progesterone and testosterone, she said.

This is one of those shops where people need this, they just do not know that the services are here, she said.

For more information about Definite Wellness, visit http://www.definitewellness.net, their Facebook page Definite Wellness, their Instagram @definitewellness, or call 434-0439.

Definite Wellness is located at 401 Wilson Ave. in the Coker building.

Continue reading here:
Definite Wellness brings definite results | Local News - Tullahoma News and Guardian

Is your idea of getting hot and steamy taking a shower afterspin class? Join the club. Many women discover their libido is lacking,especially as they get older.

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

Thats not necessarily a problem, as long as yourecomfortable with the (in)frequency of your romantic dalliances. But it can befrustrating if you miss the intimacy that goes along with sex. And if you andyour partner have mismatched libidos, that can be a big source of relationshipstrife.

Luckily, treatments are available to rev up a sluggish sex drive, says womens health specialist Holly Thacker, MD.

There are all sorts of reasons your sex drive might have shifted into neutral. Pregnancy, breastfeeding and menopause can do a number on your hormones. Stress, illness, medications and relationship challenges can also interfere with sexual desire.

If you notice a dramatic dip in your arousal level, firstrule out any medical causes. Yes, it might feel weird talking to your doctorabout getting frisky, but medical professionals have heard it all. Your Ob/Gynor primary care doctor or womens health specialist can pinpoint problems suchas medication side effects or hormonal changes (like perimenopause) that mightbe interfering with intimacy.

Yet many women experience reduced sexual desire for no obvious reason a condition sometimes called hypoactive sexual desire disorder (HSDD). And in the last few years there has been more research and medical options for this condition. We now have some excellent options, Dr. Thacker says.

Several treatments are available to turn up a womans arousal:

This prescription pill has been available to treat HSDD since 2015. Flibanserin is taken nightly and can ramp up sex drive, says Dr. Thacker. It may cause drowsiness and shouldnt be taken within 2 hours of drinking alcohol.

The downside is it takes about 2 months for the medicationto start working. But for many women (and their satisfied partners), thetreatment is worth the wait.

This on-demand prescription medication was approved totreat HSDD in 2019. Women inject it under the skin at least 45 minutes beforethey anticipate getting frisky.

Dr. Thacker notes that as many as 40% of women experiencenausea after taking the drug. So she suggests this workaround: Take it rightbefore bed and cancel your morning meetings. Since the medication lasts 16hours, youre likely to sleep through any discomfort and can enjoy the amorouseffects when the sun comes up.

This hormone suppository can ease vaginal dryness and discomfort in postmenopausal women. Some women with low libido find it increases genital sensitivity (in a good way).

Testosterone can treat low libido in women but its not approved by the Food and Drug Administration, so this off-label use is controversial. It can cause side effects, including acne, hair loss, facial hair growth and mood changes.

Medications arent always the best way to deal with a limp libido. Sometimes, low sex drive is related to psychological issues, such as poor body image, past negative sexual experiences, trust issues or relationship problems. In those cases, it can help to work through your thoughts and feelings with a mental health professional.

And some women just need a crash course in sex education,Dr. Thacker says. Learning the ins and outs of your sexual anatomy includingthe importance of clitoral and G-spot stimulation can also improve desire,she adds. After all, if it doesnt feel good, you wont crave it.

And remember that you can have a healthy sex drive withoutbeing a seductress. Most women just arent thinking about sex that often. Theyhave a more responsive reaction to sex, Dr. Thacker says.

You dont have to be the initiator to enjoy a roll in thehay. You just have to be open to it, she adds. Its like exercise: You may notfeel like doing it, but once you start, youre usually glad you did.

Read this article:
What Help Is Available for Low Sex Drive in Women? - Health Essentials from Cleveland Clinic

In a year when the General Assembly passed sweeping LGBTQ-friendly legislation, its a relatively low-profile health bill that has opponents questioning whether the state is going too far in its protections for transgender Virginians.

The Senate Commerce and Labor committee voted 12-2 on Monday to report a bill from Del. Danica Roem, D-Manassas, that would ban health insurance companies from denying or limiting coverage based on a patients gender identity or transgender status. The legislation, which passed the House 54-41, is expected to clear the Senate in a similarly party-line vote.

The bill codifies federal protections first established under the Affordable Care Act. In 2016, the Department of Health and Human Services issued final regulations clarifying that the law would extend nondiscrimination protections to patients on the basis of race, color, national origin, sex, age, or disability. While the federal government has never clarified that sex discrimination includes disparate treatment based on sexual orientation or transgender status (the subject of an ongoing Supreme Court case), the regulations make it clear that the federal Office for Civil Rights would consider gender identity when evaluating discrimination complaints from patients.

Since then, health insurance carriers have covered treatment thats consistent with a patients gender identity, said Doug Gray, executive director for the Virginia Association of Health Plans. That can include hormone therapy for a patient experiencing gender dysphoria the diagnostic term for someone whose gender identity doesnt align with their sex assigned at birth.

Patients dictate the extent of their treatment, but current medical standards include hormones or gender reassignment surgery. Numerous research papers, including a 2018 study on transgender veterans, have found that the treatments can significantly improve mental health outcomes and reduce the risk of suicide.

Roems bill would require carriers to cover those treatments and other medically necessary transition-related care, including mental health services. It would also ban plans from denying coverage based on a patients transgender status or imposing extra fees.

Even post-2017, transgender people are given misinformation about what these policies actually are, said Roem, Virginias first openly transgender lawmaker. Supporters of the bill, including Gray, argue the policy simply codifies federal protections to ensure theyre applied equally to Virginia patients.

But shifting federal guidelines and inconsistent application of the regulations have led opponents to argue that the bill goes farther than other LGBTQ protections by mandating coverage for transition-related medical services. In his testimony against the bill, Jeff Caruso, founding director of the Virginia Catholic Conference, likened the legislation to the 2014 Hobby Lobby case when a Christian-run craft store chain successfully challenged the contraception coverage requirement imposed by the Affordable Care Act.

Due to the tenets of our faith, the health plans of the two dioceses I represent do not cover gender-transition surgeries, he said in an email Tuesday.

Our understanding of the human person is that one has an innate sexual identity that is reflected in the persons biology, he added. Gender reassignment surgeries do not align with this understanding.

Caruso argued that the bill should include a religious exemption, while Josh Hetzler, legislative counsel for the Christian-affiliated Family Foundation of Virginia, opposed the bill entirely.

Were creating a new category of personhood, he argued in his testimony against the bill on Monday. Family Foundation President Victoria Cobb added that the bill set a new precedent by defining gender identity as an internal sense of gender that could include male, female, neither, or a combination of the two.

How can anyone know how to provide medical direction to someone who claims they are an unknown combination of male and female?, she wrote in an email on Tuesday. Why should the insurance company bear the liability to cover unexplored areas of medicine?

Their arguments gained little traction with members of the Senate committee, including Chairman Dick Saslaw, D-Fairfax, who sharply reminded Caruso that the Hobby Lobby ruling was narrowly tailored to apply to contraceptives. Sen. Lionell Spruill, D-Chesapeake who visibly rolled his eyes during the opposing testimony strongly implied that Catholic Church should refrain from criticizing anything on moral grounds in light of the ongoing sexual abuse scandals that have embroiled the church for years.

One church should be the last to say that kind of stuff, given whats going on, he said during Mondays meeting.

They garnered even less sympathy from Roem herself, who said she was unwilling to explicitly deny care for transgender patients under Virginia laws. Advocates argue that the law is especially important given proposed revisions to federal protections, which could roll back nondiscrimination mandates on the basis of sexual identity.

Even with the ACA requirements, health care plans often fail to cover services for transgender patients, said Afton Bradley, care coordination manager for the Virginia League of Planned Parenthoods transgender health care services division.

