Archive for the ‘Hormone Clinic’ Category

Imagine your 13-year-old daughter is depressed and withdrawn and then, one day, she tells you shes trans and will, henceforth, be known as Sean. You must no longer call her by her dead name. Even the most liberal parent may swallow hard and ask her (them) to have counselling with an experienced psychologist who can explore those feelings before the teenager embarks on drastic hormone treatment.

Thats a loving reaction, in my book. Astonishingly, in some countries it would be illegal. Therapists are forbidden to try and find out if anything else may lie behind a young persons misery in their own body. According to trans activists, talking therapies are the same as conversion therapy, an abhorrent practice which puts pressure on a gay boy or girl to renounce their sexuality.

Stonewall, the LGBTQ campaign group, insists that only affirmation is acceptable. You are not allowed to suggest your child is confused or to point out that there has been an extraordinary increase in girls seeking to transition from female to male or that many of those girls have autism. Nor that some kids who think they are trans have been bullied for being gay.

I agree with Debbie Hayton, a transwoman and campaigner, who says that the denial of meaningful therapy for vulnerable youngsters is chilling. But loving parents who make the same objection are branded transphobic.

This is the background to the Governments U-turn in which it excluded trans people from legislation banning conversion therapy. The Prime Minister drew a crucial distinction, saying, There are complexities and sensitivities when you move from the area of sexuality to the question of gender ... I dont think its reasonable for kids to take decisions about their gender without a parents involvement.

Boris is right. It isnt reasonable and nor is it kind. Kids who are in a distressed state can fixate on one solution to all their problems. Society owes them more than a reckless rush down the clinic for hormones which will wreck their fertility.

How tragic that this personal matter should become a political football. Terrified of their ideological commissars, Labour MPs look like complete wallies as they refuse to confirm or deny whether a person with a penis can be a woman. Angela Rayners tortuous answer to that vexed question sounded like a stoned sociology lecturer speaking Swahili. Its encouraging to see women across the spectrum, from Mumsnet to radical feminists, uniting against this insulting nonsense.

Ironically, many trans people do not want all this aggro on their behalf. Its frightening. A wise friend of mine whose partner transitioned successfully says, Every family starts from a position of denial and sadness. Sometimes they are right, sometimes they are wrong. Exactly. Some children will turn out to be correct in believing they would feel more themselves as another gender. For others, gender dysphoria may have been a peg on which to hang all the neuroses which are so common in that difficult phase of life.

Those young people all deserve loving support and proper counselling. What they dont need is fearful affirmation as they make the biggest, potentially most irreversible, decision of their lives.

Much amusement here at Pearson Towers after a headache and feeling tired were added to the official list of Covid symptoms. Isnt that the chronic and irreversible condition called Being Over 50?

Before half the population decided to throw a Covid sickie (Cickie?), Sajid Javid said that he personally would first reach for the Nurofen and go into work. I should think so too. The Health Secretary has got a six-million-long hospital waiting list to tackle.

I wonder, is Mr Javid aware of the further delays that an ongoing Covid fixation is causing in the NHS? One surgeon emailed me to express his alarm. A 66-year-old patient had arrived in hospital for heart surgery. Just hours before the operation, the poor man tested positive for Covid. Although he was not displaying any serious symptoms except, possibly, feeling tired the operation was cancelled.

That patients risk of death from surgical intervention has just risen to 90 per cent from an estimated 30 per cent directly because of the delay, fumes my source. I cannot believe that so many allegedly intelligent people are unable to make a sound judgment on the risk-benefit ratio of what is now just a flu.

Covid is no longer likely to kill you. But hospitals cancelling your operation or urgent appointment may well. The NHS needs to get a grip. We have nothing to fear but the fearful.

See more here:
It's cruel to deny trans children the chance to think again - The Telegraph

Eating a balanced diet and taking high-quality supplements can help support your body as you stop taking the pill.

Image Credit: LIVESTRONG.com Creative

What Really Happens to Your Body When examines the head-to-toe effects of common behaviors, actions and habits in your everyday life.

The side effects of starting hormonal birth control are pretty widely discussed. But there's a little more mystery about what happens to your body when stopping birth control.

Birth control pills, also known as oral contraceptive pills, are the second most common type of contraceptive method as of 2019 (the latest data available), per the Centers for Disease Control and Prevention (CDC). If you've been thinking about stopping birth control after being on the pill for years, you should know that it's safe to stop at any time, according to the Mayo Clinic. But you should expect your body to go through some changes.

Here's the scoop on the side effects of stopping birth control pills and tips for taking care of yourself as you make the transition.

When to Stop Birth Control Pills

There are several reasons why someone might want to stop using birth control pills. According to Felice Gersh, MD, ob-gyn and the founder/director of Integrative Medical Group of Irvine, those reasons include:

Your Period Could Become Irregular

While some people who menstruate go back to their normal periods soon after stopping birth control pills, other people may have irregular periods for a while.

"Even if ovulation resumes during the first cycle post-pill, there's no guarantee the next few cycles will be regular. In fact, it can take up to a year for their cycles to go back to regular," says Kerry-Anne Perkins, DO, ob-gyn and member of the medical review board of Women's Health Interactive. "This is true for both types of pills, progesterone or estrogen-free and combined hormonal, which has both estrogen and progesterone."

And if you took birth control in order to regulate your menstrual cycle, there's a chance that previous unpleasant period-related symptoms may make a return, she notes.

You may also notice a change in the flow and duration of your period, per the Cleveland Clinic. It may be longer and heavier birth control pills typically give you shorter and lighter periods.

Your Fertility Levels Could Be Lower

It's valid to have concerns about how your fertility may be affected by discontinuing birth control pills, especially if you are trying to become pregnant.

A July 2018 meta-analysis in Contraception and Reproductive Medicine found stopping contraceptive use doesn't significantly delay or negatively affect fertility.

But your fertility levels may also be lower than they were when you started taking birth control pills. "If you have been on birth control for many years, your fertility has naturally declined and may be significantly lower than when you started the birth control," Dr. Perkins says.

When stopping the pill, be sure to use a backup method of contraception if you aren't looking to get pregnant at all or right away, per the Cleveland Clinic.

You Could Lose or Gain Weight

The belief that oral contraceptives commonly cause you to gain weight is a longstanding one, per a January 2014 study in the Journal of Women's Health.

But researchers of the study found birth control pills weren't linked to short-term changes in weight or body composition after observing 150 people assigned female at birth (AFAB) with both normal weight and obesity who used oral contraception over three to four months.

Typically, the pill doesn't cause more than a pound of weight gain per year, according to the Cleveland Clinic.

There are chances that you can lose or gain weight after you stop taking the pill, though. "Some women retain water while on the pill, so if this is you, you may drop a couple of pounds after quitting it," Dr. Perkins says. "Others could retain water after quitting the pill, due to some temporary hormonal imbalances. Again, it shouldn't be more than a couple of pounds."

It's also possible to experience changes in appetite due to hormonal shifts, Perkins notes, that could in turn contribute to weight changes.

When to Talk to Your Doctor

Talk to your doctor if you have questions or concerns about what to expect when stopping birth control pills, per the Cleveland Clinic. That's also a good time to discuss how being off of the pill will affect any prior conditions you have.

You May Have Acne or Hair Loss

You have hormonal changes to thank for any adverse skin and hair-related side effects you may experience after you come off birth control pills. Quitting birth control pills leads to a temporary hormonal imbalance, according to Dr. Perkins.

"For example, acne is fairly common in the first few months post-pill," she says. Experiencing hair loss or a condition called hirsutism (excessive facial hair) is also possible.

You Might Experience Mood Shifts

Most people won't experience significant emotional changes related to stopping the pill; most of the effects are physical, per Jefferson Health. But if you experienced mood swings or emotional instability on birth control, those things may stop post-pill.

On the flip side, if you were prone to depression, anxiety and mood swings before using birth control pills, those conditions may return when you nix oral contraception, according to Oschner Health.

Your Sex Drive May Change

A September 2012 review in The Journal of Sexual Medicine found a small correlation between the use of hormonal contraceptives and decreased libido, however research shows there are mixed results overall on how hormonal birth control affects your sex drive.

If you experienced lower desire while on the pill, you could find yourself feeling more sexual than usual after you stop taking it. "After quitting the pill, you may also experience changes in your libido usually higher libido, especially around ovulation," Dr. Perkins says.

Stopping Other Types of Hormonal Birth Control

Here are some potential side effects of stopping other types of hormonal birth control, according to Dr. Perkins:

Tips to Help Make Stopping the Pill Easier

Many of the side effects of discontinuing your birth control pill are temporary, but there are things you can do to help ease them.

1. Take a High-Quality Multivitamin

A September 2016 study in The Journal of Clinical Endocrinology and Metabolism found an association between higher vitamin D levels and estrogen-containing contraceptive use among more than 1,600 people identified in the study as African American women.

It may be beneficial to focus on naturally increasing your nutrient levels after you're off the pill. Some ways to raise your vitamin D levels, per the Mayo Clinic, include:

Dr. Gersh also recommends supplementing if you can't fit enough crucial nutrients from your diet alone. "Taking a high-quality multivitamin is key. Be sure it contains methyl B12, methyl folate, selenium and the usual array of vitamins," she says. "Extra magnesium would be of benefit, along with omega-3s and vitamin D."

2. Finish Out Your Current Pill Cycle

While you can quit the pill cold turkey, it may be best to finish out your current pill pack before stopping altogether.

You can expect to have your period within a few days after stopping the pill if you stop in the middle of the current pill cycle, according to the Cleveland Clinic.

Try to finish out your current round of pills, if possible, to avoid messing with your period.

A balanced diet can help as you transition away from birth control pills. Eating well is especially important if your appetite is affected by stopping the pill. For example, you may experience cravings.

"Pay attention to those cravings and try to eat a healthy and balanced diet to minimize them, and you shouldn't have weight issues," Dr. Perkins says.

Original post:
What Happens When You Stop Taking Birth Control Pills - Livestrong

The report titled Adenomyosis Treatment market offers a primary overview of the Adenomyosis Treatment industry covering different product definitions, classifications, and participants in the industry chain structure. The quantitative and qualitative analysis is provided for the global Adenomyosis Treatment market considering competitive landscape, development trends, and key critical success factors (CSFs) prevailing in the Adenomyosis Treatment industry.

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Bayer AG, Ferring B.V, Johnson & Johnson, Novartis, Merck, Pfizer.

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Market Segmentation: By Type

Anti-inflammatory drugsHormone medicationsOther

Market Segmentation: By Application

HospitalClinicOthers

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Chapter 2 Industry Cost Structure and Economic Impact

Chapter 3 Rising Trends and New Technologies with Major key players

Chapter 4 Global Adenomyosis Treatment Analysis, Trends, Growth Factor

Chapter 5 Adenomyosis Treatment Application and Business with Potential Analysis

Chapter 6 Global Adenomyosis Treatment Segment, Type, Application

Chapter 7 Global Adenomyosis Treatment Analysis (by Application, Type, End User)

Chapter 8 Major Key Vendors Analysis of Adenomyosis Treatment

Chapter 9 Development Trend of Analysis

Chapter 10 Conclusion

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Adenomyosis Treatment Market Analysis and Demand with Future Forecast to 2029 | Bayer AG, Ferring BV, Johnson & Johnson, Novartis Political Beef...

Its mid-afternoon on a mild spring day at Artemisia Clinic in Taos. Dr. Clara Wetmore, a doctor of Oriental Medicine, is treating Amy Dondanville, who has difficulty sleeping. Soothing music plays and fragrant herbs in orderly rows surround the treatment table of the well-lit clinic.

Wetmore consults with Dondanville and then checks her pulse at various points on her body, asking questions in a quiet voice, How is your stress level? Energy level? She asks how much caffeine Dondanville consumes.

Dondanville is experiencing a high level of stress, having just returned to her job as a clinical social worker after being gone for three weeks. She reports that she is not sleeping well and feels more frantic, like she is running on adrenaline that causes her to crash. She has removed most caffeine from her diet, drinking just one cup of black tea a day.

While Dondanville relaxes on the treatment table, Wetmore places needles in various parts of her body: her forehead, wrist, midsection and lower legs. I place needles at specific points along the relevant or affected meridians, based on symptoms, presentation and pulse diagnosis. Each point has unique indications, and I pick the points that relate to or address the symptoms and underlying health concerns, Wetmore explained. Today, she is inserting needles to help calm the mind, as well as reduce racing thoughts, anxiety, pain and insomnia. As the needles are placed, Dondanville explains that shes not feeling any pain, although sometimes she experiences a sensation.

Wetmore uses another tool, known as an ear or auricular seed, which is a tiny stainless steel pellet with a latex-free adhesive patch. Ear seeds are a type of auriculotherapy rooted in Chinese medicine. They're meant to promote comfort and relaxation and have become very popular in the West in recent years, despite some disagreement among medical professionals as to their efficacy. Occasionally, Wetmore uses gold pellets, depending on the treatment, or even small pellets with crystals on the top that look like little earrings if brought in by a patient.

Wetmore cleans and disinfects the ear and then places the tiny pellets in specific spots on the left ear that are tender, indicating trouble somewhere in the body. Dondanville will wear them for a week, after which they fall out or she will remove them. The ear seeds do their work while in place, Wetmore says, and their effectiveness can be increased by periodically pressing on them. Right now, I am placing an ear seed to regulate the nervous system and treat an insomnia point," she explains. "I also checked the liver point, usually aggravated by stress but that spot wasnt tender, so I am moving on to the heart spot which is calming to the mind.

Dondanville is experiencing difficulty powering down and falling asleep, which is her most common sleep struggle, although she does sometimes wake up in the middle of the night and have a hard time going back to sleep. She usually comes in weekly, but since she has been out of town, this is her first appointment in almost a month. She says, Ive had chronic sleep problems since I was a kid; its always been a struggle for me. The practice of coming regularly allows me to connect with my body and speak to what is specifically happening with my digestion, sleep, mood and energy levels. The act of reflecting is helpful itself. When accessing treatment regularly, I find I can fall asleep with great ease, which I wasnt previously able to achieve.

Wetmore also gives Dondanville a Chinese herbal formula for sleep. At the beginning of treatment, she was taking three to four doses per night and that has been reduced to one or none. This is what I want for all my patients: to get to the point where their bodies remember how to sleep without external help, says Wetmore.

Dondanville has been seeing Wetmore for about two and a half years. She sought Wetmore out for help with another issue, but through the comprehensive check-ins done at each appointment, the two discovered the extent of Dondanvilles sleep disturbances. The practice of attending appointments and engaging in reflection has created a sense of mindfulness and awareness about what is happening outside appointments and brought a deeper sense of noticing about which routines and habits nurture my body and which ones harm them, reflects Dondanville.

When asked what advice she would give to people struggling with sleep problems, Dondanville recommends that people become aware of what content is stimulating to the brain in a negative way, whether it be watching TV, listening to audio recordings or scrolling on the phone.

According to a study by Harvard Medical School, the blue light emitted by smartphones "can affect your sleep and potentially cause disease." The study notes a well-known fact about the brain that the absence of light signals to the brain to shut down for sleep and the presence of light triggers wakefulness. As such, turning down any bright lights before bed can help people to achieve deeper sleep. Conversely, exposure to daylight upon waking can boost alertness and mood.