Afton said roughly a third of VLPPs hormone clinic patients, among those with insurance, were denied coverage by their insurance carriers. Sometimes the denials are based on administrative errors, such as a health plan flagging a prostate exam administered to a patient who identified as female. But Afton said insurers often made it difficult to correct the error during the appeals process, or ended up denying the claim after several weeks of back-and-forth.

Unfortunately, that leads to a lot of our patients paying out of pocket or going without medication, Afton said. And we know that when patients dont have access to transition care, there are serious consequences to their health.

Read the rest here:
Over the objections of religious groups, Virginia is poised to mandate nondiscriminatory care for transgender patients - Virginia Mercury

When I last droned on about car insurance, you may recall I was on the verge of biting the bullet and staying with my current insurer, even though they'd hiked the premium by eight per cent. Instead, I phoned them. The upshot was that they increased my annual mileage allowance by 2,000 miles, extended my policy to cover driving other cars and raised my premium by just 1 a year. Go on, haggle.

Did anybody not see this coming? A 23-year-old started life as a girl, transitioned through surgery and medication to become a man and now, having abandoned hormone treatment, identifies as a woman. She is suing the NHS clinic responsible on the grounds that, as a teenager, she was not challenged enough about her desire to become male. Her lawyers will tell the court that children such as she was cannot give informed consent for such procedures. The clinic says it welcomes this legal examination to clarify things. And so should we all.

Until now, anyone daring to question gender-transition, including medical staff, has been denounced as transphobic by the small but noisy trans-activist lobby. This stifling of dissent may explain why hundreds of young transgender people are now seeking help to return to their original sex. They have been through hell. As this column noted on October 7 last year, While these cases are individual tragedies, the financial outlook for the NHS is terrifying. Five or ten years from now, how many sad transitioned young people will be suing the Department of Health for wrongly advising and treating them?

I got the time-scale wrong. This ethical and financial nightmare is right here, right now and you and I and every other tax payer must foot the bill. (If you resent paying you are, of course, transphobic).

Meanwhile, coronavirus marches on. I am aware, thanks, that it is no laughing matter but doesn't it make you smile just a bit to see a nation preparing to mark the 75th anniversary of VE-Day and to celebrate the courage, resilience, self-sacrifice and community spirit of the wartime generation, while frantically stripping supermarket shelves of tinned food and antiseptic gel?

On the other hand, the wartime generation wasn't composed entirely of angels. I was once researching a book and ploughing through hundreds of back issues of local and national newspapers from 1939-45. I was amazed how many court and tribunal cases involved soldiers deserting from their barracks, civilians refusing to do war work in city factories, publicans watering the booze and plucky Brits fiddling the rations on an industrial scale. The nation that produced heroes like George Mainwaring also produced plenty of spivs like Private Walker.

And if you don't recognise Captain Mainwaring as a hero, then you don't know your Dad's Army.

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Peter Rhodes on panic-buying, gender-changing and the not-so-noble side of the Home Front - expressandstar.com

CHARLOTTE, N.C. On Sunday, March 8, we "spring ahead" by changing our clocks forward one hour for Daylight Saving Time.

But can one hour of lost sleep really impact how we feel? As it turns out, yes, especially if you already struggle to fall asleep at night. Luckily, there are some things experts say you can do to prevent feeling sluggish in the days after the bi-annual time change.

Dr. Harneet Walia of the Cleveland Clinic says people who struggle to get a good night's sleep will feel it the most.

"We, as a society, are already sleep-deprived," Dr. Walia said. "A normal person requires at least seven to eight hours of sleep on a daily basis, and we know that the majority of us don't get that much amount of sleep."

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Luckily, the time change doesn't come as a surprise, so there are things you can do ahead of time to minimize its impact.

"We recommend a few days earlier than the time change is supposed to occur, start going to bed 15 to 30 minutes earlier than your usual time," Dr. Walia said. "That way, your body will adapt, slowly, but surely, when that time change occurs."

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For a good night's sleep, it's best to keep the room dark and avoid looking at devices. Blue light from screens can suppress melatonin, a hormone that regulates sleep. If you're still dragging in the morning, sunshine and caffeine may help.

"We tell people to expose themselves to bright light in the morning. Sunlight is a great thing," Dr. Walia said. "If they're feeling sluggish, caffeine is okay for that day, but not later during the day, because that can then impair their sleep during the nighttime."

Daylight Saving Time officially begins in the Carolinas at 2 a.m. on Sunday, March 8. We will "fall back" to Standard Time on Sunday, November 1.

Read this article:
'Sunlight is a great thing:' Doctor explains how to get over Daylight Saving Time sluggishness - WCNC.com

A 17-year-old trans girl has spoken out about the heartbreaking impact of being forced to go through male puberty because she wasnt given access to puberty blockers.

Sonja, a college student in the West Midlands, told the ithat missing out on puberty blockers left her feeling self-conscious, uncomfortable, on the verge of self-harming, suffering from regular panic attacks and struggling to sleep.

I know theres a lot of debate at the moment about hormone blockers and regret but nobody is listening to people like me, Sonja said.

I cant put into words how much I regret nothaving access to blockers and hormones.

Theyre a necessary requirement for me to comfortably live my truth and the fact that Im still not being given that opportunity has such a negative impact on my psychological well-being.

Puberty blockers have been in the news for the past week, since the UKs High Court finally granted permission for a judicial review into whether young transgender people are able to give informed consent to the treatment.

The medication is prescribed to trans teens by specialist gender doctors at the NHSs gender clinic for under 18s, GIDS.

The legal challenge is an attempt to force trans teens to go before a judge before being given medical treatment by doctors.

I think it is important for there to be a judicial review in any system, Sonja said. I do think there are parts that need to be reviewed, like waiting list times.

But the idea being lodged that a person is rushed into taking the blockers and transitioning seems to me a rare occurrence.

I know an exhaustive amount of people who have gone through the system at GIDS.

They wont even approach the issue of puberty blockers until they address a patients preexisting mental health conditions first, and make sure they are making the right decision in a mentally sound state.

Sonja was put on the waiting list for GIDS in November 2017, but two years later was told she was being taken off the waiting list because she wouldnt be seen before her 18th birthday.

In the time she spent waiting for an appointment at GIDS, Sonja went through male puberty and its irreversible effects, which means shell have to undergo invasive surgery to minimise.

The idea of puberty blockers is to halt the natural progression of biological puberty, stop the effects, at least halt the effects of [testosterone] on the body, the enlargement of the Adams apple, the change in muscle density, overall bone structure, and bone growth, she says.

The blockers are taken to pause the onset of puberty while a person contemplates whether or not they want to transition. It means that if they do, they wont have to undergo invasive surgery to remove those characteristics brought about by biological puberty.

Ive had to come to terms with the fact that part of my transition will require significant amount of surgeries, invasive and not. Because the blockers wont put a pause on my puberty, I will enter adulthood tasked with feminising my male characteristics.

To alter from just my neck upwards, theres probably around five facial feminisation surgeries, including the reduction of my jawline, rhinoplasty, and a tracheal shave to reduce the size of my Adams apple. Those surgeries are specifically to remove the effects that male puberty has had on my body.

Mermaids, the charity working with young transgender and gender-diverse people that supports Sonja, has said it may apply to intervene in the High Court case on behalf of the young people it supports.

The Tavistock and Portman NHS Trust, which GIDS falls under, said: We welcome the opportunity to make the case for the quality of care the service provides in a thorough and nuanced way. Our work in GIDS is provided in accordance with best practice and relevant national and international specifications and guidelines.

We are disturbed by the level of misinformation in relation to the support provided to these young people. The often-toxic debate around the topic has caused considerable distress to patients and families. We hope the hearing will serve to set the record straight and put centre-stage the voice and interests of young people living with gender dysphoria.