Wetmore added, Id suggest that people establish a routine that cues the body that it is time to move towards sleep, which might be stretching, taking a bath or shower, or applying cream to nurture the body.

Sleep disorders and effective treatment

Wetmore opened her practice five years ago. She earned a Master's of Science in Oriental Medicine degree from the Southwest Acupuncture College in Santa Fe and is licensed by the state and certified nationally. For the best results, she sees patients on a regular basis, but even a single treatment can help. One new patient who was skeptical of acupuncture came to see Wetmore to get help with her racing thoughts. Wetmore treated her with acupuncture, ear seeds and an herbal formula. When Wetmore saw the patient next, she had gone from sleeping for about an hour a night to sleeping seven hours. Sometimes its dramatic like that, and other times it can take weeks or months to see results like hers, says Wetmore.

More than 100 different types of sleep disorders have been identified, according to the Sleep Foundation. Wetmore sees many of them at her clinic. People come to me with sleep issues ranging all over the insomnia spectrum; some who cant fall asleep, some who cant stay asleep or wake up too early, some light sleepers, some with crippling nighttime anxiety, some who cant turn their minds off at night," she says. "Some patients sleep for a few minutes per night if at all some for a few hours and some just dont get quite enough for their particular needs. The causes range from trouble sleeping due to menopausal or perimenopausal hormone shifts, which account for about half of her patients, while others are dealing with stress, anxiety, trauma, grief, pain or other issues. Sometimes, there is no obvious cause.

Because sleep disorders are so unique to each individual, being able to tailor acupuncture treatments and herbal formulas to each patients needs is hugely important in my work, says Wetmore. My goal is to regulate the sleep cycle so that patients dont need to take herbs and supplements forever to get a good nights sleep. Its like giving a gentle nudge and reminder for the body to remember how to do such a fundamental and necessary regenerative process on its own. Another advantage is that I spend a lot of time with each patient, so I really get to know each persons life, physical health and emotional health, giving me the insight to treat very specifically.

As part of her approach, Wetmore checks for any medications being taken by the patient to make sure there wont be interactions between the medications and herbs she recommends for sleep. In addition to making recommendations about nutrition, Wetmore refers patients to other needed services, such as therapy, meditation, exercise, primary care and other physicians.

When asked how her approach is different than a medical doctors might be, Wetmore said, In some ways, my approach probably isnt all that different than that of Western medicine; were all trying to help people feel better, and are using the tools, knowledge and skillsets we have. I have tremendous respect for my medical colleagues, and although folks dont always expect it, Im very much in support of Western medicine and science, and love to work in tandem with my patients other providers.

The questions of how much sleep we need as humans and how the lack of sleep impacts our health are the subjects of numerous studies over the past few years. In his 2017 book, Why We Sleep, Matthew Walker, Ph.D., professor of neuroscience and psychology at UC Berkeley and the director of the Center for Human Sleep Science, reports that two-thirds of the adults in developed nations do not get the full eight hours of recommended sleep. Through his research, he has pioneered work showing that insufficient sleep depresses the immune system, doubles risk of cancer, adds to weight gain and is a key factor in whether or not a person will develop Alzheimers disease. To find out more and see tips for better sleep, visit masterclass.com/articles/matthew-walker-on-improving-sleep-quality. There are also several free podcasts featuring Walker that delve into his research.

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Chinese medicine and the pursuit of a good night's sleep - taosnews

New York, United States A2Z Market Research published new research on Global Osteoporosis Treatment covering the micro-level of analysis by competitors and key business segments (2022-2029). The Global Osteoporosis Treatment explores a comprehensive study on various segments like opportunities, size, development, innovation, sales, and overall growth of major players. The research is carried out on primary and secondary statistics sources and it consists of both qualitative and quantitative detailing.

Some of the Major Key players profiled in the study are Merck & Co AGNovartis AGEli Lilly and CompanyAmgen, Inc.Allergan PlcActavis Plc.Pfizer, Inc.GlaxoSmithKline Pharmaceutical Ltd.F. Hoffmann La Roche Ltd.Novo Nordisk A/STeva Pharmaceuticals Industries Ltd.

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Various factors are responsible for the markets growth trajectory, which are studied at length in the report. In addition, the report lists down the restraints that are posing threat to the global Osteoporosis Treatment market. This report is a consolidation of primary and secondary research, which provides market size, share, dynamics, and forecast for various segments and sub-segments considering the macro and micro environmental factors. It also gauges the bargaining power of suppliers and buyers, threat from new entrants and product substitutes, and the degree of competition prevailing in the market.

Key market aspects are illuminated in the report:

Executive Summary: It covers a summary of the most vital studies, the Global Osteoporosis Treatment market increasing rate, modest circumstances, market trends, drivers and problems as well as macroscopic pointers.

Study Analysis: Covers major companies, vital market segments, the scope of the products offered in the Global Osteoporosis Treatment market, the years measured, and the study points.

Company Profile: Each Firm well-defined in this segment is screened based on a products, value, SWOT analysis, their ability and other significant features.

Manufacture by region: This Global Osteoporosis Treatment report offers data on imports and exports, sales, production and key companies in all studied regional markets

Global Osteoporosis Treatment Market Segmentation:

Market Segmentation: By Type

BisphosphonatesParathyroid Hormone TherapyCalcitoninSelective Estrogen Inhibitors Modulator (SERM)

Market Segmentation: By Application

HospitalsClinicOthers

Market Segmentation: By Geographical Analysis

The Middle East and Africa (GCC Countries and Egypt)North America (the United States, Mexico, and Canada)South America (Brazil etc.)Europe (Turkey, Germany, Russia UK, Italy, France, etc.)Asia-Pacific (Vietnam, China, Malaysia, Japan, Philippines, Korea, Thailand, India, Indonesia, and Australia)

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The cost analysis of the Global Osteoporosis Treatment Market has been performed while keeping in view manufacturing expenses, labor cost, and raw materials and their market concentration rate, suppliers, and price trend. Other factors such as Supply chain, downstream buyers, and sourcing strategy have been assessed to provide a complete and in-depth view of the market. Buyers of the report will also be exposed to a study on market positioning with factors such as target client, brand strategy, and price strategy taken into consideration.

Key questions answered in the report include:

Table of Contents

Global Osteoporosis Treatment Market Research Report 2022 2029

Chapter 1 Osteoporosis Treatment Market Overview

Chapter 2 Global Economic Impact on Industry

Chapter 3 Global Market Competition by Manufacturers

Chapter 4 Global Production, Revenue (Value) by Region

Chapter 5 Global Supply (Production), Consumption, Export, Import by Regions

Chapter 6 Global Production, Revenue (Value), Price Trend by Type

Chapter 7 Global Market Analysis by Application

Chapter 8 Manufacturing Cost Analysis

Chapter 9 Industrial Chain, Sourcing Strategy and Downstream Buyers

Chapter 10 Marketing Strategy Analysis, Distributors/Traders

Chapter 11 Market Effect Factors Analysis

Chapter 12 Global Osteoporosis Treatment Market Forecast

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Osteoporosis Treatment Market See Huge Growth for New Normal | Merck and Co AG, Novartis AG, Eli Lilly and Company Bloomingprairieonline -...

Although hot flashes are the quintessential symptom, there are several other menopause-related symptoms, such as brain fog or memory trouble, that women may not realize are connected to their changing hormones.

A new study published January 12 in the journalMenopause found a link between menopausal symptoms, especially depression and sexual dysfunction, and cognitive performance in areas such as memory, attention, and language skills.

Often women dont recognize these symptoms as part of menopause, says Margaret Nachtigall, MD, a gynecologist at NYU Langone Health and a clinical assistant professor at the NYU School of Medicine, both in New York City. Because cognitive issues can develop slowly, they might not see it as related to a loss of estrogen, she says.

According to theOffice on Womens Health, part of the Department of Health and Human Services, up to two-thirds of women in perimenopause report cognitive problems.

In the women that I see in clinic, that can manifest as difficulty remembering, the inability to find the right word for what they are trying to say, putting dishes in the cabinet instead of the dishwasher, not remembering everything on their list that they wanted at the store, or being in a meeting and forgetting what they were going to say, says Dr. Nachtigall.

RELATED: Predicting How Long the Menopausal Transition Will Last, and When Youll Reach Menopause: 10 Questions and Answers

To examine whether the cognitive performance of women is related to the severity of menopausal symptoms, investigators looked at 404 women in a rural area in north India. The subjects were between ages 40 and 65 and were not using hormone therapy (HT).

The women were divided in four groups so that researchers could look at the frequency and severity of different symptoms according to the stage in the menopause transition.

Researchers used standardized tools to record the presence and intensity of 21 different menopause symptoms, including sexual dysfunction, vasomotor symptoms (hot flashes), depression, and anxiety.

A Hindi version of the Mini-Mental State Examination (MMSE) was used to gauge cognitive performance and evaluate the effect of the severity of menopause symptoms on overall cognitive performance and its five domains, including

Investigators found that the kind of menopausal symptoms the women experienced were different depending on their life stage.

Researchers found that the cognitive performance of the women was linked to the severity of certain menopause symptoms, especially depression and sexual dysfunction.

Sexual dysfunction can manifest in different ways during menopause and people are often reluctant to talk about it, says Nachtigall. Some women feel as though they have vaginal dryness, itchiness, or a feeling like sandpaper in the vagina, she says.

A decrease in arousal or in sexual response and pleasure are also symptoms of sexual dysfunction, according to theNorth American Menopause Society.

The authors found no association between the severity of vasomotor symptoms and cognitive performance, although other studies have suggested that such an association exists.

In menopause, the ovaries arent producing any estrogen, notes Nachtigall. We have estrogen receptors almost everywhere brain, eyes, teeth, bones and so its not surprising that when we have a lack of estrogen that all these different symptoms can occur. It makes sense that a person with more menopause symptoms and more severe symptoms would also have a lower cognitive function, but interesting that they were able to show that in this study, she says.

These findings reflect what Nachtigall sees in her own practice. Often, people who have more hot flashes, more depression, and more symptoms of menopause in general are also the same people who experience difficulties with cognitive functioning.

This study provides further support that women should seek care when you are going through menopause or perimenopause, says Nachtigall. When you see a provider, talk about the symptoms you are experiencing, even if you dont think they are related to menopause, she says.

This can lead to an important discussion around different treatment options, including whether or not hormone therapy (HT) may help with your symptoms, says Nachtigall. Its been shown in multiple studies that estrogen does improve symptoms of cognitive functioning. Its also been shown in many studies that estrogen will reverse hot flashes, will improve mood, will improve sexual functioning and vaginal dryness, and therefore may be a good option for many people, she says.

Research published in Menopause in December 2019 found that there could be a cognitive benefit later in life for some women who had more exposure to estrogen, both through a longer reproductive window and the use of longer-term HT.

The risks and benefits of hormone therapy should be discussed with your doctor, as it is not appropriate for everyone, including women who have unexplained bleeding, estrogen receptor positive cancer or severe liver disease or a serious clotting disorder, says Nachtigall.

The findings of this study point to the fact that not all symptoms related to the menopause transition are hot flashes; there are other symptoms, says Stephanie S. Faubion, MD, the director of the Center for Womens Health at the Mayo Clinic in Rochester, Minnesota, and the medical director of theNorth American Menopause Society (NAMS).

Included in that are these cognitive type changes that women commonly describe, as well as mood issues that need to be addressed, says Dr. Faubion. That doesnt mean that all these symptoms can be treated with hormone therapy there could be other issues or conditions contributing to these symptoms that need to be addressed and evaluated, she adds.

RELATED: What Experts Want Women of Color to Know About Menopause

Its important to note that we dont know if giving hormone therapy during menopause helps with memory, short or long term. But we do know if youre going to take hormone therapy for other menopause symptoms hot flashes, night sweats it does tend to help with mood, she says. The relationship between depression and memory issues is well-established, adds Faubion.

If not through hormone therapy, is there a way to treat brain fog or memory issues? Solutions to memory issues might be related to sleep issues or an underlying sleep disorder. It may also be improved by managing stress or treating any underlying mood disorders, such as anxiety or depression, says Faubion.

Nachtigall echoes that sleep is an important issue and often a problem for women during the menopause transition. Many people that I see complain of insomnia, and thats one of the early signs of lack of estrogen that patients in menopause will experience, she says.

View original post here:
Menopausal Symptoms and Cognitive Problems Connected, Study Says - Everyday Health

Even 10-step skin care routine devotees get pimples. If youre suffering from red, irritated acne blemishes, there are ways you can minimize redness through skin care efforts.

However, if youve arrived to this page with little time to spare, there are also some tips for concealing blemishes until you can get the redness to go away for good.

The keys to reducing redness from acne are to apply anti-inflammatory compounds while being gentle to your skin. Thats right gentle. This means dont try to use every scrub or irritating product to treat your acne. Instead, try using a keep it simple approach.

If you apply too many oil-removing products, your skin could react the opposite way: It could start to overproduce oil, which will worsen your acne. The goal is to keep your skin clean and apply targeted products to reduce redness while your blemishes heal.

Here are some tips for reducing redness:

Sometimes, youll need to call in the professionals for consistent, painful, and inflamed pimples. A dermatologist can evaluate your skin and prescribe professional-level treatments, such as topical applications, chemical peels, or laser therapy.

Acne can also closely resemble rosacea, a condition that causes significant skin redness. Because the treatments for rosacea can be different from traditional acne-fighting approaches, its a good idea to see a dermatologist if youre not sure.

You can also apply a mild cortisone cream to an inflamed pimple to decrease redness and swelling. This should be done sparingly and only as a spot treatment, as topical steroids themselves can actually cause acne, as well other potential side effects such as skin thinning.

Sometimes, even your best efforts at reducing redness dont show enough immediate results. When this is the case, you can use makeup to cover up the redness. Heres how to start:

Youll want to use products that are all oil-free and noncomedogenic when concealing your pimple. Otherwise, youll run the risk of making it worse.

Consistent skin care is beneficial for reducing redness, and so is adopting an acne prevention plan. Your acne prevention skin care routine should include the following:

If this plan doesnt help your acne subside, see a dermatologist.

Acne redness can indicate underlying irritation and inflammation in your skin. A lot of this can be hormone-related, as hormones can determine how much oil your skin produces. However, you can use a consistent skin care routine with topical agents intended to reduce blemishes.

Keeping redness fighters (plus a good concealer) on hand isnt a bad idea for when the occasional blemish pops up. But remember to call your dermatologist if your blemish wont go away after a few days of at-home care.

Link:
Quick and Easy Ways to Get Rid of Redness from Pimples and Acne - Healthline

Results of the search

We retrieved 139 records from the search of the electronic database and no other records from other sources (Fig.1). A total of 94 records were screened after duplicates were removed. We reviewed full copies of 13 and assessed them for eligibility. We identified four articles as possibly meeting the review inclusion criteria, and nine of them were ineligible for inclusion. One article was a non-randomized controlled trial that evaluated the clinical response of elagolix-treated women who did not achieve the primary outcome [22]. Two reviews, one on predictors of response to elagolix with add-back therapy and the other on medical treatment of uterine leiomyoma, were relevant to our research query [4, 23]. There was no outcome of interest in the four papers as two papers [3, 11] on elagolix pharmacotherapy and pharmacodynamics and another two more papers [14, 24] on drug-drug interactions were written. Adenomyosis was the topic of two more publications [25, 26]. We attempted to contact the trial authors for the full article but received no response. Therefore, we included four trials.

Four randomized controlled trials with 1949 participants were included in the study [27,28,29,30]. All four trials reported the primary outcome. All trials were sponsored by AbbVie [27,28,29,30].

All four studies were carried out in 323 locations across the United States, Puerto Rico, and Canada. One trial recruited participants from clinic settings [27]. The other three trials did not mention the location from which participants were recruited [28,29,30]. Three studies included premenopausal women aged 18 to 51 at the screening time [28,29,30], while one study recruited participants aged 2049 [27]. They underwent ultrasonography-confirmed diagnosis of uterine fibroids and heavy menstrual bleeding, as characterized by more than 80ml of menstrual blood loss per menstrual cycle for at least two cycles. The trials excluded participants due to a complex ovarian cyst, cancer, pelvic inflammatory disorder, osteoporosis history, or metabolic bone disease. Participants who had a myomectomy or hysterectomy for symptomatic uterine fibroid were exempted from the study [27,28,29,30].

Participants in the trials were randomized to the intervention and comparison groups. Two identical, double-blind, randomized, placebo-controlled, six-month phase 3 trials (Elaris Uterine Fibroids 1 and Elaris Uterine Fibroid 2) have been reported in one trial [29]. Elaris Uterine Fibroid-1 and Elaris Uterine Fibroid-2 participants were later randomized or pooled into a new study [30] to look at the long-term twelve-month safety and efficacy of elagolix with or without estradiol/norethindrone acetate. The meta-analysis included four trials that evaluated the primary outcomes. Three trials compared elagolix with placebo [27,28,29], and four trials compared to elagolix with estradiol/norethindrone acetate [27,28,29,30]. Only one trial compared elagolix to placebo at different doses of 100mg bd, 200mg bd, 300mg bd, 400mg qd, and 600mg qd [27]. One study was compared to placebo at doses of 300mg bd and 600mg qd [28]. Another trial was compared elagolix to placebo at a dose of 300mg bd [29].

In a comparison of elagolix to elagolix with estradiol/norethindrone acetate, one trial compared it at a dose of 0.5mg estradiol/0.1mg norethindrone acetate [27], while two trials compared it at a dose of 1.0mg estradiol/0.5mg norethindrone acetate [29, 30]. In one trial, elagolix was compared to elagolix with estradiol/norethindrone acetate at two doses: 0.5mg estradiol/0.1mg norethindrone acetate and 1.0mg estradiol/0.5mg norethindrone acetate [28]. All medications are taken orally as tablets or capsules. The duration of treatment differed between trials compared to elagolix versus placebo, as only one trial was three months [27], and the other two trials were six months [28, 29]. In contrast, the length of treatment differed between trials when comparing elagolix to elagolix with estradiol/norethindrone acetate, with a three-month [27], a six-month [28, 29], and a twelve-month [30] period.

The validated alkaline hematin method was used to quantify and evaluate the primary outcome in all four trials [27,28,29,30]. Any spotting or bleeding episodes on a sanitary pad were reported at the time of screening or during treatment. Participants kept an electronic daily bleeding diary (eDiary) and assessed bleeding patterns using the validated Mansfield-Voda-Jorgenson Menstrual Bleeding Scale [31]. All studies were followed up to at least three-months duration. The primary outcome was measured during the last month of the treatment period.

All four trials reported all secondary outcomes except for one study [27], which did not record bone mineral density due to a limited study time and a small sample size per group. Reduction of uterine and fibroid volume was calculated using trans abdominal or transvaginal ultrasound. The mean percentage change from baseline to the end of the treatment month was recorded.

The Uterine Fibroid Symptom and Quality of Life questionnaires cumulative score were used to measure symptom severity reduction and change in health-related quality of life in women with symptomatic uterine fibroids. It was a disease-specific, self-administered, validated questionnaire. There were 37 questions in all, split into two parts. The first part consisted of an 8-item symptom severity scale. The second part consisted of a 29-item health-related quality of life subscale with six domains (concern, behaviors, energy/mood, power, self-consciousness, and sexual function). All items are rated on a 5-point scale, with symptom intensity items ranging from not at all to a great deal, and health-related quality of life items ranging from none of the time to all of the time. The cumulative score for each of the two components was determined by adding the symptom intensity and health-related quality of life subscale scores and translating them to a 0-to-100-point scale. Higher overall health-related quality of life scores indicated better quality of life, while lower symptom severity scores indicate better quality of life.

The percentage of increase in hemoglobin concentration from baseline to the last month of treatment was reported in all trials. Loss of bone mineral density was assessed by dual-energy x-ray absorptiometry scans of the lumbar spine, total hip, and femoral neck. The mean percentage change in bone mineral density from baseline to the last month of treatment was recorded in three studies [28,29,30]. Any adverse events were recorded beginning with the first dose of the study drug and continuing for up to 30days after completing the last dose of the study drug. All four trials identified common adverse events such as hot flushes, headaches, nausea, and fatigue. In this review, only two trials documented adverse events such as abdominal pain, dizziness, and hypertension [27, 28]. Other non-significant adverse events identified in clinical trials will not be addressed in this review.

The assessment risk of bias is shown in Figs.2 and 3. Figure2 shows the proportion of studies assessed as low, high or unclear risk of bias for each risk of bias indicator. Figure3 shows the risk of bias indicators for individual studies. The details of these trials are found in the table of characteristics of included studies (Table 1).

Risk of bias graph: review authors judgements about each risk of bias item presented as percentages across all included studies

Risk of bias summary: review authors judgements about each risk of bias item for each included study

Only one trial, with 271 participants, was reported to have been recruited in a clinic setting, while the other three were not [27]. The method of randomization was not reported in all four trials [27,28,29,30]. Thus, we judged random sequence generation as having an unclear risk of bias. Allocation concealment was not mentioned and regarded as unclear in four trials [27,28,29,30].

Participants, care provider, investigator and outcome assessor were masked in all four trials. The details on blinding were not recorded in all four trials, but the outcomes were unlikely to be influenced as it was objectively collected and measured using standardized methods [27,28,29,30]. Therefore, they are judged as having a low risk of bias.

More than 80% of participants completed the studies in two trials [27, 30]. Meanwhile, 74.4% of participants in one trial completed the study [28]. Approximately 129 of the 571 participants failing to complete the analysis due to hypoestrogenism side effects (n=39), withdrawal (n=38), loss of follow up (n=25), noncompliance (n=11), lack of efficacy (n=3), surgery (n=4) and other (n=9) [28]. About 78% of 791 participants completed studies in Elaris Uterine Fibroid-1 and Elaris Uterine Fibroid-2 [29]. The study drug was discontinued by similar proportions of women in both treatment groups (16.5% for elagolix with estradiol/norethindrone acetateand 19.4% for elagolix alone), with the most common primary reason being lost to follow-up (5.0%and 5.1%,respectively) in one trial [29]. Missing data were evenly balanced across groups, and the reasons were similar. The most common reasons for missing outcome data included withdrawal, noncompliance, loss to follow up, hypoestrogenism side effects, pregnancy, and surgery, which led to discontinuation.

All four trials reported the outcomes as specified in their methods section[27,28,29,30]. The outcomes listed in the registered protocol were those reported. Although changes in bone mineral density were assessed as an exploratory parameter, one trial did not report due to the short duration of the study and the relatively small sample size per group [27]. We graded it as having a low risk of bias.

We discovered that women with asymptomatic anemia and a hemoglobin level of less than 12g/dl at screening or during the study period were advised to take iron supplements in two trials [27, 30]. This could have an influence on the hemoglobin level at the end of the treatment period. Thus, we judged it as having a high risk of bias. We detected no other potential source of bias in the other two trials [28, 29].

There would be two comparisons evaluated in this review, i.e., comparing elagolix versus placebo and comparing elagolix versus estradiol/norethindrone acetate.

Elagolix has increased the number of patients with a reduction of menstrual blood loss of less than 80ml (RR 4.81, 95% CI 2.45 to 9.45; I2 statistic=89%; P<0.001; four trials, 869 participants; moderate quality evidence) (Fig.4, Table 2) [27,28,29] or more than 50% from baseline (RR 4.87, 95% CI 2.55 to 9.31; I2 statistic=87%; P<0.001; four trials, 869 participants; moderate quality evidence) (Fig.5, Table 2) [27,28,29] compared to placebo. The sensitivity analysis did not change the cumulative effect estimate. Table 3 showed the subgroup analysis for reduction of menstrual blood loss of less than 80ml or more than 50% reduction from baseline stratified by frequency of drug administration, uterine and fibroid volume (Additional file 1).

Comparison between elagolix and placebo for the outcome reduction of menstrual blood loss of less than 80ml

Comparison between elagolix and placebo for the outcome reduction of menstrual blood loss of more than 50%

For the secondary outcomes, elagolix has increased the number of patients with improved hemoglobin level (RR 2.46, 95% CI 1.93 to 3.13; I2 statistic=0%; P<0.001; four trials, 554 participants; moderate quality evidence) [27,28,29], reduced the mean percentage change in uterine volume (MD 34.50, 95% CI 43.48 to 25.53; I2 statistic=63%; P<0.001; four trials, 783 participants; moderate quality evidence) [27,28,29], fibroid volume (MD 31.39, 95% CI 44.69 to 18.09; I2 statistic=65%; P<0.001; four trials, 750 participants; moderate quality evidence) [27,28,29], severity of symptoms (MD 31.54, 95% CI 41.85 to 21.22; I2 statistic=96%; P<0.001; four trials, 814 participants; low quality evidence) [27,28,29], and improved health-related quality of life (MD 30.64, 95% CI 20.14 to 41.15; I2 statistic=95%; P<0.001; four trials, 812 participants; low quality evidence) [27,28,29] (Additional file 1, Table 2) compared to placebo.

Elagolix has reduced bone mineral density in lumbar spine (MD 2.82, 95% CI 3.30 to 2.35; I2 statistic=0%; P<0.001; three trials, 574 participants; moderate quality evidence) [28, 29], total hip (MD 1.97, 95% CI 2.37 to 1.57; I2 statistic=46%; P<0.001; three trials, 574 participants; moderate quality evidence) [28, 29] and femoral neck (MD 1.92, 95% CI 2.61 to 1.23; I2 statistic=34%; P<0.001; three trials, 574 participants; moderate quality evidence) [28, 29] (Fig.6, Table 2) compared to placebo.

Comparison between elagolix and placebo for the outcome of bone mineral density (A: lumbar spine, B: total hip, C: femoral neck)

There was no significant of severe, serious or adverse event led to discontinuation of elagolix treatment. Elagolix has increased the number of patients with side effect of hot flush (RR 7.47, 95% CI 4.99 to 11.18; I2 statistic=8%; P<0.001; four trials, 890 participants; moderate quality evidence) [27,28,29] and headache (RR 1.88, 95% CI 1.25 to 2.83; I2 statistic=0%; P<0.001; four trials, 890 participants; low quality evidence) [27,28,29] (Fig.7, Table 4) compared to placebo.

Comparison between elagolix and placebo for the outcome of adverse events (A: hot flush, B: headache)

B) Comparison between elagolix and elagolix with estradiol/norethindrone acetate.

There was no difference in menstrual blood loss of less than 80ml (RR 1.08, 95% CI 1.00 to 1.16; I2 statistic=56%; P=0.070; five trials, 1365 participants; moderate quality evidence) (Fig.8, Table 5) [27,28,29,30] or more than 50% reduction from baseline between the elagolix (RR 1.08, 95% CI 1.01 to 1.15; I2 statistic=43%; P=0.020; five trials, 1365 participants; high quality evidence) (Fig.9, Table 5) [27,28,29,30] and elagolix with estradiol/norethindrone acetate. The sensitivity analysis did not change the cumulative effect estimate. Table 6 showed the subgroup analysis for reduction of menstrual blood loss of less than 80ml or more than 50% reduction from baseline stratified by dosage and uterine volume (Additional file 1).

Comparison between elagolix and elagolix with estradiol/norethindrone acetate for the outcome reduction of menstrual blood loss of less than 80ml

Comparison between elagolix and elagolix with estradiol/norethindrone acetate for the outcome reduction of more than 50% menstrual blood loss

Foe secondary outcomes, there was no difference improvement in hemoglobin level between elagolix (RR 0.99, 95% CI 0.80 to 1.22; I2 statistic=68%; P=0.930; five trials, 899 participants; low quality evidence) [27,28,29,30] and elagolix with estradiol/norethindrone acetate. However, elagolix has reduced mean percentage change in uterine volume (MD 17.47, 95% CI 27.54 to 7.40; I2 statistic=58%; P<0.001; five trials, 1250 participants; moderate quality evidence) [27,28,29,30], fibroid volume (MD 23.18, 95% CI 28.98 to 17.38; I2 statistic=0%; P<0.001; five trials, 1208 participants; high quality evidence) [27,28,29,30], symptoms severity (MD 9.05, 95% CI 9.68 to 8.43; I2 statistic=0%; P<0.001; five trials, 1288 participants; high quality evidence) [27,28,29,30], and increased health-related quality of life (MD 9.94, 95% CI 5.82 to 14.06; I2 statistic=76%; P<0.001; five trials, 1287 participants; low quality evidence) [27,28,29,30] (Additional file 1, Table 5) compared to elagolix with estradiol/norethindrone acetate.

Elagolix has reduced bone mineral density in the lumbar spine (MD 2.63, 95% CI 3.12 to 2.14; I2 statistic=49%; P<0.001; four trials, 1126 participants; moderate quality evidence [28,29,30], and total hip (MD 1.93, 95% CI 2.56 to 1.31; I2 statistic=75%; P<0.001; four trials, 1126 participants; very low quality evidence) [28,29,30] except femoral neck (MD 0.77, 95% CI 1.84 to 0.30; I2 statistic=78%; P=0.160; four trials, 1126 participants; very low quality evidence) [28,29,30] (Fig.10, Table 5) compared to elagolix with estradiol/norethindrone acetate.

Comparison between elagolix and elagolix with estradiol/norethindrone acetate for the outcome of bone mineral density (A: lumbar spine, B: total hip, C: femoral neck)

There was no difference of severe, serious or adverse event led to discontinuation between elagolix treatment and elagolix with estradiol/norethindrone acetate. Elagolix has increased the number of patients with side effect of hot flush (RR 2.67, 95% CI 2.30 to 3.10; I2 statistic=0%; P<0.001; five trials, 1403 participants; moderate quality evidence) [27,28,29,30], reduced the number of patients with risk of nausea (RR 0.63, 95% CI 0.43 to 0.91; I2 statistic=0%; P=0.010; five trials, 1403 participants; low quality evidence) [27,28,29,30] and fatigue (RR 0.43, 95% CI 0.23 to 0.80; I2 statistic=0%; P=0.008; five trials, 1403 participants; low quality evidence) [27,28,29,30] (Fig.11, Table 7) compared to elagolix with estradiol/norethindrone acetate.