Read the original post:
Trans teen who waited three years for puberty blockers reveals devastating impact of being denied the treatment - PinkNews

Aesthetic treatments have become increasingly popular among Irish women; not because they make you look radically different, but for their ability to make you look like the best version of yourself.

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Internationally renowned Claudia McGloin, a registered nurse with dual nursing registration in both the UK and Ireland, is the clinical director and owner of The New You Clinic, a multi-award-winning business in Sligo.

The clinic has gone from strength to strength over the past eight years to become one of Irelands most recognised and trusted medical aesthetic clinics. Due to growth and demand, the clinic has recently rebranded to include Womens Health to address hormone health and the menopause. The New You Clinic also owns the franchise for Motivation Weight Management.

The clinic offers a variety of medical aesthetic procedures including: Claudia Rejuvula Vagina Rejuvenation - a procedure that Claudia co-created to help women suffering with menopause, stress incontinence and sexual dysfunction. Currently, this is only available at The New You Clinic.

In addition, Claudia also has her own skincare brand called New You which currently has 13 products in the range, as well as four Bespoke Medical Facials.

Being a featured writer for the Journal of Aesthetic Nursing, Claudia is also regularly featured in the media. She is passionate about Patient safety and is highly involved in educating the public and highlighting issues regarding the lack of regulation within the Aesthetic Medicine sector.

The New You Clinic was recently awarded Commended Best Clinic Ireland and a full list of medical procedures and information can be found on the clinic website.

The New You Clinic, First Floor Millennium House, Stephen Street, Sligo

Ph: 0719140728

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Irelands Leading Aesthetic & Skincare Clinics: The New You Clinic - RSVP Live

Rep. Brad Daw, R-Orem, said he will not run a bill this legislative session banning transgender hormone therapy and surgery for minors. He has opted instead to run legislation to study puberty blocking drugs.

The replacement bill directs the Health Department to commission a review of scientific research on the effects of puberty blocking drugs. Some lawmakers had told Daw they needed more clarity on the effects of the drugs before they would support a bill banning them, according to Daw.

He said he also heard concerns from parents who told him their kids needed the drugs to treat their gender dysphoria and avoid serious mental health issues.

If they look at what the potential side effects are, and what theyre potentially buying in to, they may decide, you know what, I can wait, Daw said. It's giving them information to make a better decision.

The drugs dont cause a permanent change to someones body, but instead pauses puberty, providing time to determine if a child's gender identity is long lasting, according to the Mayo Clinic. Side effects may include weight gain, headaches and fertility issues.

Daw said right now he has no plans to introduce a bill to banhormone therapy or surgery, as he had originally intended, and wants to gather more information before he makes a decision.

If we need to take the next step, we will, Daw said.

While Equality Utah executive director Troy Williams is glad that Daw has abandoned his original bill, hes worried that the results of the review would be skewed.

We need more than one doctor reviewing the literature, Williams said, adding that the people reviewing the scientific literature should have experience in transgender-related health care. We also need to look at not just the side effects of medication, but also benefits of medication.

And though hes advocating for those changes to the bill, Williams hopes it never sees a committee hearing.

No transgender youth who's struggling with their care and navigating school needs to hear a bunch of bunk and transphobic rhetoric spewed at the Utah state Capitol, Williams said. That's not good for their mental health This is really about trying to intimidate and create fear in within the transgender community.

Sonja Hutson covers politics for KUER. Follow her on Twitter @SonjaHutson

The rest is here:
Utah Lawmaker Won't Introduce Legislation To Ban Transgender Hormone Therapy For Minors This Session - KUER 90.1

In the mid-2000s, Dr. Nadine Burke Harris opened a children's medical clinic in the Bayview section of San Francisco, one of the city's poorest neighborhoods. She quickly began to suspect something was making many of her young patients sick.

She noticed the first clues in the unusually large population of kids referred to her clinic for symptoms associated with attention deficit hyperactivity disorderan inability to focus, impulsivity, extreme restlessness. Burke Harris was struck not just by the sheer number of ADHD referrals, but also by how many of the patients had additional health problems. One child arrived in her clinic with eczema and asthma and was in the 50th percentile of height for a 4-year-old. He was 7. There were kindergarteners with hair falling out, two children with extremely rare cases of autoimmune hepatitis, middle-school kids stricken with depression and an epidemic number of kids with behavioral problems and asthma.

Burke Harris noticed something else unusual about these children. Whenever she asked their parents or caregivers to tell her about conditions at home, she almost invariably uncovered a major life disruption or trauma. One child had been sexually abused by a tenant, she recalls. Another had witnessed an attempted murder. Many children came from homes struggling with the incarceration or death of a parent, or reported acrimonious divorces. Some caregivers denied there were any problems at all, but had arrived at the appointment high on drugs.

Although none of her mentors at medical school back in the early 2000s had suggested that stress could cause seemingly unrelated physical illnesses, what she was seeing in the clinic was so consistentand would eventually so alarm herit sent her scrambling for answers.

"If I were a doctor, and I was seeing incredibly high rates of autism, I'd be doing research on autism," she says. "Or if I saw incredibly high rates of certain types of cancer, I'd be doing that research. What I was seeing was incredibly, incredibly high rates of kids who were experiencing adversity and then having really significant health outcomes, whether it was difficulty learning, or asthma, or weird autoimmune diseases. I was seeing that the rates were highest in my kids who were experiencing adversity. And that drove me to the latest scientific literature."

What Burke Harris found there would eventually thrust her to the forefront of a growing movement that aims to transform the way the medical profession handles childhood adversity. Childhood stress can be as toxic and detrimental to the development of the brain and body as eating lead paint chips off the wall or drinking it in the waterand should be screened for and dealt with in similar ways, in Burke Harris' view. As California's first Surgeon General, a newly created position, she is focusing on getting lawmakers and the public to act.

Earlier this year, thanks in part to her advocacy, California allocated more than $105 million to promote screening for "Adverse Childhood Experiences" (ACEs)10 family stressors, first identified in the late 1990s, that can elicit a "toxic stress response," a biological cascade driven by the stress hormone cortisol that is linked to a wide range of health problems later in life.

In recent years, epidemiologists, neuroscientists and molecular biologists have produced evidence that early childhood experiences, if sufficiently traumatic, can flip biological switches that can profoundly affect the architecture of the developing brain and long-term physical and emotional health. These "epigenetic" changesmolecular-level processes that turn genes on and offnot only make some people more likely to self-medicate using nicotine, drugs or alcohol and render them more susceptible to suicide and mental illness later in life. They can impair immune system function and predispose us to deadly diseases including heart diseases, cancer, dementia and many others, decades later. Not only does childhood stress harm the children themselves, but the effects may also be passed down to future generations.

A groundswell of support has arisen in the world of public health in favor of treating childhood adversity as a public health crisis that requires interventiona crisis that seems to run in families and repeat itself in trans-generational cycles. At last count, at least 25 states and the District of Columbia had passed statutes or resolutions that refer to Adverse Childhood Experiences. Since 2011, more than 60 state statutes aimed at ACEs or intervening to mitigate their effects have been enacted into law, according ACEs Connection, a website devoted to tracking the phenomenon and providing resources. California's effort is among the most aggressive. The state has set aside $50 million for next year to train doctors to provide screening, and $45 million to begin reimbursing doctors in the state's MediCal program for doing so ($29 for each screening). If it proves effective, other states may soon follow.

"The social determinants of health are to the 21st century, what infectious disease was to the 20th century," says Burke Harris. She rose to national prominence after writing a 2018 book on the subject, embarking on a national book tour and recording a TED Talk that has been viewed more than 6 million times. She was tapped for her new post by Governor Gavin Newsom in January 2019.

The research is so fresh that many clinicians are still debating the best way to tackle the problem, most significantly whether the science is mature and the interventions effective enough to implement universal screening. And the details of California's approach to screening are controversial in the world of public health. (The epidemiologist who developed a key questionnaire being used as a screening tool says it was never intended to be used to evaluate individuals.) But there is broad consensus, at least, about one thing. For all the buzz in public health and policy circles about "ACEs," few people have heard the term before. The first task, many people on the front lines of health education agree, will be to change that so that caregivers themselves can learn about the vicious cycle of childhood adversity, and get the help they need to break it.

The Science of Toxic StressThe research on ACE stems from a seminal 17,000-person epidemiological study published in 1998. The first clue came years earlier, however, with the plight of an obese, 29-year-old woman from San Diego named Patty.

Over the course of a 52-week trial of a weight-loss diet, Patty dropped from 408 lbs. all the way down to 132. Then, over a single three-week period, she abruptly gained 37 pounds of it backa feat that her doctors didn't even know was scientifically possible.

Patty's dramatic weight swings got the attention of Vincent Felitti, the head of the preventative medicine program at the massive managed care consortium Kaiser Permanente, and the man who had designed the obesity study. Felitti had been astounded at the rapid pace with which the study subjects lost weight. "In the early days of the obesity study, I remember thinking 'wow, we've got this problem licked,'" Felitti recalls. "This is going to be a world-famous department!"

Then, for reasons nobody could explain, patients began dropping out of the program in droves. Felitti found it particularly alarming because the ones leaving the fastest seemed to be the ones losing the most weight. When Felitti heard about Patty, he arranged a chat. Patty claimed she was just as mystified by her massive weight gain as he was; she assured him she was still vigilantly sticking to the diet. But then she offered up a suggestive clue: Every night when she went to bed, she told Felitti, the kitchen was clean. Yet when she woke up, there were boxes and cans open and dirty dishes in the sink. Patty lived alone and had a history of sleepwalking. Was it possible, she wondered, that she was "sleep eating?"

When Felitti asked her if anything unusual had happened in her life around the time the dirty pots and pans began to appear, one event came to mind. An older, married man at work had told her she looked great and suggested they have an affair. After further questioning, Felitti learned Patty had first started gaining weight at age 10, around the time her grandfather began sexually molesting her.

Felitti came to believe that for Patty, obesity was an adaptive mechanism: she overate as a defense against predatory men. Felitti began asking other relapsing study participants if they had a history of sexual abuse. He was shocked by their answers. Eventually, more than 50 percent of his 300 patients would admit to such a history.

"Initially I thought, 'Oh, no, I must be doing something wrong. With numbers like this, people would know if this were true. Somebody would have told me in medical school,'" he recalls.

Felitti started bringing patients together in groups to talk about their secrets, their fears and the challenges they facedand their weight loss began to stick. Within a couple years, the program was so successful that Felitti was receiving regular invitations to speak about his program to medical audiences. Whenever he brought up sexual abuse and its apparent link to obesity, however, audience members would "storm explosively" out of the room or stand up to argue with him, he says. Nobody, it seemed, wanted to hear what he had to say.

At least one person was intrigued by his findings. Robert Anda, a researcher at U.S. Centers for Disease Control (CDC), had been studying chronic diseases and the counterintuitive links between depression, hope and heart attacks. He knew firsthand what it was like to deal with colleagues who considered his work flaky. Anda and Felitti got to talking. They realized there was only one way that both of them would be able to overcome the skepticism they were encountering: they needed to do a rigorous study. At Anda's urging, Felitti agreed not just to recruit a larger sample but to expand its scope to examine the link between a wide array of common childhood stressors and health later in life.

This became the ground-breaking "ACE Study," a 17,000-person retrospective project aimed at examining the relationship between childhood exposure to emotional, physical and sexual abuse and household dysfunction, and risky behaviors and disease in adulthood. Starting in 1998, and continuing with follow-ups well into the 2000s, Felitti and Anda's team published a series of counterintuitive papers that upended much of what we thought we knew about the mind-body connection.

To gather the data, Felitti persuaded Kaiser Permanente-affiliated doctors to recruit patients in Southern California undergoing routine physical exams. The patients were asked to complete confidential surveys detailing both their current health status and behaviors, and the types of adversity they've endured: physical, emotional and sexual abuse, neglect, domestic violence, parental incarceration, separation or divorce, family mental illness, the early death of a parent, alcoholism and drug abuse. To analyze the data, the researchers added up the number of ACEs, calculated an "ACE score," then correlated those scores with high-risk behaviors and diseases to see if they could find any patterns.

The first shocker was just how common these ACEs were. More than half of those participating had at least one, a quarter had two or more and roughly 6 percent reported four or more. This was not just a problem of the poor. Childhood emotional adversity cut across all racial, ethnic and economic lines. Even more surprising was the impact of these stressors later in life. When the researchers ran their analysis, they discovered a direct, dose-dependent link between the number of ACEs and behavioral issues like alcoholism, smoking and promiscuitythose who had experienced four or more categories of childhood exposure had a four- to 12-fold increased risk of alcoholism, drug abuse, depression and suicide attempts.

The results went beyond these common trauma-related health risks. The study also linked childhood trauma to a host of seemingly unrelated physical problems, including ischemic heart disease, cancer, chronic lung disease, skeletal fractures and liver disease.

What made the study so shocking was that the data suggested that even those who didn't drink, use drugs or act out in risky ways still had a far higher rate of developing ischemic heart disease, cancer, chronic lung disease, skeletal fractures and liver disease. Unexpectedly, the researchers had discovered that childhood adversity seemed to be an independent risk factor for some of the leading causes of death decades later.

"We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults," the authors wrote.

The study dropped like a bomb in the world of public health. But the scientific work was just beginning. In the years since, scores of researchers have begun to dig into the biological mechanisms in play. And with emerging brain scanning technologies and advances in molecular biology, an explanation for the ACE study has begun to emerge. Some clinicians and scientists have begun to turn these findings into concrete interventions and treatments they hope can be used to reverse or at least attenuate the impact.

Much of the research has focused on how ACEs affect the functioning of the hypothalamic-pituitary-adrenal (HPA) axis, a biological system that plays a key role in the mind-body connection. The HPA axis controls our reactions to stress and is crucial in regulating an array of important body processes including immune function, energy storage and expenditureeven our experience of emotions and mood. It does so by adjusting the release of key hormones, most notably cortisol, the release of which is increased by stress or low blood sugar levels.

Cortisol has many functions. On a daily basis, it regulates the level of energy we have as the day progresses: we generally experience our highest levels of cortisol, and energy, upon waking up. These levels gradually diminish throughout the day, reaching very low levels just prior to bedtime.

Cortisol also serves a role in the body's energy allocation during times of crisis. When all is calm, the body builds muscle or bone and socks away excess calories for future consumption as fat, performs cellular regeneration and keeps its immune system strong to fight infection. In the case of a child, the body fuels normal mental and physical development.

In an emergency, however, all these processes get put on hold. The HPA axis floods the bloodstream with adrenaline and cortisol, which signals the body to kick into overdrive immediately. Blood sugar levels spike and the heart pumps harder to provide a fast boost in fuel. If an 11-foot-tall grizzly bear is lumbering in your direction and licking his chops, the additional burst of energy helps you run screaming through the woods or wrestle the critter to the ground and plunge a Bowie knife into its heart.

However, when the emergency goes on for a long timeperhaps over an entire childhood of abusethe resulting high levels of cortisol take a big and lasting toll.

Almost as soon as the ACE study was published, dysregulated cortisol levels seemed a likely culprit to explain the study's startling implications. Was it possible that the chronic stressors identified by Felitti and Anda led to elevated cortisol levels in children? And could those elevated levels account for seemingly unrelated diseases and the range of additional problems that researchers were beginning to link to ACEs?