Comparison between elagolix and elagolix with estradiol/norethidrone acetate for the outcome adverse event (A: hot flush, B: nausea, C: fatigue)

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Elagolix treatment in women with heavy menstrual bleeding associated with uterine fibroid: a systematic review and meta-analysis - BMC Women's Health...

Excess weight gain is never great news. But one form of weight gain is more dangerous than others. Putting on belly fatalso known as visceral fat or abdominal fatis a major hazard to your health. That's because this type of fat lies deep within the abdomen, near vital organs like the liver, pancreas, and intestines. It's metabolically active, meaning it actively releases toxic substances into those organs and bloodstream that raise the risk of cancer, heart disease, and diabetes. The good news: If you've packed on abdominal fat, you can take specific steps to burn it off. Here's what science says are some of the most effective ways to reverse that potentially deadly weight gain. Read on to find out moreand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

The easiest way to reduce visceral fat is to lose weight. According to W. Scott Butsch, MD, an obesity medicine specialist with the Cleveland Clinic, weight loss alone can effectively reduce visceral fat. And just sending the scale slightly in the right direction can have a major effect on deadly belly fat gain. By losing 10% of your body weight, you may lose up to 30% of your body fat, he says.

Visceral fat lives for sugar. "Fructose, or sugar, causes fat cells to mature faster, specifically in the visceral fat," says the Cleveland Clinic. Reduce the amount of sugar in your dietlike sugar-sweetened drinks, simple carbs, baked goods, processed foods, and fast foodsand you'll likely see your waistline shrink.

RELATED: I'm a Doctor and Here's How to Lose Visceral Fat

Researchers at Wake Forest University found that dieters who slept five hours or less every night put on 2.5 times more belly fat than people who got an adequate amount of sleep. Not sleeping enough can increase the production of cortisol, a stress hormone that tells the body to hold onto fat around the abdomen. Poor sleep alters the production of leptin and ghrelin, two hormones that regulate appetite, and that can increase feelings of hunger. And just plain being tired can cause you to overeat to try and boost your energy. How much sleep is ideal? Experts say seven to nine hours a night.

RELATED: The #1 Place to Not Walk Into Now, Say Virus Experts

According to a 2020 study published in the journal Nutrients, exercise reduces visceral fat even if you don't lose weight. That's because it lowers circulating insulin (which tells the body to hang on to fat) and tells the liver to burn nearby belly fat deposits. The best kind of exercise for belly-fat reduction is moderate-intensity activity combined with strength training, a 2021 review of studies found.

RELATED: Diabetes Warning Signs You Need to Know, Say Experts

Reducing stress can provide a one-two punch in the battle of the bulge. Chronic feelings of stress cause the brain to produce more cortisol, which makes belly fat hang around. Stressing out can also lead to comfort-eating fatty and sugary foods. The combination is a shortcut to belly fat, says a study published in The Annals of the New York Academy of Sciences.

RELATED: 7 Reasons to Use Marijuana, Say Doctors

Several studies have found that a high-protein diet can burn belly fat and help keep it off. One of the latest was published this summer in the journal Scientific Reports: Researchers found that a test group that took a protein supplement along with a mildly calorie-restricted diet lost more visceral fat than a group that took a placebo. Protein fills you up faster and for longer, and studies have found that it reduces levels of ghrelin, the hormone that tells the body it's hungry.And to get through this pandemic at your healthiest, don't miss these 35 Places You're Most Likely to Catch COVID.

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Best Ways to Reverse Deadly Weight Gain Eat This Not That - Eat This, Not That

(THE CONVERSATION) One of my patients who had been struggling with obesity, uncontrolled diabetes and the cost of her medications agreed in June 2019 to adopt a more whole-food plant-based diet.

Excited by the challenge, she did a remarkable job. She increased her fresh fruit and vegetable intake, stopped eating candy, cookies and cakes and cut down on foods from animal sources. Over six months, she lost 19 pounds and her HbA1c a measure of her average blood sugar dropped from 11.5% to 7.6%.

She was doing so well, I expected that her HbA1c would continue to drop and she would be one of our plant-based successes who had reversed diabetes.

Her three-month follow-up visit in March 2020 was canceled because of COVID-19 lockdowns. When I eventually saw her again in May 2021, shed regained some of the weight and her HbA1c had climbed to 10.4%. She explained that her diabetes doctor and a diabetes nurse educator had told her that she was eating too much sugar on the plant-based diet.

Shed been advised to limit carbohydrates by cutting back on fruits and starchy vegetables and eating more fish and chicken. Sugar-free candy, cakes, cookies and artificial sweeteners were encouraged. In the face of conflicting medical advice, she fell back on conventional wisdom that sugar is bad and should be avoided whenever possible, especially if you have diabetes.

Im a physician, board certified in preventive medicine with a lifestyle medicine clinic at Morehouse Healthcare in Atlanta. This emerging medical specialty focuses on helping patients make healthy lifestyle behavior modifications. Patients who adopt whole-food plant-based diets increase carbohydrate intake and often see reversal of chronic diseases including diabetes and hypertension. In my clinical experience, myths about sugar and carbohydrates are common among patients and health professionals.

Fruit vs. sugar

Your body runs on glucose. It is the simple sugar that cells use for energy.

Glucose is a molecular building block of carbohydrates, one of the three essential macronutrients. The other two are fat and protein. Starches are long, branching chains of glucose.

Naturally occurring carbohydrates travel in nutrient-dense packages such as fruits, vegetables, whole grains, nuts and seeds.

Humans evolved to crave sweet tastes to get the nutrients needed to survive. A daily supply of vitamins, minerals and fiber is needed because our bodies cannot make them. The best source of these substances for our ancient ancestors was sweet, ripe, delicious fruit. In addition, fruits contain phytonutrients and antioxidants, chemicals produced only by plants. Phytonutrients such ellagic acid in strawberries have cancer-fighting properties and promote heart health.

Refined sugars, on the other hand, are highly processed and stripped of all nutrients except calories. Theyre a concentrated form of carbohydrates. The food industry produces refined sugars in many forms. The most common are sucrose crystals, which youd recognize as table sugar, and high-fructose corn syrup, which is found in many processed foods and sweetened beverages.

If you continually satisfy your taste for sweet with foods that contain refined sugar rather than the nutrient-rich fruits at the core of this craving passed on by evolution you may not get all the nutrients you need.

Over time, this deficit may create a vicious cycle of overeating that leads to obesity and obesity-related health problems. Women who eat the most fruit tend to have lower rates of obesity.

Sugar toxicity

Refined sugars are not directly toxic to cells, but they can combine with proteins and fats in food and in the bloodstream to produce toxic substances such as advanced glycation end products (AGEs). High blood glucose levels may produce glycated low-density lipoproteins. High levels of these and other glucose-related toxic substances are associated with an increased risk of a wide range of chronic health problems, including cardiovascular disease and diabetes.

The disease most commonly associated with sugar is Type 2 diabetes. A surprising number of people, including health professionals, incorrectly believe that eating sugar causes Type 2 diabetes. This myth leads to a focus on lowering blood sugar and counting carbs while ignoring the real cause: progressive loss of pancreatic beta cell function. At diagnosis, a patient may have lost between 40% and 60% of their beta cells, which are responsible for producing insulin.

Insulin is a hormone that controls how much glucose is in the bloodstream by blocking glucose production in the liver and driving it into fat and muscle cells. Loss of beta cell function means not enough insulin gets produced, resulting in the high blood glucose levels characteristic of Type 2 diabetes.

Beta cells have low levels of antioxidants and are susceptible to attack by metabolic and dietary oxidized free radicals and AGEs. Antioxidants in fruit can protect beta cells. Researchers have found that eating whole fruit decreases the risk of Type 2 diabetes, with those who eat the most fruit having the lowest risk.

Detoxing from sugar

People interested in losing weight and improving health often ask if they should do a sugar detox. In my opinion this is a waste of time, because it is not possible to eliminate sugar from the body. For instance, if you ate only baked chicken breasts, your liver would convert protein to glucose in a process called gluconeogenesis.

Low-carb diets may lead to weight loss, but at the expense of health. Diets that significantly reduce carbohydrates are associated with nutrient deficiencies and higher risk of death from any cause. On low-carbohydrate ketogenic diets the body will break down muscles and turn their protein into glucose. The lack of fiber causes constipation.

Eliminating foods sweetened with refined sugar is a worthy goal. But dont think of it as a detox it should be a permanent lifestyle change. The safest way to go on a refined sugar detox is to increase your intake of nutrient-dense fruits and vegetables. Once you eliminate refined sugar, youll likely find that your taste buds become more sensitive to and appreciative of the natural sweetness of fruits.

Article written by Jennifer Rooke,Morehouse School of Medicine via Associated Press.

Continued here:
Sugar detox? Cutting carbs? A doctor explains why you should keep fruit on the menu - WJW FOX 8 News Cleveland

How do you diagnose hormonal acne?

While it's best to see a trusted doctor to determine if you have hormonal acne, there are a few things you can look out for to self-diagnose it. Here's what Dr Joshi said:

Now onto the part that anyone with hormonal acne wants to know about: how TF do you fix it?

"Treatment is similar to that in adolescence," Dr Joshi explained. "However, due to persistence, more aggressive treatments and a combination of treatments may be needed to get it under control even for relatively mild symptoms."

"By the time I see patients with persistent acne, they have usually tried various over-the-counter products, they may have been to salons for facials and other treatments, some of which may have made the acne worse, and may contribute to scarring andpigmentation."

Dr Joshi explained that because acne is a medical disease, treatment options need to be medical.

She suggests a combination of topical prescription medication, oral medication (for a period of time), and a personalised, usually basic, skincare regimen.

Listen to Mamamia's podcast for your face, You Beauty. Post continues after audio.

"You can speed up the process by adding a series of in-clinic treatments if you wish but it will take on average three to six months minimum to begin tosee results," she said.

With that being said, Dr Joshi suggests saving your time and money and going straight for a skin consultation with a trusted doctor to obtain personalised advice and prescription medication, if appropriate.

"Treatment is time-consuming and depending on what is involved, may be costly, but the alternative means that acne continues to persist and cause unwanted side effects such as scarring and pigmentation that will also need to be addressed at some point,with added time and cost," she said.

"See a doctor who understands acne and save yourself time, money and the heartache of complications, and have realistic expectations," Dr Joshi said.

"The longer people leave it, thinking it will go away, or trying a variety of different over-the-counter things, the longer the disease is percolating under the surface and the longer it takes to rein it in and the chances of complications such as scarringand pigmentation.

"Treatment takes time, which is the single biggest thing I tell patients. And relapses are common if life gets in the way and they drop the ball."

Feature Image: Getty/Canva/Mamamia.

Excerpt from:
Struggling with hormonal acne and how to fix it? A skin expert shares her best advice. - Mamamia

There are pros and cons to letting Fluffy or Fido snuggle up with you at night.

Image Credit: LIVESTRONG.com Creative

How Bad Is It Really? sets the record straight on all the habits and behaviors youve heard might be unhealthy.

If you crave peak cozy, welcoming your cat or dog or both onto your bed delivers. After all, it's just so companionable to have a pet nearby thanks to the comfort of touching fur and the soft sounds of purrs and snuffles. But should you let your dog sleep with you?

And after a day spent together cats twining through your legs while you make a morning cup of coffee, or your dog curled up nearby while you watch TV cuddling in bed with your pet seems only natural. Indeed, a slim majority (56 percent) of pet owners invite cats and dogs into their bedroom, according to a December 2015 article in Mayo Clinic Proceedings.

But there are some health implications to this practice. Here's what experts have to say about the pros and cons of bringing pets in the bedroom, and whether your dog (or other furry friend) should sleep with you.

1. Your Allergies and Asthma Might Get Worse

About a third of people in the U.S. are allergic to cats and dogs (with cat allergies more common), according to the Asthma and Allergy Foundation of America.

If you're one of that group, allowing your pet in the bedroom means about eight hours of exposure to allergens, says immunologist Heather Moday, MD, author of The Immunotype Breakthrough.

"Breathing in this level of allergens all night long can cause nasal congestion, sinus inflammation and airway irritation if you have asthma," Dr. Moday says. That makes it harder to get restful sleep, and means you'll wake up stuffy and tired in the morning, she says.

And it's not only pet allergies that you need to consider. Cats and dogs carry pollen and dust on their fur, Dr. Moday says. That means allowing pets in bed puts you in close contact with two more common allergens.

This can also exacerbate asthma, as allergies and asthma often go hand-in-hand. Common triggers (like dander, dust and pollen) that lead to allergic reactions like sniffles or itchy eyes can also set off asthma symptoms, according to the Mayo Clinic.

Regularly washing yourself and your pet is one allergy remedy that can help prevent excess dander, dust and pollen.

2. You Might Get Flea Bites

Some parasites like to live on cats and dogs (think: fleas, ticks and lice). And allowing your cat or dog in the bedroom is placing yourself in very close contact with these itch-causing creatures.

Fleas, for instance, bite humans, which can cause itching and irritation, per the Cleveland Clinic.

3. Your Sleep Could Suffer

When it comes to sleep hygiene, there aren't any benefits to having pets in bed, says sleep psychologist Samina Ahmed Jauregui, PsyD, a Pluto Pillow advisor.

But there are some drawbacks: Pets like to move at night, says Abhinav Singh, MD, facility director of the Indiana Sleep Center and member of the National Sleep Foundation medical advisory board. "That can wake people up," he says.

And it's hard to go back asleep after waking up, especially as we age, Dr. Singh says which could reduce the quantity of sleep you get each night.

You'll know it if your pet wakes you up at 3 a.m. and you can't fall back to sleep right away. But what might be more insidious is when a pet's movement causes you to readjust more frequently than you would otherwise.

"Micro-awakenings are not recallable," Dr. Singh says. In other words, if you briefly wake up to toss and turn due to your cat or dog stirring, it's not long enough for your brain to register as a moment of wakefulness. But those brief bursts of sleeplessness still have an effect.

Dr. Singh compares it to flying: Would you rather fly nonstop or have seven connecting flights en route to your destination? These small, routine disruptions diminish the quality of your shut-eye. That'll leave you feeling unrested in the morning, even if you diligently clocked the Centers for Disease Control and Prevention-recommended seven-plus hours of sleep.

Jauregui sums it up: "Even if you are able to return to sleep quickly, having woken up in the first place is a disturbance in quality of sleep."

4. It Could Improve Your Mood

It's not all doom and gloom. Bringing a pet into your bedroom is associated with some significant mental health benefits.

"Many people claim to really enjoy sleeping with their animals because they feel less lonely and happier with their pets," Dr. Moday says. And there are studies to back that up.

For instance, in a survey of just under 1,000 pet owners assigned female at birth, dogs were "associated with stronger feelings of comfort and security" compared to human bed partners, according to November 2018 research in Anthrozos.

Also among the research-backed benefits of time with pets are an increase in oxytocin (a feel-good hormone) and a decrease in cortisol (a stress hormone), according to Johns Hopkins Medicine.

While Dr. Singh generally thinks bringing a pet to bed is best avoided, he makes an exception for someone who is overcoming loss or trauma and finds comfort in a pet's presence. "The dog or cat can be there to support you [and] help you recover emotionally," he says.