In the decade after the 1998 ACE study, researchers began seeking out children in Romanian orphanages and measuring cortisol levels, in the hopes of verifying this hypothesis. When researchers began to compare their levels to that of children who had not faced adversity, they found substantial differences. But the results were difficult to interpret.

"There was growing evidence that there was an impact, but the studies were contradictory," says Jackie Bruce, a research scientist at the Oregon Social Learning Center, an NIH-funded research center in Eugene that studies child development. "Sometimes people were finding kids with early adversity had low cortisol and sometimes they were finding they had high cortisol."

In 2009, Bruce and her colleagues demonstrated a possible explanation for the discrepancies. Since morning cortisol levels play such an important role in getting well-functioning individuals ready for the day, they sought out a group of 117 maltreated 3- to 6-year-old children transitioning into new foster care placements in the United States. The researchers then trained the children's caregivers to collect saliva samples before breakfast. For comparison, they recruited a control group of 60 low-income children living with their biological parents who had no previous record of abuse or maltreatment.

Children who had experienced more severe emotional, physical and sexual maltreatment did indeed have abnormally high morning cortisol levels. But scientists also found that children who experienced more severe neglect had abnormally low morning cortisol levels. Different types of adversity, in other words, had different impacts on the HPA system. But whether the adversity took the form of an absence of stimulation or the presence of negative, threatening stimulation, the effect was bad for normal development.

"Low cortisol levels, particularly in the morning, had been linked to externalizing disordersthings like delinquency and alcohol usewhereas high cortisol levels have been linked to more anxiety and depression," and post-traumatic stress disorder, Bruce says.

Even so, Bruce and her colleagues noted that within both groups, "some kids are doing really well, some kids are not doing well." This suggested other factors were also involved. And in recent years, much of the research has focused on understanding the complex interaction between external stressors, genetics and interpersonal interventions.

One of the most important findings to emerge recently is that the experience of childhood adversity, by itself, does not appear to be enough to lead to toxic stress. Genetic predispositions play a role. But even among those predisposed, the effects can be blunted by what researchers call emotional "buffering"a response from a loving, supportive caregiver that comforts the child, restores a sense of safety and allows cortisol levels to fall back down to normal. Some research suggests that this buffering works in part because a good hugor even soft reassuring words from a caregivercan cause the body to release the hormone oxytocin, sometimes referred to as the "cuddle" or "love" hormone.

One of the reasons the ACE study was so effective at highlighting the potential long-term health effects that early childhood adversity can have on health, says Burke Harris, was the nature of the stressors measured. The stressors took place within the context of a family situation that often reflected the failure of a caregiver to intervene as a needed protector.

"The items that are on the ACE screening have this amazing combination of being high stress and also simultaneously taking out the buffering protected mechanisms," Burke Harris says. "If you're being regularly abused, often it's partially because your parents are not intervening."

This hypothesis is supported by experiments in rodents. Back in the 1950s, the psychiatrist Seymour Levine demonstrated that baby rats taken away from their mothers for 15 minutes each day grew up to be less nervous and produce less cortisol than their counterparts. The reason, he suggested, was due to affection from their distressed parent in the form of extra licking and grooming. Studies in the 1990s confirmed that the extra affection and comfort offered by the affectionate parents seemed to have flipped biological "epigenetic" switches that caused their offspring to internalize the sense of safety that had been provided and replicate it biochemically as adults.

Scientists have since documented many biochemical mechanisms by which emotional buffering can help inoculate children exposed to adversity to long-term consequences, and how chronic overactivation of the HPA axis can interfere with developmentor, as one widely cited scientific paper put it, can have an impact akin to "changing the course of a rocket at the moment of takeoff." Neglected and abused Romanian orphans were shown to have smaller brains as a population than those placed in loving foster homes, suggesting a lack of stimulation interfered with normal neuronal growth. Adversity and stress without adequate buffering can turn on genes that flood the system with enzymes that prime the body to respond to further stress by making it easier to produce adrenaline and reactivate the fight-or-flight response quickly, which can make it harder for children with toxic stress to control their emotions.

Toxic stress can also have powerful influences on the developing immune system. Too much cortisol suppresses immunity and increases the chance of infection, while too little cortisol can cause an inflammatory immune response to persist long after it is needed. That can act directly on the brain to produce "sickness behavior," characterized by a lack of appetite, fatigue, social withdrawal, depressed mood, irritability and poor cognitive functioning, according to a 2013 review paper aimed at bringing pediatricians up to speed on the emerging science. As adults, children maltreated during childhood are more likely to have elevated inflammatory markers and a greater inflammatory response to stress, the researchers reported. Chronic elevations in cortisol have also been linked to hypertension, insulin resistance, obesity, type 2 diabetes and cardiovascular disease.

In recent years, Fellitti and Anda's original 1998 paper has been cited more than 10,000 times in further studies. And as awareness in the public health community has risen, so too has the amount of data available to work with, and the vast body of research documenting the far-reaching consequences of ACEs. Last fall, the CDC analyzed data from 25 states collected between 2015 and 2017, and more than 144,000 adults (a sample 8.5 times larger than the original 1998 study). The authors noted that ACEs are associated with at least five of the top 10 leading causes of death; that preventing ACEs could potentially reduce chronic diseases, risky health behaviors and socioeconomic challenges later in life and have a positive impact on education and employment levels. Reducing ACEs could prevent 21 million cases of depression; 1.9 million cases of heart disease; and 2.5 million cases of obesity, the authors said.

Hundreds of new studies are published every year. In just the last month, studies have come out analyzing the "mediating role of ACEs in attempted suicides among adolescents in military families," the impact of ACEs on aging and on "deviant and altruistic behavior during emerging adulthood."

How to Save the KidsWhile these findings help explain the link to chronic diseases, Harris Burke and other public health officials believe they also provide the basis for some of the most promising interventions in the clinic today. Not surprisingly given her background, Burke Harris looks to pediatric caregivers and other doctors to lead the effort to detect and treat patients suffering from toxic stress. To help them do it, late last year, California released a clinical "algorithm": basically a chart spelling out how doctors should proceed once they compiled a patient's ACE score.

Patients are found to be high-risk for negative health outcomes if the doctor, using a questionnaire, can identify four or more of the adverse childhood experiences or some combination of psychological, social or physical conditions found in studies to be associated with toxic stress. For children, that's obesity, failure-to-thrive syndrome and asthma, but also other indicators such as drug or alcohol use prior to the age of 14, high-school absenteeism and other social problems. For adults, the list includes suicide attempts, memory impairment, hepatitis, cancer and other conditions found to be higher in populations with high ACE scores.

Doctors are encouraged to educate all patients about ACEs and toxic stress regardless of their ACE scores. For patients found to be at intermediate or high risk, additional steps are recommended. The first step in the case of children is to make sure parents or caregivers understand the links ACEs can have to adverse health outcomes. That way, they can be on the lookout for new conditions and take action to prevent them.

Key to this educational process is making sure caregivers understand the protective role buffering can play in countering the corrosive effects of stress. Buffering includes nurturing caregiving, but it can include simple steps like focusing on maintaining proper sleep, exercise and nutrition. Mindfulness training, mental health services and an emphasis on developing healthy relationships are other interventions that Burke Harris says can help combat the stress response.

The specifics will vary on a case-by-case basis, and will rely on the judgment and creativity of the doctor to help adult caregivers design a plan to protect the childand to help both those caregivers and high-risk adults receive social support services and interventions when necessary. In the months ahead, the protocols and interventions will be further refined and expanded. "Most of our interventions are essentially reducing stress hormones, and ultimately changing our environment," says Burke Harris. "But some of the things that I think are really exciting are on the horizon."

In recent years researchers have begun to explore whether the "love drug," oxytocina hormone released when a parent hugs a child might form the basis for potent pharmaceutical interventions. For now, however, "we're on the scientific frontier," she says.

The relatively young state of the science and the fuzziness and subjective nature of the tools California plans to use to evaluate the threat have alarmed some public-health experts. They worry that the state is moving too fast, before more is known about the science of toxic stress. Robert Anda, for one, is uncomfortable with the use of screening tools that rely on an ACE score. He worries it might be misused in the doctor's office because it doesn't measure caregiver buffering or genetic predispositions that might prove protective. The questionnaire he and Felitti developed for the original study was always meant to be a blunt instrumentsuited for a survey of a huge population of patients. The problem with applying it to individual patients, he says, is that it doesn't take into account the severity of the stressor. Who's to say, for instance, that someone with an ACE score of one who was beaten by a caregiver every day of their life is less prone to disease than someone with an ACE score of four who experienced these stressors only intermittently? On a population level, surveying thousands, the outliers would cancel each other out. But on the individual level they could be misleading.

It's a concern echoed by others. "I think the concept behind ACE screening, if it's about sensitizing all of us to the importance of looking for that part of the population that's experiencing adversity, I'd say that's good," says Jack Shonkoff, a professor of child health and development who directs the Center on the Developing Child at Harvard University. "But if it's used as an individual diagnostic test or indicator child by child, I would say that's potentially dangerous in terms of inappropriate labeling or inappropriate alarm. We need to make sure that people don't misuse this information so that parents don't feel like they've just been given some kind of deterministic diagnosis. Because it's not that. It's also dangerous to totally give a clean bill of health for a kid who may be showing symptoms of stress."

Burke Harris notes that she has been using ACE scores as part of her clinical care for more than a decade. When used correctly, it is only one part of a larger screening process. And she points out that despite the early phase of the field, the stakes are too high to wait any longer. "This is extremely urgent," she says. "It's a public health crisis. We have enough research now to act. And once we have enough research to act, not acting becomes an unconscionable path."

In the years ahead, more precise methods of detection will likely be available. Harvard's Shonkoff recently completed a large, nationwide feasibility study aimed at developing and rolling out a saliva test which could be used to screen for biomarkers that indicate a toxic stress response in both children and adults. The test, developed as part of a six-year, $13 million grant, measures the level of inflammatory cytokines present in the spit sample. Shonkoff and his colleagues are in the process of taking the next step, which involves gathering enough data to develop benchmarks that indicate normal and abnormal levels for stress markers by age, sex, race and ethnicity.

Even the cautious agree a little education will go a long way. "The most important fundamental prevention idea is that people who are caring for children, who are parenting children, need to understand that childhood adversities are likely leading to issues in their own lives," Shonkoff says. "And if they don't find a way to do things differently with support, they will be embedding that same biology back in their children."

Originally posted here:
Yes, Stress Really Is Making You Sick - Newsweek

News'Missing out on hormone blockers has made me feel self-conscious and uncomfortable in my testosterone-filled body'

Tuesday, 3rd March 2020, 11:50 am

Sonja is a 17-year-old college student in the West Midlands. She is a transgender teenager, and has been on the NHS Gender and Identity Development Service (GIDS) patient waiting list since November 2017. Here, she shares how she feels after discovering she will not be given puberty blockers, also known as hormone blockers, by the clinic for transgender children and young adults.

For the longest time throughout my childhood, I thought there was something wrong with me. I wasn't sure what it was, but it didn't feel comfortable. I couldn't understand it, which made me feel isolated, so Id play alone and enjoy my own company. My nursery teachers were concerned.

Fast forward a couple of years towards secondary school, I became more involved with the internet and the online world, and I started to learn the vocabulary for what I was feeling. I considered the prospect that I was transgender, and I thought, maybe this is who I am.

It took a good few years before I spoke to my my student support staff at my secondary school about my feelings. From there, they listened to me, and helped me create a referral to be seen by GIDS, the NHS's specialist children and young adults gender identity clinic, to consider my next steps. They helped me with external support through youth groups and various charities.

Missing out on puberty blockers

But two years down the line, I've received confirmation I will never been seen by GIDS, nor will I be given the chance to take puberty blockers. In December 2019, the December just gone, I received a phone call from a woman at GIDS, saying they would refer me to adult services, because I wouldnt be seen before my 18th birthday. Getting seen by GIDS, in short, is a mission in itself.

Being referred to an adult clinic, where I will not be offered puberty blockers, took me aback. It sucks because by the point of me getting referred in the first place, to get puberty blockers, took so long I had gone through most of my puberty anyways. I already have the effects and it sucks.

Ive had to come to terms with the fact that part of my transition will require significant amount of surgeries, invasive and not. Because the blockers won't put a pause on my puberty, I will enter adulthood tasked with feminising my "male" characteristics.

To alter from just my neck upwards, theres probably around five facial feminisation surgeries, including the reduction of my jawline, rhinoplasty, and a tracheal shave to reduce the size of my Adams apple. Those surgeries are specifically to remove the effects that male puberty has had on my body.

From what I understand of the process, some surgery is considered to be cosmetic, with tracheal shave (reduction of the Adam's apple) and facial feminisation surgery seen as this by the NHS. As it stands, there's only one surgery, gender reassignment surgery, that is usually funded by the NHS.

Constantly painful

If someone told me I was lucky not to have gone on hormone blockers I would struggle to put into words how wrong that is. Missing out on hormone blockers has made me feel self-conscious and uncomfortable in my testosterone-filled body. Its like wearing a pair of shoes with rocks inside them. It's constantly painful, you never forget its there and you cannot take the rocks out.

There are times when Im on the verge of harming myself and I cry alone. Its like sitting in the library at college but constantly looking over my shoulder, hyper-aware of whether people are talking about me and whether someone is going to attack me. I have regular panic attacks which are getting worse. I struggle to sleep because theres so much going round in my head. Every minute of the day I struggle with negative thoughts.

I know there are people who say I should just make peace with my body. Its not like changing your hair colour or weight, its so much deeper than that. I know there are people who cant change their bodies but this isnt about trying to change the way I look for vanity its trying to live as the woman I am.

I am constantly afraid of being attacked on street. Its not a question of wanting to pass" as a woman, its about longing to feel safe. Throughout my transition, I have always been tentatively cautious. Ive always been mindful, am I doing this for me, or am I doing it to fit some societal expectation of what a woman looks like? Through every step of my transition, I have taken a step back and evaluated my situation. I want to do whats comfortable for me, and me alone.

I will never be seen by GIDS after years of waiting. The right to enjoy my life as who I am has been disregarded and taken from me. I cant feel comfortable who I am, and fully experience my young adult life because of my trans status and physically who I am. If I could have started it earlier, and reaped the benefits of puberty blockers, I would be in a much better situation than I am now.

'I regret not having access to blockers'

Throughout my entire transition, I have sought a lot of support. Its a lot to deal with. Im so thankful that there are amazing support networks and charities like Mermaids with dedicated helplines. Samaritans are great for general mental health issues. I would encourage anyone who needs support to go and seek help, and have that support in place.

I just want to specifically reiterate and reinforce that it is important for there to be a judicial review. But people need to be mindful that their situation, if it is unusual, where someone might seek a reversal, or feels uninformed, might be the rarity, and to not harm the wider community as a whole.

I know theres a lot of debate at the moment about hormone blockers and regret but nobody is listening to people like me. I cant put into words how much I regret not having access to blockers and hormones. Theyre a necessary requirement for me to comfortable live my truth and the fact that Im still not being given that opportunity has such a negative impact on my psychological well-being.

Tavistock, representing the NHS's Gender and Identity Services clinic (GIDS), has been approached by i for comment.