7 Healthy Tips for Sleeping With Your Pet in the Bed

Though there are some solid reasons why your dog shouldn't sleep with you, the joys of companionship likely outweigh these potential downsides if you and your pet are in the habit of sharing a bed.

We get it. So if you're disregarding the experts' take and persist in welcoming Fluffy or Fido onto the mattress, follow these strategies to reduce potential pitfalls:

So, How Bad Is It Really to Let Your Pet Sleep in Bed With You?

When it comes to deciding if you should let your dog sleep with you, truly, it depends.

Dr. Singh notes he has cats, and is an animal-lover but if forced to give a bottom line, he notes it's "generally not advisable" to sleep with your pet. It's also best avoided if you have allergies or allergy-trigged asthma. Instead, he recommends having a cat or dog bed or blanket in your bedroom, beside your bed, but not on it.

Jauregui agrees that it's best to keep the bedroom pet-free. But, she adds: "If you struggle with sleep and are not comfortable sleeping in the bed by yourself, then having a pet in the bed with you (that is large enough for both of you) can be OK." Some sleep even if it's potentially disrupted would be better than none, she says.

And if you just can't quit those nighttime snuggles (guilty!), follow the best practices described above when it comes to laundry, pet care and adjusting your sleep routine.

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How Bad Is It Really to Let Your Pet Sleep in Your Bed? - Livestrong

FROM NORTH AMERICA SYNDICATE, 300 W 57th STREET, 15th FLOOR, NEW YORK, NY 10019

CUSTOMER SERVICE: (800) 708-7311 EXT. 236

TO YOUR GOOD HEALTH #TFB20211018

FOR RELEASE WEEK OF OCT. 18, 2021 (COL. 1)

BYLINE: By Keith Roach, M.D.

---

DEAR DR. ROACH: I am a 71-year-old female in very good health. I have been taking a thyroid replacement since I was 12 years old. I currently take 125 mcg of thyroxine once daily, as well as 60 mg of Cymbalta. Other than arthritis and obesity, I have no health problems. My question is regarding my lab results. My TSH is 0.04 (the normal range is 0.30-5.5); my T3 and T4 are in the normal range. My physician assures me that as long as my T3 and T4 are normal, the TSH is of no concern. I cannot lose weight, no matter what I try. Would you suggest I see an endocrinologist, or is my primary doctor correct? -- D.A.

ANSWER: The thyroid stimulating hormone is a signal from the pituitary gland to the thyroid to "tell" the thyroid to make more hormone. Since your TSH level is low, it suggests that the dose of replacement thyroid hormone is too high. This is despite the fact that the T3 (the active form of thyroid hormone) and T4 (thyroxine, the major thyroid hormone, which T3 is made from) are normal, and despite the fact that you report no symptoms. The range of normal for T3 and T4 is very broad, and the low TSH is good evidence that those levels are too high for you.

Excess thyroid hormone can cause bone disease and predispose to heart problems, such as atrial fibrillation. I think an endocrinologist is likely to say that your dose of thyroxine should be decreased.

Story continues below video

DEAR DR. ROACH: I have a history of C. diff. I had the shingles vaccine, and developed severe diarrhea, which has lasted eight weeks. Could the vaccine have instigated this? I'm now on vancomycin, and it is helping. -- M.G.

ANSWER: Clostridioides difficile is most commonly associated with antibiotic use, but can be acquired in a hospital or other nursing facility or even out in the community. I have never heard of C. diff as a complication of a vaccine, so I did a search on the VAERS database of vaccine side effects. I found no reported cases of C. diff with the shingles vaccine. I really didn't expect to.

Vaccines are a powerful public health tool, and like all medicines, they have the potential for side effects. It is human nature, when presented with a health change, to ascribe it to any new event, such as a new medicine or vaccine. Sometimes they are linked, but sometimes they are not. In this case, I think they most likely are not.

DEAR DR. ROACH: I had my first pneumonia injection (PCV13) in October 2015 and the second injection (PPSV23) in October 2016. My primary care physician sends me reminders that my pneumonia shot is past due. The head nurse at the same primary care clinic reviewed my medical files and says I do not need additional pneumonia shots for the rest of my life. I have asked my cardiologist, urologist and gastroenterologist if I need to update my pneumonia injections, but they avoid answering me. I am 72 years old and have health problems. Since the COVID virus affects the lungs and many suffer from pneumonia, I am concerned about my protection, although I have both Moderna vaccinations. Should I get a pneumonia shot? -- C.V.

ANSWER: Your nurse is correct, you are not recommended for any additional pneumonia vaccines at this time. These pneumonia vaccines protect against only one bacterium, Streptococcus pneumoniae, with no protection against COVID-19. You should get your third dose of Moderna when it's recommended (expected at the time of this writing to be eight months after your second dose). That is, unless the recommendations have changed by then -- this is a fast-moving area!

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

(c) 2021 North America Syndicate Inc.

All Rights Reserved

More here:
TSH tells thyroid gland to make more hormone - New Castle News

Introduction

Polymyalgia rheumatica (PMR) and remitting seronegative symmetrical synovitis with pitting edema syndrome (RS3PE syndrome) are diseases of unknown etiology that affect elderly persons. They are characterized by pain of sudden onset that continues and elevated erythrocyte sedimentation rate and C-reactive protein levels.1 Once the symptoms develop, they greatly impair patients quality of life. With the aging of the population, an increase in the number of such patients has been reported from the UK.2 The incidence of PMR has been found to be higher in individuals of Scandinavian background, lower in Southern European countries, and unknown in Japan.3,4 Although the symptoms improve markedly with glucocorticoid (GC) treatment, prudent tapering of GC is required.5 Although GC could be decreased from the initial dose in all PMR patients, it is difficult to stop GC treatment, as has been previously reported.6 Past studies reported that relapse has been variably associated with female sex, longer duration of morning stiffness, peripheral arthritis, higher erythrocyte sedimentation rate at diagnosis, persistent elevations of C-reactive protein, interleukin-6 levels, and soluble interleukin-6 receptor levels, larger initial doses of prednisone, and a faster rate of tapering.7 Furthermore, reports of GC continuation and risk factors for relapse in Japanese PMR patients are few.4 To better estimate GC treatment duration, the percentage of patients who could stop GC treatment and the baseline variables associated with inability to withdraw GC after the time when the GC continuation rate stopped decreasing were examined. In particular, sex differences were examined.

A total of 105 patients (64 women) who were started on GC treatment for PMR and/or RS3PE syndrome at Ikeda City Hospital from July 2004 to December 2019 were evaluated. Birds criteria8 were used up to 2014, and the EULAR/ACR polymyalgia rheumatica interim standard of classification9 was used between 2015 and 2019 for PMR diagnosis. Patients who showed pitting edema of both hands and both lower extremities and did not fulfill the diagnostic criteria of rheumatoid arthritis,10 spondyloarthropathy,11 or other diseases were diagnosed as having RS3PE syndrome. Both PMR and RS3PE syndrome were diagnosed in patients with PMR who showed pitting edema of both hands and both lower extremities without other cause.

The GC dose was left to the discretion of the attending physician. The initial dose of prednisolone is generally 10 to 16 mg/day, and the aim is to discontinue it by 24 years. The dose was actually reduced by 2.5 mg/day every 24 weeks in patients treated with >10 mg/day, and by 1 mg/day every 24 weeks in patients treated with 10 mg/day.7 When symptoms returned with GC reduction, the attending physician increased the dose promptly. GC was continued when it was resumed for disease recurrence once it had been stopped.

The days from GC initiation to GC withdrawal were calculated. If GC could not be stopped, the last observation day was used. The GC continuation rate during the observation period was then estimated by the KaplanMeier method, creating KaplanMeier curves by sex.

Furthermore, cases that had stopped GC (withdrawal group) and cases that had continued GC for 7.5 years (continuation group) were identified, and the following were compared between them: Age at time of starting GC treatment; sex; type (PMR and/or RS3PE syndrome); erythrocyte sedimentation rate, C-reactive protein, hemoglobin, ferritin, aspartate aminotransferase, and alanine aminotransferase levels before starting GC; days from onset of symptoms to GC initiation; GC maximum dose; GC dose half a year after it was started; presence of relapse (GC restarting or increasing due to deterioration of symptoms); and the presence of concomitant malignant disease. Cases belonging to neither the withdrawal group nor the continuation group constituted the intermediate group. Patients with malignant diseases were counted when they were diagnosed with them within 6 months since GC was started for PMR or RS3PE syndrome. It was thought that cases in the intermediate group included cases that would be reclassified to the withdrawal group or the continuation group if they were observed for a longer time. It was expected that the parameters associated with GC continuation in the intermediate group would be between those of the withdrawal group and the continuation group and totaled the parameters in the intermediate group.

This survey was based on a chart review, but a telephone poll of patients whose charts could not be reviewed was conducted.

Statistical analyses were performed with IBM SPSS Statistics, version 27. KaplanMeier curves were compared using the Log rank test. Comparisons between the withdrawal group and the continuation group were made with Students t-test for independent continuous variables, and the chi-squared test was used to compare categorical data between groups.

This investigation protocol adopted the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Ikeda City Hospital Ethics Committee (approval number A20010). The data accessed from the medical records were de-identified in this report. Because this report contains no individual persons data, and this investigation was observational and noninterventional, the Ikeda City Hospital Ethics Committee waived the need for patient consent.

There were 58 cases diagnosed by Birds criteria, 43 cases diagnosed by the EULAR/ACR polymyalgia rheumatica interim standard of classification, and 4 cases with pure RS3PE syndrome. There were 32 cases in the withdrawal group and 17 cases in the continuation group.

The dose of GC could be reduced from the initial dose in all patients.

The duration from the onset of symptoms to GC therapy starting was 79.579.6 days (meanSD) in all patients.

The GC continuation rate 7.5 years after starting GC was 52.5% in all patients, 69.2% in women, and 27.1% in men. The rates remained unchanged for 15 years (Figures 1 and 2). The GC continuation rate was significantly higher in women (Log rank test). No patients were prescribed immunosuppressants.

Figure 1 Glucocorticoid continuation rate of all cases (KaplanMeier method).

Figure 2 Glucocorticoid continuation rate by sex (KaplanMeier method). The glucocorticoid continuation rate is higher in women (P=0.020).

P values by Students t-test or the chi-squared test are shown in the table for the other survey items, including numbers of cases, with data displayed as mean standard deviation (Table 1). Since there was a case with suspected temporal arteritis at the beginning in the withdrawal group that was treated with prednisolone 50 mg/day, this case was excluded as an abnormal value for the GC maximum dose and the GC dose half a year after its initiation. In the withdrawal group, there were few women (P=0.016). In all patients, hemoglobin levels (mean SD) before starting GC were lower (10.51.6 g/dL) in women than in men (11.41.8 g/dL) (P=0.014). In the withdrawal group, they were 10.91.5 g/dL in women and 11.91.6 g/dL in men. In the continuation group, they were 10.41.9 g/dL in women and 10.02.8 g/dL in men. Relapses were fewer in the withdrawal group than in the continuation group (P=0.0003).

Table 1 Clinical Features of the 105 Patients

In this study, the duration of GC treatment for PMR and RS3PE syndrome in Japanese patients was longer than in previous reports in English.12 GC treatment was needed for a longer time in women than in previous reports, and it was difficult to stop GC treatment in cases with severe anemia.

Although it has been reported that female sex is a risk factor for long-term GC treatment by Narvez et al13 and Cimmino et al,14 there has been no English-language report from Japan. Aoki et al reported the GC treatment duration of Japanese PMR patients, and they found no difference between men and women.12 They classified their patients into two groups by whether they had stopped GC therapy as of 24 months. Therefore, their observation period was shorter than in the present study. Two important factors causing sex-based disparities are genetics and sex hormones.15 Estrogen enhances B cell differentiation and immunoglobulin production.16 Several studies reported an immunosuppressive role of testosterone on different components of the immune system.15 Furthermore, the small number of GC receptors or low GC receptor affinity in woman may have an effect.14

In the present study, although the GC continuation rate fell to 55.6% at 7 years and 5 months, it did not fall further. The necessity for continuing GC differed among reports. Aoki et al reported that the median time of remission was 16 months.12 Cimmino et al reported that about 26% of the patients required GC treatment for 6 years or more.14 Shbeeb et al reported that the median GC treatment period was 5.95 years.17 Although the present study found a longer GC treatment period than previous reports, a prudent approach to GC dose reduction may have been one reason, given the report of a certain rate of disease recurrence in the report by Aoki et al.12 In 17 patients in the continuation group, three patients have not relapsed. This may show that our treatment is sometimes passive with respect to reducing the GC dose. Although there may have been a bias among certain institutions for longer GC treatment, the bias among institutions cannot explain the sex difference. There sometimes were newly suspected patients who received no GC treatment while waiting for spontaneous resolution. This study included no spontaneously resolved patients. The duration from the onset of symptoms to the start of GC therapy in all patients was over 2 months. This might be one reason for the long GC continuation in this study, and it might be a characteristic of Japanese/Asian people.

There are many more female than male patients. In Ikeda City, in which our hospital is located, the population aged 60 years and over as of March 31, 2020, included 18,880 women and 14,506 men.18 Therefore, it cannot be said that the incidence is higher among women than men.

Since PMR and the RS3PE syndrome often merged, they were considered together in one group.1,19 Since there are few pure RS3PE syndrome cases, whether there are differences between PMR and RS3PE syndrome in GC continuation and by sex is unknown. Aoki et al observed peripheral edema in 41 of 93 PMR patients.12 Such cases would be considered combined PMR and RS3PE syndrome cases according to the definition used in the present study.

Origuchi et al reported that GC dose and CRP 1 year after starting therapy were high in men with RS3PE syndrome.20 In the report by Origuchi et al, the observation period was 1 year, shorter than in other reports.20 In the present study, the womens continuation rate was also not high until 1.4 years after starting.

The present data showed severe anemia in the GC continuation group. Narvez et al reported that hemoglobin levels were low in women with PMR.13 They considered that anemia reflects intense inflammation. The range of ferritin was large for every case, and the difference between the withdrawal group and the continuation group was not clear. Ferritin levels were high in all groups, reflecting the impaired iron utilization in these diseases.

As a limitation of the present investigation, the number of patients was insufficient for a multivariable statistical analysis of the GC continuation rate and anemia. In addition, because some of the patients were interviewed by telephone, recall bias may have occurred. Because this study was retrospective, sex hormone levels were not measured before treatment; it is a future task to measure them in order to identify causes of the sex difference.

When considering the future treatment strategy for PMR and RS3PE syndrome in Japan, it is important to note that it is difficult to stop GC treatment for women and for those with severe anemia.

It is difficult to stop GC for PMR and/or RS3PE syndrome in women in Japan, especially in cases with severe anemia.

All authors have no conflicts of interest that should be declared. All authors take full responsibility for the content of this paper.

1. Mimori A. Polymyalgia rheumatica/PMR & remitting seronegative symmetrical synovitis with pitting edema/RS3PE (in Japanese). In: Mimori A. Physicians Notes on Rheumatology: The Process of Clinical Consideration. 4th ed. Tokyo, Japan: Japan medical journal; 2019:413426.

2. Partington RJ, Muller S, Helliwell T, Mallen CD, Sultan AA. Incidence, prevalence and treatment burden of polymyalgia rheumatica in the UK over two decades: a population-based study. Ann Rheum Dis. 2018;77(12):17501756. doi:10.1136/annrheumdis-2018-213883

3. Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ, et al. Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Care Res. 2009;61(10):14541461. doi:10.1002/art.24459

4. Nishioka K, Tanaka T. [Rheumatology: Progress in diagnosis and treatments. topics: III. Rheumatoid arthritis and allied conditions; 2. Allied conditions. 2) polymyalgia rheumatica]. Nihon Naika Gakkai Zasshi. 2014;103(10):24402448. Japanese. doi:10.2169/naika.103.2440

5. Hernndez-Rodrguez J, Cid MC, Lpez-Soto A, Espigol-Frigol G, Bosch X. Treatment of polymyalgia rheumatica: a systematic review. Arch Intern Med. 2009;169(20):18391850. doi:10.1001/archinternmed.2009.352

6. Muratore F, Pipitone N, Hunder GG, Salvarani C. Discontinuation of therapies in polymyalgia rheumatica and giant cell arteritis. Clin Exp Rheumatol. 2013;31(4 Suppl 78):S86S92.

7. Docken WP. Treatment of polymyalgia rheumatica [homepage on the Internet]. Wolters Kluwer; 2018 [Updated September 7, 2018]. Available from: https://www.uptodate.com/. Accessed February 21, 2020.

8. Bird H, Esselinckx W, Dixon AS, Mowat A, Wood P. An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis. 1979;38(5):434439. doi:10.1136/ard.38.5.434

9. Dasgupta B, Cimmino MA, Kremers HM, et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European league against rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012;64(4):943954. doi:10.1002/art.34356

10. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheumatism. 1988;31(3):315324. doi:10.1002/art.1780310302

11. Dougados M, Linden SVD, Juhlin R, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheumatism. 1991;34(10):12181227. doi:10.1002/art.1780341003

12. Aoki A, Kobayashi H, Yamaguchi Y. Predictors of long-term therapy with glucocorticoid in polymyalgia rheumatica. Modern Rheumatol. 2020;31(2):417426. doi:10.1080/14397595.2020.1777680

13. Narvez J, Nolla-Sol JM, Valverde-Garca J, Roig-Escofet D. Sex differences in temporal arteritis and polymyalgia rheumatica. J Rheumatol. 2002;29(2):321325.

14. Cimmino MA, Parodi M, Caporali R, Montecucco C. Is the course of steroidtreated polymyalgia rheumatica more severe in women? Ann N Y Acad Sci. 2006;1069(1):315321. doi:10.1196/annals.1351.030

15. Trigunaite A, Dimo J, Jrgensen TN. Suppressive effects of androgens on the immune system. Cell Immunol. 2015;294(2):8794. doi:10.1016/j.cellimm.2015.02.004

16. Moulton VR. Sex hormones in acquired immunity and autoimmune disease. Front Immunol. 2018;9:2279. doi:10.3389/fimmu.2018.02279

17. Shbeeb I, Challah D, Raheel S, Crowson CS, Matteson EL. Comparable rates of glucocorticoid-associated adverse events in patients with polymyalgia rheumatica and comorbidities in the general population. Arthritis Care Res. 2018;70(4):643647. doi:10.1002/acr.23320

18. Ikeda City Office [homepage on the Internet]. Populations in Ikeda city by age and sex (in Japanese); April 2, 2020. Available from: http://www.city.ikeda.osaka.jp/material/files/group/4/020331_nenreibetu.pdf. Accessed July 25, 2020.

19. Cantini F, Salvarani C, Olivieri I, et al. Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome: a prospective follow up and magnetic resonance imaging study. Ann Rheum Dis. 1999;58(4):230236. doi:10.1136/ard.58.4.230

20. Origuchi T, Arima K, Umeda M, et al. Clinical outcomes in the first year of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. Modern Rheumatol. 2017;27(1):150154. doi:10.1080/14397595.2016.1192744

Read more:
Glucocorticoid therapy withdrawal in polymyalgia rheumatica | IJGM - Dove Medical Press

Komal Jhaveri, MD, discussed the case of a 63-year-old patient with HER2-positive metastatic breast cancer during a Targeted Oncology Case-Base Roundtable event.

During a Targeted OncologyTM Case-Based Roundtable event, Komal Jhaveri, MD, the section head of the Endocrine Therapy Research Program, clinical director, of Early Drug Development Service, and a medical oncologist at Memorial Sloan Kettering Cancer Center in New York, NY, discussed the case of a 63-year-old patient with HER2-positive metastatic breast cancer.

Targeted OncologyTM: How typical is the presentation of this patient in your clinical practice, and what data are most relevant to you in choosing a treatment approach?

JHAVERI: According to the recently updated NCCN [National Comprehensive Cancer Network] guidelines in systemic therapy options for recurrent stage IV disease, we use a taxane with a dual HER2 blockade, which is trastuzumab and pertuzumab in the first line.1 This is obviously based on the unprecedented progression-free survival [PFS] and overall survival [OS] benefit in the CLEOPATRA trial [NCT00567190].2 The paclitaxel was based out of a phase 2 trial that was conducted by my colleague, Chau Dang, MD, here at Memorial Sloan Kettering Cancer Center, and we did not see any febrile neutropenia with the paclitaxel, so that has really become our go-to regimen in the first line.3

What data support treatment options in the second-line setting?

In the second-line setting, we have data from the EMILIA trial (NCT00829166), which led to T-DM1, or ado-trastuzumab emtansine, an antibody-drug conjugate [ADC], the first one for breast cancer.4 This is despite this trial not having patients progressing on trastuzumab, but in clinic this is our contemporary choice...for our patients. Additionally, we have a plethora of options that patients can receive on the third line and beyond. These include tucatinib [Tukysa] plus trastuzumab plus capecitabine [Xeloda] and fam-trastuzumab deruxtecan-nxki [Enhertu].1 We also have other chemotherapies with trastuzumab, such as capecitabine with trastuzumab and capecitabine with other TKIs [tyrosine kinase inhibitors]. There are targeted therapies, including a recent approval for margetuximab-cmkb [Margenza], an Fc-optimized antibody that was approved for use with chemotherapy in this last year.5

We have these many options, but what we do not know is the optimal sequence for third-line therapy and beyond.

Now, what is interesting here is that the triplet of tucatinib plus trastuzumab plus capecitabine, per the NCCN guidelines, is preferred in patients with both systemic and CNS progression on ado-trastuzumab emtansine.1 However, it may be given even in the second-line setting. Fam-trastuzumab deruxtecan is preferred in patients with visceral metastases [if there is disease] progression on ado-trastuzumab emtansine. [However, it is] contraindicated for patients with known pneumonitis or interstitial lung disease.

What makes this ADC special? Why is it distinct from T-DM1?

I think there are a few key attributes that we might want to think of [in] T-DXd [trastuzumab deruxtecan]. One is that the drug-to-antibody ratio [DAR] is 8 molecules of chemotherapy that can be delivered. Now, to put this into context when we think of T-DM1 therapy, that DAR is 3.5. So we are delivering more chemotherapy to the tumor cell. The payload itself is a topoisomerase I inhibitor, which we do not regularly use for our HER2- positive patients.

It is a highly potent payload, which the patients have not seen...in their regimens, and it has a very short half-life, so the free payload has a very short half-life, which is great. The linker is stable, and it is a tumor selective cleavable linker. Once this is delivered to the tumor, it is the pepsin in the tumor that makes the linker cleave and then deliver the payload. It is very tumor selective, so one can potentially expect less off-target toxicity.

And another important attribute to keep in mind is the bystander effect. It has membrane permeability, and so this payload can be membrane permeable and go to the neighboring cells, which might not necessarily be HER2 overexpressing. But that is why we have also seen activity in what we now call HER2 low, which is HER2 IHC 1+ and 2+ patients who have shortened benefit with T-DXd and other novel inhibitors that are also being developed and have this bystander effect. Of note, T-DM1 does not have that. And as we know, we do not utilize T-DM1 for patients who do not have HER2-amplified or HER2- expressive tumors.

Please discuss how the DESTINY-Breast01 trial [NCT03248492] has affected decisions for this patient.

[These data that] led to the approval of trastuzumab deruxtecan [were from] an open-label, multicenter, phase 2 trial [that enrolled] patients 18 [years] or older with unresectable metastatic breast cancer who had centrally confirmed HER2-positive disease and who had prior T-DM1.6,7 Patients with a history of interstitial lung disease were excluded.

This was because [of what] we had already learned from an adjudication committee that was put in place with the phase 1 experience of this agent. And stable, treated brain metastases were allowed to enroll on this trial. These patients were then enrolled in 2 parts. Part 1 included a PK [pharmacokinetic] stage and a dose-finding stage. In the PK stage, we studied 3 doses of which two, 5.4 mg/kg and the 6.4 mg/kg, moved on to the dose-finding stage. Based on the PK data and the safety data, the 5.4 mg/kg [dose] was selected to move forward and is the current recommended and approved dose.

This was the dose that moved into the continuation stage, where most of the patients had TDM-1 resistant disease. There were 4 patients who had TDM-1 intolerance, for a total of 184 patients [who] were treated with this dose, 5.4 mg/kg, with a primary end point of ORR [overall response rate]. One thing that I would like to highlight is that these patients have received up to 6 prior lines of therapy, and [approximately] two-thirds received prior pertuzumab therapy.

Additional baseline characteristics [also should be considered]. Median age was [approximately] 55 years. These were patients predominantly with a good performance state. [Approximately] 50% of these patients were hormone receptor positive. [Approximately] 84% had HER2 positivity by IHC 3+ expression. The remaining were IHC 2+ or 1+ or ISH [in situ hybridization] positive. Visceral disease was present in 92% of patients, of whom 57% had lung metastases. This is important to remember for the discussion of our case. Liver metastases were present in 30%, and the rest also had bone disease. There were 24 [13%] of these patients enrolled in the trial who also had stable, treated brain metastases.

How do the updated data from the DESTINY-Breast01 trial affect treatment decisions?

In the updated DESTINY-Breast01 trial data from June 2020, all but 4 patients had tumor shrinkage.8 The overall response rate, despite this [population being] heavily treated with a median of 6 prior lines of therapy, was 61.4%, including patients who had a complete response. The median duration of response, which is also very important to understand for our patients who are heavily pretreated, was 21 months in this phase 2 trial. And this response was seen rather early: time to response was 1.6 months. So if you are really worried about somebody with extensive disease or burdened disease, this was a quick response with this drug.

The median PFS in DESTINY-Breast01 was 19.4 months. This is rather impressive for such a heavily pretreated population. Just to put this into context and into perspective, when we think of other trials in the third line and beyond, whether it was the TH3RESA trial [NCT01419197] that studied TDM-1 with physician choice therapy, the NALA study [NCT01808573], the HER2CLIMB study [NCT02614794], or the SOPHIA trial [NCT02492711], the median PFS for the patient population [in the] third line [was approximately] 7 to 8 months.9-12 The PFS [in DESTINY-Breast02] of 19.4 monthsin such a heavily pretreated population, I think it is really unprecedented.8 The median OS data at 21 months was 25 months, but what I would really like to highlight here is that this is just 35% maturity of data, and we really need follow-up maturity now to understand the implications. [Approximately] 119 patients were already censored, and 17 were thought to have events at month 2, so at 18 months we had 74% alive, but [these are] still immature data.

Did these data show progression of disease in other areas?

A subgroup analysis for the 24 patients [13%] in the CNS subgroup was presented at ASCO [American Society of Clinical Oncology Annual Meeting] this year.13 Seventeen patients had brain lesions at baseline, and the data [were] available to evaluate responses in the brain for 15 of the 17. Though this was a small subgroup, it was important that there were responses seen in patients with stable brain metastases; 41% had a partial response and another 41% had disease stabilization in the brain. Again, this subgroup also had median of 6 lines of therapy, the same as the total population. Median follow-up here was 11 months, and...in the CNS subgroup, the ORR, PFS, and duration of response were comparable to those in the total patient population treated at the same dose. The median PFS in this population with brain metastases was 18 months [95% CI, 6.7-18.1]. There was also an additional case report where we saw 55% regression of a metastatic brain lesion.

The most common sites when we looked at progression were the liver, lung, and lymph nodes, which was similar in all patients total and the CNS subgroup. Meaning, once you were in the CNS subgroup or the total patient population and then you progressed, the common types of progression were within the liver, lungs, and lymph nodes. Progression in the brain was not as common. There were only 4 of 48 patients who had progressed in the brain, including 2 out of the 8 patients with baseline CNS metastases.

What is the safety profile of T-DXd?

I think the most common adverse events [AEs] that we see, and that were seen in more than 10% of the patients in the study, were nausea, vomiting, alopecia, fatigue, and neutropenia.14 But an important AE that we want to keep in mind is the drug-related ILD [interstitial lung disease] or pneumonitis. The ILD incidence that was reported initially with the August 2019 data cutoff was 25 patients [13%] who developed ILD or pneumonitis. The majority had grade 1 or grade 2 ILD or pneumonitis; however, there were 4 fatal events. The median time to developing ILD was 4.1 months. At the additional 1-year cutoff, and overall median cutoff, there were 3 additional ILD cases determined by the independent adjudication committee.

ILD events were seen mostly within the first 12 months, and after the 12-month mark, only 1 patient developed ILD, perhaps suggesting that ILD is not a cumulative AE. But this is something that we really must be aware of, and not just us, but also our frontline nursing staff who are fielding the calls when the patient calls in. [If there are symptoms that may indicate ILD or pneumonitis,] whether they have shortness of breath, a new cough, extreme fatigue, [we need] to quickly interrupt therapy, get pulmonology involved, and give patients steroids. [There are] patients who are asymptomatic, [so we have] to keep a very close eye on this to make sure that we are not missing anything.

We have become more trained look for these [potential AEs] given that there are so many classic agents with breast cancer that cause pneumonitis: checkpoint inhibitors and everolimus, and [also] CDK4/6 inhibitors....I think we all have become a little more vigilant about keeping a close eye on symptoms for our patients and for also for keeping an eye on the scans to make sure that we are not missing the so-called ground glass opacities for which we might want to interrupt or discontinue therapy. Fortunately, the heart events or cardiac events were very low, including left ventricular ejection fraction decreases or cardiac failure, as is seen with trastuzumab.

What was the design of the HER2CLIMB phase 2 trial?

[Lets move on] then to the phase 2 HER2CLIMB trial of tucatinib [Tukysa] and capecitabine and trastuzumab, which studied patients with HER2-positive metastatic disease who had prior treatment with trastuzumab, pertuzumab, and T-DM1.15 What was key in the study was that active brain metastases not needing local therapy were allowed, but they were not required. So you could have had treated, stable brain metastases, but you were also allowed to have active brain metastases. What is important to remember here is that these are patients with small tumors, less than 2-cm tumors, who do not have symptoms warranting local therapy. They did not require immediate radiation and they were [still] considered eligible.