Read the rest here:
'I'm trans, and I've waited since 2017 to be given puberty blockers. Now, I've been told it's too late' - inews

February 2020

Are you looking for a health care provider who offers innovative alternatives and a customized approach to your health issues? Indiana Regenerative Medicine Institute (IRMI) believes in offering specialized alternatives to health care. Its medical team, headed by Doctor of Chiropractic Preston Peachee, utilizes the latest developments in regenerative medicine, hormone replacement and pain management.

Dr. Peachee is a native of Jasper, Indiana. He graduatedfrom Logan College of Chiropractic and has been in practice since 2003. Hisareas of specialty include patients with chronic and severe back, neck andjoint pain as well as other complex neurological conditions.

Dr. Peachee has earned a reputation as an innovative thinkeras well as a compassionate practitioner who brings his wide expertise andexperience to the Greater Indianapolis area. His ability to help those in needof regenerative medicine, neuropathy pain relief, low testosterone or otherphysical ailments, such as back pain or fibromyalgia, makes him not only uniquebut highly sought-after.

A key member of the IRMI team is Leann Emery, FNP. Emery isa family nurse practitioner with more than 20 years of experience in hormonereplacement and alternative pain management. Emery provides optimal patientcare through personal consultations and assessments to identify her patientsspecific health needs. She was rated in the top 10% of providers in the U.S.with patient satisfaction.

Regenerative medicine is making huge leaps in our understanding of the human body, and it is offering real, possible treatments that would have seemed like science fiction a few short years ago, according to IRMI. Most patients we see have tried other more traditional treatments and have either not gotten any better or have gotten even worse. Unfortunately, a lot of people we see depend on multiple medications per day to try and function but still are not happy with how they feel or how they live their lives. It is unfortunately the nature of deteriorating and degenerative joints, they will get worse with time, and generally the pain increases as well.

Depending on the injury, Dr. Peachee will often combinelaser therapy with the regenerative medicine protocols to improve the outcomesand try and speed the recovery process.

We offer mesenchymal stem cell therapy, Dr. Peachee said. With the combination of laser therapy, mesenchymal stem cell therapy is incredibly effective for rotator cuff problems and treating knee pain. Eighty percent of our stem patients are dealing with knee pain or Osteoarthritis. Osteoarthritis-or O.A. of the knee- is a huge problem for a lot of people, and we get great results from these therapies. Most people can even avoidknee surgery.

Dr. Peachee recently introduced hormone treatments for low testosterone. Family Nurse Practitioner Leann Emery has been doing [hormone] treatments for 20 years, and that area of medicine became a natural fit for IRMI.

I have several patients who were seeking this type ofcaremany who are police officers and firefighterswho couldnt find thetherapy and individualized care and attention that they needed.

Dr. Peachee explained that low T treatments help patients with unique and even complicated cases of Erectile Dysfunction (E.D.). Most people seek us out for treatment because they are tired, worn out, stressed out and just simply lack the energy they used to have.

We are able to fill a niche with patients who hadcomplicated cases that were not responding well with their primary careproviders or other places, Dr. Peachee shared. We have a patient who hasstruggled for a long time with fertility issues but has done very well [withtreatments], and we just got good news that he and his wife are expecting aftertrying for a really long time. So, he is really enthused about that.

The typical candidates for low T treatments, according toDr. Peachee, are men who feel worn out, are lethargic and have lost theirzest for life.

Our patients dont have the same pep that they had 10 or20 years ago, Dr. Peachee stated. They struggle getting up in the morning andmight be struggling in the afternoon after having six cups of coffee or threeRed Bulls just to get through the day. We have a lot of people that want to getback into the gym and get the maximum benefit of their workouts. We can helpthem improve their overall health and energy so that they can enjoyrecreational activities like working out or practice with the Little Leaguewith their kids. Many times we hear from spouses, friends and family how muchbetter they feel and that they seem happier and get more out of life again.

It goes without saying that proper hormonal balance canimprove a patients personal relationships as well and improve the overallmental health of a patient by reducing stress, anxiety and depression oftencaused by symptoms related to low testosterone levels.

We focus on injectable [low T] treatments because we canmodify the dosage and give more frequent doses to keep our patients at a levelthats going to give them the maximum benefit and improvement for theirconditions, Dr. Peachee explained.

With the modern changes in medicine over the last 20 and 50years, were helping people to live a lot longer and adding 20 to 30 years totheir lives, but we have not given them an improved quality of life as theyage. By working with their hormones and getting them in balance, their qualityof life becomes way better, and were seeing a positive improvement for manypeople with these treatments.

Patients suffering from severe disc injuries, such a bulgingor herniated disc or discs, or who suffer from degenerative disc disease mayhave undergone treatment from chiropractors or have seen physical therapistsbefore coming to Indiana Regenerative Medicine Institute.

Our typical patient who comes in for this type of treatmenthas seen other therapists or chiropractors but hasnt found lasting relief,Dr. Peachee said. Many of our patients want to get off the rollercoaster ofopioids and pain medications. They are looking for a solution without narcoticsand risk of addiction or other possible negative side effects of narcoticsand/or surgery. We are generally able to alleviate the pain in 90% of patientsand are able to keep them from having surgery or from taking addictivemedications.

Laser therapy allows Dr. Peachee to work on the damaged tissue so that it can heal, and the method reduces inflammation and swelling in a way that traditional treatments cannot.

Its an innovative new therapy within the last decade thatallows us to do some amazing things, Dr. Peachee stated. We perform ourprocedures in our office and have several different devices for the specificneeds and issues of our patients. For instance, we have a unique device forpeople with knee pain that can help the majority of our patients walk betterand live more pain-free. We get a phenomenal outcome with this procedure.

One of the other major differentiators that sets IndianaRegenerative Medicine Institute apart from other offices and clinics is thatthey are advocates for their patients, especially when it comes to dealing withtheir patients insurance providers.

A lot of our low T patients are able to get their insurancecarriers to cover the services so that it doesnt cost them as much out ofpocket for the care they seek, Dr. Peachee said. Weve partnered with abilling company that has helped us to be able to navigate the craziness of ourmodern insurance companies, and by doing so, were able to keep the cost downfor a lot of patients. Not every insurance plan will cover this type of care,but a lot of them will. When its possible and ethical, we do whatever we canto benefit our patients to help keep the cost low. I have spent a lot of freetime writing letters on behalf of our patients. We go above and beyond with ourservice and care of our patients.

The Indiana Regenerative Medicine Institute team will make housecalls or come to a patients place of work when the situation calls for thatlevel of care.

We will go and draw blood for blood work, bring medications and even do exams in some situations, Dr. Peachee said. As I mentioned before, we see a lot of police officers and firemen all over the statefrom Mishawaka to South Bend and all over Indiana. We go once a month to see these patients at their departments and stations so that we see them all in one day versus making 10 to 15 guys drive hours to come in to see us. Its a service we can offer because we are a small clinic and we are focused on that one-on-one patient attention and relationship building. We have great relationships with our patients, and thats something that we work very hard at.

Building trust and transparency is crucial to the success ofhis practice, Dr. Peachee emphasized. The trust that we build with ourpatients is crucial to not only the success of the practice but to thepatients outcomes. And not just with hormone therapy but also with ournonsurgical spinal decompression patients. These are patients with significant discinjuries, and we need them to tell us everything we need to know so we can givemore accurate and complete care for a better outcome.

I would say to anybody if you have any doubts or reservations to take some of the burden and some of the anxiety out of the equation and schedule an initial consultationabsolutely free of charge, Dr. Peachee encouraged.

Dont put off living your best life any longer. Visit Indiana Regenerative Medicine Institutes website at indianaregen.com or call (317) 653-4503 for more information about its services and specialized treatments and schedule your free consultationtoday!