[More than] 600 patients were enrolled410 in the tucatinib arm and 202 in the placebo arm.15 And they were well-balanced groups with a median age of [approximately] 55 years, all with predominantly good performance status; 60% were hormone receptor positive; overall, they had received 4 prior lines of therapy. Forty-eight percent had a history of brain metastasis. Of these 48%, 60% [of the brain metastases] were stable and treated. The remaining were what was called active, which could be untreated brain metastases. Untreated [meant] no local therapy or systemic therapy or [that they had been] treated in the past with some kind of local therapy but [were] progressing again. Even though they are progressing again, they are not symptomatic enough to warrant additional local therapy.

REFERENCES:

1. NCCN. Clinical Practice Guidelines in Oncology. Breast cancer, version 7.2021. Accessed August 20, 2021. https://bit.ly/2Y4zXiQ

2. Swain SM, Miles D, Kim SB, et al. Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer (CLEOPATRA): end-of-study results from a double-blind, randomised, placebo-controlled, phase 3 study. Lancet Oncol. 2020;21(4):519-530. doi:10.1016/S1470-2045(19)30863-0

3. Dang C, Iyengar N, Datko F, et al. Phase II study of paclitaxel given once per week along with trastuzumab and pertuzumab in patients with human epidermal growth factor receptor 2positive metastatic breast cancer. J Clin Oncol. 2014;33(5):442-447. doi:10.1200/JCO.2014.57.1745

4. Diras V, Miles D, Verma S, et al. Trastuzumab emtansine vs capecitabine plus lapatinib in patients with previously treated HER2-positive advanced breast cancer (EMILIA): a descriptive analysis of final overall survival results from a randomised, open-label, phase 3 trial. Lancet Oncol. 2017;18(6):732-742. doi:10.1016/ S1470-2045(17)30312-1

5. FDA approves margetuximab for metastatic HER2-positive breast cancer. News release. FDA. December 17, 2020. Accessed August 20, 2021. https://www.fda.gov/drugs/resources-information-approved-drugs/ fda-approves-margetuximab-metastatic-her2-positive-breast-cancer

6. Krop IE, Saura C, Yamashita T, et al. [Fam-] trastuzumab deruxtecan (T-DXd; DS-8201a) in subjects with HER2-positive metastatic breast cancer previously treated with T-DM1: a phase 2, multicenter, open-label study (DESTINY-Breast01). Abstract presented at: San Antonio Breast Cancer Symposium; December 10-14, 2019; San Antonio, TX. Accessed August 20, 2021. https://www.abstractsonline.com/ pp8/#!/7946/presentation/2039

7. Modi S, Saura C, Yamashita T, et al. Trastuzumab deruxtecan in previously treated HER2-positive breast cancer. N Engl J Med. 2020;382(7):610-621. doi:10.1056/ NEJMoa1914510

8. Modi S, Saura C, Yamashita T, et al. Updated results from DESTINY-breast01, a phase 2 trial of trastuzumab deruxtecan (T-DXd) in HER2 positive metastatic breast cancer. Abstract presented at: San Antonio Breast Cancer Symposium; December 8-11, 2020; virtual. Accessed August 20, 2021. https://www. sabcs.org/Portals/SABCS2016/2020%20SABCS/ALL%20ABSTRACTS%202-9. pdf?ver=2020-12-09-104626-337

9. Krop IE, Kim SB, Martin AG, et al. Trastuzumab emtansine vs treatment of physicians choice in patients with previously treated HER2-positive metastatic breast cancer (TH3RESA): final overall survival results from a randomised open-label phase 3 trial. Lancet Oncol. 2017;18(6):743-754. doi:10.1016/S1470-2045(17)30313-3

10. Saura C, Oliveira M, Feng YH, et al. Neratinib plus capecitabine vs lapatinib plus capecitabine in HER2-Positive metastatic breast cancer previously treated with 2 HER2-directed regimens: phase III NALA trial. J Clin Oncol. 2020;38(27):3138-3149. doi:10.1200/JCO.20.00147

11. Murthy RK, Loi S, Okines A, et al. Tucatinib, trastuzumab, and capecitabine for HER2-positive metastatic breast cancer. N Engl J Med. 2020;382(7):597-609. doi:10.1056/NEJMoa1914609

12. Rugo HS, Im SA, Cardoso F, et al. Efficacy of margetuximab vs trastuzumab in patients with pretreated ERBB2-positive advanced breast cancer: a phase 3 randomized clinical trial. JAMA Oncol. 2021;7(4):573-584. doi:10.1001/jamaoncol.2020.7932

13. Jerusalem GHM, Park YH, Yamashita T, et al. Trastuzumab deruxtecan (T-DXd) in patients with HER2+ metastatic breast cancer with brain metastases: a subgroup analysis of the DESTINY-Breast01 trial. J Clin Oncol. 2021;39(suppl 15):526. doi:10.1200/ JCO.2021.39.15_suppl.526

14. Jerusalem GHM, Park YH, Yamashita T, et al. CNS metastases in HER2-positive metastatic breast cancer treated with trastuzumab deruxtecan: DESTINY-Breast01 subgroup analyses. Ann of Oncol. 2020;31(suppl 2):S63-S64. doi:10.1016/j. annonc.2020.03.239

15. Enhertu. Prescribing information. Daiichi Sankyo, Inc; 2021. Accessed August 20, 2021. https://bit.ly/3hkf3mN

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Focus on These Data When Making Treatment Decisions in Breast Cancer - Targeted Oncology

Aspirin-induced asthma (AIA) is a condition where asthma symptoms can develop after taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Its also known as aspirin-exacerbated respiratory disease (AERD) or Samters Triad.

The American Academy of Allergy, Asthma, and Immunology (AAAAI) estimates that 9 percent of adults have asthma and that 30 percent of adults who have asthma and nasal polyps may also have AERD.

Read on to learn more about the underlying causes and risk factors of AIA as well as how this condition may be treated.

Acetylsalicylic acid (aspirin) is a type of NSAID used to relieve pain, inflammation, and fever. Similar medications include ibuprofen (Advil) and naproxen (Aleve).

Aspirin and other NSAIDs interact with an enzyme known as cyclooxygenase-1 (COX-1). While the exact triggers are unknown, its thought that people with AIA have a sensitivity to the way these medications inhibit this enzyme.

You may be more prone to AIA if you have all three of these conditions:

A doctor may still recommend aspirin for the treatment of other conditions, such as preventing heart attacks or strokes, in cases where a person may have already experienced one of these conditions and when the benefits outweigh the risks of triggering asthma symptoms.

Symptoms of AIA tend to develop shortly after taking aspirin or other NSAIDs often within minutes or hours after exposure.

While its important to address any suspected symptoms of AIA with a doctor, heres a breakdown of mild symptoms as well as more severe symptoms that require immediate medical attention.

Mild symptoms of AIA may include:

More severe symptoms of AIA can make it harder to breathe even if you take a rescue inhaler. Although rare, these acute symptoms can be life threatening.

Seek emergency medical help if you experience the following:

People who develop AIA are usually between ages 20 and 50 years old and likely have a combination of:

You may also be more susceptible if you experience the following on a recurring basis:

Age is another consideration. You more generally can become more vulnerable to side effects from NSAIDs as you age past your 50s.

Its also possible that reactions to aspirin could be induced by drug allergies. Besides NSAIDs, other common drug allergies include:

Symptoms of AIA may also be further exacerbated if you also drink alcohol. The AAAAI estimates that 75 percent of people with the condition may experience symptoms after drinking alcohol along with aspirin use.

AIA is typically diagnosed with the help of an asthma specialist, such as an allergist, pulmonologist, or immunologist.

Theres not just one test that can diagnose AIA. Instead, a diagnosis is made with a combination of the following factors:

A doctor may also recommend ordering a test called an aspirin challenge to rule out drug allergies. This involves taking aspirin either in the doctors office or at the hospital while under medical supervision. Any reactions you have to taking aspirin can then be identified and treated.

Along with avoiding NSAIDs, treatment for AIA involves managing symptoms of asthma, sinusitis, and nasal polyps.

You can also talk with a doctor about the following options.

Home treatments can include:

A doctor may recommend one or more of the following medical treatments:

Besides exacerbated asthma symptoms, complications of AIA may include hives (urticaria). The AAAAI estimates that between 20 and 40 percent of people who have chronic hives may have worsening symptoms if they also experience AIA. A type of swelling called angioedema can also occur.

Its also important to consider long-term side effects of taking aspirin and other NSAIDs, especially when taken for longer than recommended. These include:

Avoid mixing aspirin with the following, too:

Aspirin is a type of NSAID primarily used to relieve pain. But be careful using aspirin if you have a history of asthma, sinusitis, and nasal polyps. These underlying conditions may put you at a higher risk of developing AIA.

Talk with a doctor if youre concerned about the risks or side effects of taking NSAIDs or if you have a history of side effects after taking these types of medications. They can help diagnose and treat potential AIA along with related medical conditions.

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What Is Aspirin-Induced Asthma? Causes, Symptoms & More - Healthline

Leading clinicians at Allegheny General Hospital support first islet cell transplant to treat chronic pancreatitis.

PITTSBURGH (PRWEB) October 05, 2021

Allegheny Health Network (AHN) today announced a groundbreaking new capability for treating patients who suffer from chronic pancreatitis, an inflammation of the pancreas that occurs over many years and, in severe cases, can be life-threatening. Every year, more than 80,000 people are diagnosed with the disease, according to the National Pancreas Foundation.

Surgeons at Allegheny General Hospital (AGH) have joined a select group around the country performing islet cell transplantation to restore the functions of a diseased pancreas. AGHs Institute of Cellular Therapeutics, is one of just a few in the nation that specializes in islet cell isolation, a highly sophisticated process in which islet cells, such as those that produce insulin, are extracted from the patients removed pancreas and transplanted back into the body. For the past six years, the institutes Islet Cell Isolation Laboratory has extracted and processed these life-saving cells to assist in the care of patients at select islet cell transplant centers around the country. With the launch of its own transplant program, AHN becomes one of just a few medical centers in the nation able to provide the comprehensive therapy from start to finish.

Pancreatic islets are tiny clusters of cells scattered throughout the pancreas. Included among these islets are beta cells, which produce the hormone insulin that helps the body absorb glucose from the bloodstream and use it for energy. Diabetes develops when the pancreas does not make enough insulin, the bodys cells do not effectively use insulin, or a combination of both. Massimo Trucco, MD, Director of AHNs Institute of Cellular Therapeutics and an internationally preeminent diabetes researcher, leads the islet cell extraction team at the hospital.

The islet cell transplant is critical for patients with immense pain and have failed other therapies. Dr. Trucco and his staff collaborate with AHNs gastroenterology, abdominal transplant, endocrinology, psychology and social services teams to complete the procedure and provide wrap-around patient support.

Chronic pancreatitis is a debilitating disease that can lead to frequent hospitalizations, higher use of narcotic pain medication and a lower quality of life, said Abhijit Kulkarni, MD, FASGE, an AHN gastroenterologist who evaluates patients for the islet cell transplant procedure. This treatment really represents the pinnacle of pain management for pancreatitis care and can be a true lifeline for the most critically ill patients.

According to Rita Bottino, PHD, from AHNs Institute of Cellular Therapeutics, the poor condition of the pancreas can make extraction of islet cells challenging. We sometimes have to be a little creative in finding a way to inject enzymes into the organ that will break the matrix that holds the cells together. By injecting enzymes, clusters of cells or single cells will be released from the organ and those are the kind of insulin-producing cells that we ultimately want to transplant back to the patient.

Once the islet cells are extracted and ready for transplant, AHN surgeons Harry Williams, MD, Ngoc Thai, MD, PhD, and Tadahiro Uemura, MD, PhD, transplant the cells into the patients own liver through the portal vein. Called an autologous islet cell transplant (TPAIT), the cells continue to produce insulin to control blood sugar levels in the body, eliminating the risk of becoming diabetic.

So we remove the diseased organ, which is causing debilitating symptoms for the patient, while creating a new pathway for insulin production in the body. And the advantage of a smaller time interval between extraction and transplant of these cells is significant and we believe will result in even better outcomes for our patients, said Dr. Williams.

Thus far, AHN has completed one TPAIT procedure and prepared more than 100 islets for regional hospitals including UPMC and The Cleveland Clinic. In addition to treating patients, AHN supplies research donor islets to Mt. Sinai Hospital, Stanford University Medical Center, Vanderbilt University Medical Center, and the universities of Pennsylvania, Miami and San Francisco, among others.

Our ultimate goal when starting our islet cell isolation lab several years ago was to ultimately develop the transplant capabilities and become one of the few one stop shops for this highly specialized care in the country, said Dr. Thai, Director of AHNs Center for Abdominal Transplantation. Having some of the worlds foremost experts in this field at our institution, like Dr. Trucco and his team, has afforded us with an extraordinary opportunity to build an internationally leading program.

To learn more about AHNs Cellular Therapeutics Institute or Transplant program, please visit http://www.AHN.org.

About the Allegheny Health Network: Allegheny Health Network (AHN.org), a Highmark Health company, is an integrated healthcare delivery system serving the greater Western Pennsylvania region. The Network is composed of 13 hospitals, ambulatory surgery centers, Health + Wellness Pavilions, an employed physician organization, home and community based health services, a research institute, and a group purchasing organization. The Network provides patients with access to a complete spectrum of advanced medical services, including nationally recognized programs for primary and emergency care, trauma care, cardiovascular disease, organ transplantation, cancer care, orthopedic surgery, neurology and neurosurgery, womens health, diabetes, autoimmune disease and more. AHN employs approximately 21,000 people, has more than 2,500 physicians on its medical staff and serves as a clinical campus for Drexel University College of Medicine and the Lake Erie College of Osteopathic Medicine.

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AHN Performs Its First Islet Cell Transplants to Treat Chronic Pancreatitis - PR Web

Otto Warburg probably would have been sent to a concentration camp if the Nazis werent hoping he could cure cancer.

Warburg was a Jewish gay man living openly in Berlin with his partner as Hitler rose to power. Warburg was also a biochemist, as brilliant as he was arrogant. In the 1920s, he discovered a hallmark of cancer, now called the Warburg effect. Malignant cells are ravenous for glucose, or blood sugar, consuming 10 times more than healthy cells. He dedicated his career to studying this strange metabolic anomaly because he believed it was the root cause of cancer.

He won the 1931 Nobel Prize for his work. But it was mostly forgotten by the 1950s, eclipsed by the molecular genetics revolution that set off a search for mutated, cancer-causing genes. He died in 1970 at age 86.

The rise, fall, and recent resurgence of research into cellular metabolism is the subject of Ravenous: Otto Warburg, the Nazis, and the Search for the Cancer-Diet Connection. Author Sam Apple, a journalist based in the Philadelphia suburb of Wyndmoor, weaves together this complex narrative in a way that makes arcane science accessible and fascinating.

The book is also thought-provoking for anyone interested in avoiding cancer and who isnt?

Its not obvious to me that there would be a breakthrough cancer therapy if Warburgs focus on cellular metabolism had not been shunted aside, Apple said in a recent interview. More likely, there would have been more attention to the relationship between our diets and the metabolism of the whole body and cancer. I think this could have had a dramatic impact on cancer prevention. But the link is still is not widely appreciated.

Otto Warburg was related to a wealthy German Jewish clan of bankers, scholars, and influencers. He was groomed for scientific greatness by his father, Emil Warburg, a leading physicist of the time.