Follow this link:
Indiana Regenerative Medicine Institute Offers Innovative Approaches in Regenerative Medicine, Hormone Replacement and Pain Management - Carmel...

CLAIRE Dunwell thought she was going crazy when, after turning 40, she began to suffer heart palpitations, migraines and crippling anxiety.

After going back and forth to her GP, she was given medication for anxiety, beta-blockers for her heart and even sent for an ECG heart check.

6

Claire, 42, now knows she is going through the perimenopause, a phase before menopause when hormone levels can fluctuate. She is now undergoing hormone replacement therapy to ease the effects. But it should all have been diagnosed sooner.

A Mumsnet poll found one in four women with menopausal symptoms sees a GP three times before getting the right help. One in four is told she is too young to be perimenopausal.

Here, Claire, a writer who lives in Wakefield, West Yorks, with husband Ian, 55, a chip shop owner, and sons Sam, 13, and Louie, ten shares her story.

SOAKING up the rays, I should have been living my best life.

It was last August, blazing hot, and we were halfway through a two-week family holiday in Crete.

6

While my husband Ian had his head buried in a book, planning his next trip to the all-inclusive bar, I was frantically searching Google on my phone, hoping for answers to explain the way I was feeling.

Since hitting 40 the previous February, I had been plunged into a dark, unfamiliar world.

I had become anxious, irritable and zapped of energy.

When my head wasnt thick with brain fog it throbbed with migraines, and trying to concentrate on anything for longer than half an hour had become a battle.

I felt like someone I didnt recognise not the fun, happy-go-lucky person I was in my carefree twenties and thirties.

6

Id always been fit, healthy and a cup half full kind of girl.

I exercised three times a week, ate healthily and was incredibly lucky to have a loving husband, two healthy children, great friends and a successful career.

From the outside looking in, I had it all.

But on the inside, I had suddenly lost control.

Even the most mundane jobs such as unloading the washing machine and trying to pair up socks overwhelmed me.

FACT:

1 in 4 women with symptoms have to see GP 3 times to get right help

Headaches, fatigue, anxiety and palpitations made matters worse.

It was three months after I turned 40 when the repeat trips to my GP surgery began.

I beat myself up for wasting precious NHS time.

I felt like a fledgling hypochondriac.At each visit, doctors tried hard to treat my list of ailments but nothing worked for long.

6

For the migraines, which Id never suffered before and became so unbearable I struggled to hold conversation and just wanted to sleep, a doctor prescribed Sumatriptan.

I took it when the migraines hit and although they helped with the head pain, they made me feel sick and groggy.

At another appointment, this time with a nurse, it was suggested I try a high dose of aspirin as soon as I felt a migraine coming.

If that didnt work, she would refer me to a local migraine support group.

Next came the unexplained anxiety and heart palpitations, which were at their worst during the two weeks before my period.

FACT:

A quarter are told they are too young to be premenopausal

Some days, I felt as though I was going crazy.

I could be enjoying coffee with a friend one minute and gripped by an irrational panic the next.

My heart raced, worrying something terrible was about to happen.

My husband took the brunt of my bad moods.

I felt exhausted all the time because nodding off on the sofa by 9pm most nights meant I struggled to get a good nights sleep.

I was less tolerant with the kids too.

All of this was completely out of character.

Despite the odd night every few weeks when I woke up in the night drenched in sweat, it never dawned on me that it could be down to my hormones.

6

Sobbing to my GP at yet another appointment, I was prescribed Citalopram, an anti-anxiety medication which I hoped could be a magic pill.

I was desperate to try anything.

They even gave me an ECG for the palpitations, but it showed my heart was perfectly normal.

Its only now, looking back, that I realise it was around this time my periods changed.

Some months they were lighter than normal and others they were shorter in length.

Neither me, nor my GP, made the link that I could be heading towards The Change.

It was during that family holiday to Crete last year that I finally reached the end of my tether.

I was six months into the Citalopram but because it wasnt making any difference, I stopped it.

FACT:

The average woman hits menopause at age 51

I made another appointment with my GP and was handed a prescription for beta blockers which slow the heart rate and can help with anxiety.

Instead, they left me feeling spaced out and sluggish, so I could only take them at night.

It was during my son Louies routine asthma check-up last September when everything began to fall into place.

Tearful, I begged a friendly nurse for five minutes of her time.

Youre not going crazy, she reassured me, as I blurted everything out.

Youre perimenopausal.

The nurse said how all my symptoms were likely to be down to a drop in my hormone levels.

At first, the idea seemed ridiculous.

I was 41, and the average age women reach menopause when regular periods stop is 51.

But the more I pieced together my sudden onset of symptoms, the more it made sense.

When I asked if there was a blood test I could have to check my hormone levels, I was told it would be difficult to get a reliable result because hormones fluctuate daily.

The nurse prescribed the mini Pill hoping the top-up of progesterone would help. She suggested trying oestrogen later.

6

I went away feeling both relieved and confident that I was finally on the right path.But while the mini Pill helped with the migraines and eased the anxiety, it caused frequent heavy bleeding.

I was determined to find another solution, so I tracked down Dr Louise Newson, a GP specialising in menopause, and author of the Haynes Menopause Manual.

At her clinic in Stratford-upon-Avon she talked through my symptoms and I was given a blood test which found I had low levels of both oestrogen and testosterone.

While Louise said my results suggested I was perimenopausal, she stressed it is better to go on a patients symptoms than blood tests alone.

Hormone levels change all the time, she told me.

We could do three tests on three consecutive days and get completely different results, so the most important part of the diagnosis is the history from the patient.

When Louise went on to explain how it is not unusual for some women to experience menopausal symptoms up to a decade before The Change, I felt a huge weight lift.

Louise explained: Without hormones, its like trying to drive a car without oil.

The menopause occurs because our ovaries run out of eggs and stop producing hormones.

Many women find that their hormone levels start reducing several years before this.

Louise said that the perimenopause could be just as mentally and physically draining as the real thing.

Your age is key to diagnosis

THE average woman experiences the menopause when regular periods stop aged 51. But hormone levels can fluctuate several years earlier and in some people this can have side-effects.

This is known as the perimenopause.

Dr Louise Newson, pictured, says: Most women get some symptoms linked to changing hormone levels during perimenopause.

Some have symptoms for a decade before the menopause. Guidance from the National Institute for Health and Care Excellence (Nice) says that if a woman is over 45, we dont need to test for perimenopause or menopause.

If theyre 40 to 45 tests can be useful, and if theyre under 40 its important to get a diagnosis. In these situations a woman experiencing menopausal symptoms should seek help and advice from a doctor who specialises in the menopause.

Cells in our hearts, brains, bones, muscles, bladders and blood vessels respond to oestrogen so when levels reduce, all kinds of symptoms can ensue.

My hot flushes, night sweats, low mood, anxiety, joint pains, headaches and even my reduced libido could all be attributed to this fluctuation.

Low testosterone levels can also lead to brain fog, low energy, reduced stamina and reduced libido.

In my case, Louise prescribed an oestrogen gel as well as progesterone tablets, a type of Hormone Replacement Therapy.

She told me: The only way to find out if a drop in hormones is causing the symptoms is by replacing them and then seeing what happens.

The guidelines are very clear that for the majority of women who take HRT, the benefits outweigh the risks.

The menopause needs to be seen as a long-term female hormone deficiency rather than just a natural process that causes symptoms.

By replacing these hormones, we can really improve our future health as well as our symptoms.

I never imagined Id be taking HRT at the age of 42, but I could not contemplate going on for several more years feeling like I had been.

Four weeks into the treatment, Ive found it has already made a huge difference.

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Mums migraines, anxiety & palpitations were driving her crazy for two years until she was diagnosed with p - The Sun