The pinnacle of Otto Warburgs career happened to coincide with the rise of the Third Reich. When Warburg refused to sign a declaration of Aryan descent, the Nazi customs official tasked with asking Warburg to lie endeavored to get him punished by the Kaiser Wilhelm Society, the parent organization of Warburgs scientific institute.

Warburg not only managed to get off scot free, but he asked the Wilhelm Society president to ask the Reich Ministry of Finance to rewrite racial decrees so that non-Aryan institute directors would be treated like Aryan directors.

In 1934, at a moment when Hitler had already begun sending Germans to concentration camps, Otto Warburg, a gay man of Jewish descent, wanted Nazi laws rewritten according to his personal needs, Apple writes in the book.

As the author explains, cancer rates were inexplicably rising in Germany and other developed countries, and the Nazis fear of the disease ran almost as deep as their antisemitism and homophobia They despised Warburg, but needed his scientific genius.

Warburg invented several new tools to study the metabolism of cells, including the manometer, an instrument used to measure the force exerted by a gas or liquid.

He knew that in a healthy cell, blood glucose was normally converted to energy in a process using oxygen. This process, which involves enzymes that Warburg spent years identifying, occurs in the cells power stations, now known as mitochondria.

He discovered, to his amazement, that cancer cells broke all the metabolic norms. In addition to overconsuming glucose, the cells turned it into energy using an inefficient process that did not require oxygen even though plenty of oxygen was available.

The cancer cells were chopping glucose molecules in half and spitting the fragments right back out of the cell, Apple writes in an elegantly simple description of anaerobic glycolysis, or fermentation, the biochemical process that also gives us beer and wine. Cancer cells, Warburg realized, were fermenting glucose just as simple organisms like yeast and bacteria do.

But why? Warburg hypothesized more like proclaimed that cancer cells mitochondria were somehow defective, so the cells had to resort to a backup power generator, namely fermentation.

Today, while the search for answers continues, the evidence suggests that fermentation is not a response to a defect. Rather, it gives malignant cells an advantage as they turn into uncontrollable, immortal renegades.

Glucose molecules are the building blocks that cancer needs to create daughter cells, Apple boiled it down during the interview. The most influential scientists now think its about the cancer cells bioenergetic needs.

Following the 1953 discovery of the structure of DNA the genetic instructions for everything cells do oncology researchers became focused on finding and fixing the defective genes that give rise to cancer.

In that postwar era, Warburgs focus on cell metabolism was seen as outmoded, like studying the fuel line in hopes of understanding a high-tech engine.

Beginning in the 1990s, however, some leading researchers realized that certain cancer-causing genes known for their role in cell division also regulated cells glucose consumption. One of those scientists, Chi Van Dang, former director of the University of Pennsylvanias Abramson Cancer Center and now scientific director at the Ludwig Institute for Cancer Research, showed that MYC, a family of genes regulating cell proliferation, also targets an enzyme that can turn on the Warburg effect.

Metabolism-centered cancer therapies that effectively starve tumors are no longer just a concept. Two drugs, ivosidenib and vorasidenib, have already been approved by the Food and Drug Administration for a form of leukemia and are now being tested in brain cancer patients. Rafael Pharmaceuticals experimental therapy, devimistat, has had impressive early results in bile duct cancer trials.

But as Apple points out, cancer is an incredibly persistent foe. It can mutate to evade chemotherapy, molecularly targeted therapies, and even newer immune-boosting therapies. The same thing may happen with metabolic therapies. Whats more, virtually all cancer treatments come with significant side effects.

Thats why the implications for preventing cancer in the first place are so important.

Population-wide studies have directly linked 13 cancers including breast, bladder, lung, colon, liver, and gynecological cancers to the same metabolic abnormalities that are driving the twin worldwide epidemics of obesity and diabetes. The most striking thing that the cancers, obesity and diabetes have in common is resistance to insulin, the vital hormone that enables cells to absorb blood glucose and turn it into energy. To compensate for this resistance, the pancreas pumps out more and more glucose.

The hypothesis is that patients high blood sugar impacts tumor growth by providing cancer cells with an abundance of the fuel they thrive on.

Apple spends almost half his book taking deep, incisive dives into research on the insulin connection. Refined sugar, which is a combination of glucose and fructose called sucrose, contributes to insulin resistance, So does fructose, or fruit sugar especially when it is concentrated in high-fructose corn syrup, the ubiquitous processed-food additive. Consuming fructose, a carbohydrate, also appears to make people add fat tissue more readily than actual fats, such as such as butter.

Precisely how much sugar is too much may be different for each person, depending on genes and age and exercise habits and capacity to store fat safely, he writes. But the path from refined sugar added to our diets to insulin resistance ... to cancer is now well understood and based on widely accepted science.

He touches only glancingly on a fundamental problem: Even if sugars role as a cancer-promoter becomes an article of faith, cutting back on it is tough. And controversy, not to mention quackery, abounds in the field of nutrition. The ketogenic diet, for example, restricts carbohydrates, which are converted to glucose in the body. The diet has shown promise in weight loss studies, as well as in relieving neurological disorders such as epilepsy. But the esteemed Mayo Clinic says the diets high level of saturated fats, combined with limits on nutrient-rich fruits, veggies and grains, is a concern for long-term heart health.

In the final chapter, Apple weaves in a chilling anecdote:

Sugar, of course, cannot be blamed for Nazism or for turning Hitler into a madman. But as his madness grew, so, too, did his taste for sweets. It wasnt only his cherished Viennese pastries. On any given day, Hitler might consume two full pounds of chocolates. He even added sugar to his wine.

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An old idea from a German Jewish scientist spared by the Nazis is getting new life: Prevent and treat cancer by cutting out sugar - The Philadelphia...

The American Cancer Society says that nearly 250,000 American men are expected to be diagnosed with prostate cancer in 2021. And about 1 in 8 men will be diagnosed with prostate cancer at some point in their lives.

Prostate cancers tend to grow slowly and have a fairly good outlook compared to many types of cancer. From 2010 to 2016, the 5-year survival rate in the United States was 97.8 percent, according to the National Cancer Institute.

Chemotherapy is a drug therapy thats sometimes used to treat prostate cancer. Its most commonly used to treat aggressive tumors or advanced prostate cancer that hasnt responded well to other treatments.

In this article, we break down when your doctor may recommend chemotherapy for prostate cancer and what you can expect while taking chemotherapy drugs.

Chemotherapy is a cancer treatment that involves taking drugs that kill rapidly dividing cells. Chemicals in these drugs can kill cancer cells and healthy cells in your body that quickly divide such as bone marrow and hair cells.

According to the American Cancer Society, chemotherapy is not a standard treatment for early prostate cancer. Its most likely to be used for aggressive cancer or cancer that has started growing outside the prostate.

Most men receiving chemotherapy for advanced prostate cancer will also receive androgen deprivation therapy (ADT) or anti-hormone therapy.

Chemotherapy may also be used to treat castrate-resistant prostate cancer (CRPC). CRPC is a type of prostate cancer that stops responding to hormone therapy. Prostate cancer needs male sex hormones to grow, and hormone therapy aims to lower male sex hormones to slow tumor growth.

A 2018 research review showed that docetaxel (developed in 2004) is the first chemotherapy drug that improved the survival rate of men with prostate cancer. Today, its the most commonly used chemotherapy drug to treat prostate cancer.

Docetaxel falls into a group of drugs called taxanes. These drugs block cellular processes cancer cells need to divide.

Docetaxel is often combined with the steroid prednisone. A 2016 research review showed that prednisone may help:

If docetaxel treatment doesnt work best for your health needs, doctors often recommend trying cabazitaxel. Cabazitaxel falls into the same class of drugs as docetaxel.

The following treatments are newer treatment options that often work when hormone therapy doesnt work for you:

However, there are no studies available yet directly comparing these drugs, and its not clear which is most effective.

Enzalutamide and apalutamide are in a class of drugs called androgen receptor inhibitors. They block male sex hormones from binding to receptors on your prostate.

Abiraterone is in a class of drugs called androgen biosynthesis inhibitors. They work by blocking the production of testosterone.

Other chemotherapy drugs that may be used to treat prostate cancer include:

Chemotherapy drugs are typically administered intravenously (through an IV) by a doctor who specializes in cancer treatment. The medications can be administered at a:

Drugs are administered in cycles to help give your body time to recover. Cycles are often 2 to 3 weeks long, and each session takes roughly an hour, according to the American Cancer Society.

The schedule of your cycle depends on which drugs are being used. You may only be given chemotherapy drugs on the first day of your treatment or for several days in a row.

The total length of your treatment depends on how well the chemotherapy is working and your side effects.

Some types of chemotherapy drugs like enzalutamide can be given as oral pills.

Chemotherapy can cause your red and white blood cell counts to drop, so youll likely have a blood test before each of your sessions.

If you have a very low white blood cell count, your doctor may recommend lowering the dose or stopping treatment.

Chemicals in chemotherapy drugs kill cells that divide quickly, but they cant differentiate between cancer cells and healthy cells in your body.

Many of chemotherapys side effects are due to drugs targeting healthy cells that divide rapidly such as cells in your:

Some common side effects of chemotherapy include:

Severity of symptoms can vary between people. Many of the side effects of chemotherapy go away shortly after treatment.

Docetaxel and cabazitaxel can cause neuropathy, or nerve dysfunction, that leads to the following feelings in your hands or feet:

A 2014 research review showed that about 10 percent of participants have grade 3 or 4 neuropathies, which are the highest classifications of nerve dysfunction. Your chances of developing neuropathy depend on your dose.

According to the American Cancer Society, the drug mitoxantrone can cause leukemia in rare cases, and estramustine increases your risk of developing blood clots.

Its important to discuss prostate cancer treatment options with your doctor. They can help you understand the pros and cons of chemotherapy and answer any specific questions you have about your treatment.

An oncologist, a doctor specializing in cancer, can help you develop strategies to lower your chances of developing side effects.

An oncologist can also put you in touch with support groups in your area. Many people find it helpful to talk with other people who have gone through the same treatment.

You can find online support groups or support groups in your area from these websites:

Chemotherapy is most commonly used to treat prostate cancer that has spread beyond the prostate. Chemicals in chemotherapy drugs kill cancer cells and other cells in your body that rapidly divide such as cells in your hair follicles and digestive system.

Your doctor can help you determine if you may benefit from chemotherapy. You may also find it helpful to join a support group that connects you with other people who have undergone the same treatment in the past.

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Chemotherapy for Prostate Cancer: When It's Used and What to Expect - Healthline

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Last week, Arkansas lawmakers passed a bill that could have life-threatening consequences for transgender youths. HB1570 the Save Adolescents From Experimentation (SAFE) Act bans any trans person under 18 from receiving gender-affirming health care, including puberty blockers and hormone therapy. Arkansas is the first state to pass these extreme measures, though at least nine other states are considering similar bills and more than 45,000 trans youths could be affected.

While the lawmakers who support HB1570 claim to be protecting kids from making medical decisions they cant take back, they are actually putting them at risk. Studies have shown that not only do transgender children very rarely regret these treatments but their rates of depression and suicide are greatly reduced by them. One study found that access to hormone therapy over the course of one year decreased suicide rates in transgender youths by 75 percent. This law cuts them off from potentially life-saving options.

The Cut spoke with 19-year-old Vaniel Simmons, who was raised in Arkansas, about how access to gender-affirming health care saved his life.

By the time I was 15, I felt confident that I was trans. I started wearing a binder and three layers of clothing to hide my body, even in the summer. A year earlier, I had come out to my family as bisexual, but that never felt quite right. They were more or less supportive but would still pressure me to wear makeup or dresses. It made me incredibly uncomfortable, but I couldnt articulate why. I couldnt put into words why I would have a panic attack every time my mom tried to take me shopping. I just knew that I couldnt stand looking at myself in the mirror. I started getting really depressed and began self-harming. I starved myself and overexercised, thinking weight was the reason I didnt like my body.

I did not fit in at my school, which was filled with homophobic or incredibly religious people. Every day, other students would tell me, Youre gonna go to hell. You need to come to a Christian fellowship group. One girl walked around wearing a T-shirt that spelled fag in sign language, and the teacher and principal said they couldnt do anything about it. But every year on National Coming Out Day, I would do a fun outfit when I showed up in a rainbow cape, they said I had to take it off. By my junior year, I had decided to transfer somewhere else. I applied to a boarding school in Hot Springs, Arkansas, where people dyed their hair blue and green and wore sparkly shoes. My mom was supportive, since it was a very academically prestigious place, and as I was a low-income student, they would pay the tuition. I felt a desperation that I needed to be anywhere but here.

I started finding online LGBTQ groups where people explained trans identities. I started thinking, Maybe thats me, and using he/him pronouns. I began researching hormone treatments. I was watching famous trans YouTubers and Googling, What does testosterone do to your body? and How can I get top surgery? Any provider I called said I had to be 18 to make an appointment, and I didnt have a family doctor I trusted enough to talk about these kinds of issues. I was resigned to waiting.

I felt stuck. I knew that starting hormone therapy would help. Knowing what I needed to do and not being able to do it was soul-crushing. By the time I was 16, I couldnt picture a future. That Christmas, I had a full panic attack. My family kept misgendering me, and I remember sitting on the floor of my room, crying. My grandmother came in, and I told her: Im a guy. I dont know why they cant see that. She is very accepting; whatever makes me happy will make her happy. About a month later, I got in an argument with my mom I dont remember exactly what about and I stormed out of the house. My stepdad would make uncomfortable comments about my body, and we were arguing a lot about him. My grandmother followed me to the nearby lake, and I told her, Im hiding who I am at school. I dont feel safe at home. I would rather not exist at all than continue to exist like this. That was my lowest point. And she was like, So youre going to move in with me.

I didnt expect to live long enough to have access to the health care I needed. If a teenager can make the major life decision to want to harm or kill themselves, why wouldnt they be able to make major life decisions about their health? I couldnt stand the thought of living this way any longer. Every single day was a hellscape. That feeling is more torturous than taking testosterone and deciding later on I dont want to do this anymore.

In 2018, I started boarding school, and my first semester was definitely the hardest. Everyone there was great, and they didnt mess up pronouns but I still had to live in the female hall with the girls. Then I found a booth for the Arkansas Childrens Hospital Gender Spectrum Clinic at a pride event and booked my first appointment to talk about hormone therapy. I was 16 at the time. I told my mom that if she refused her support, Id just do it when I was 18 and resent her. She showed up for the first appointment but not to any others. They did a full psychological evaluation of me, my mother, and my grandmother. They wanted every detail. Then the doctors conferred to make sure hormones were the right option for me, and there was another three- or four-month waiting period to make sure I was feeling consistent. I wasnt able to actually start the treatment until seven months after the first consultation. But while waiting, I successfully petitioned the school to move me to the guys hall in my second semester. The other students just started letting me exist as a dude, though it was still slightly dysphoric for me. They all had their deep voices, and I was still trying to get there.

About six months into testosterone treatment, my voice finally started to drop. I was 17. I remember walking into school after the Christmas break and greeting a counselor. She said, I didnt recognize your voice for a second because of how much it had deepened. It felt like, Youre finally able to hear me as I actually am. That feeling was like Christmas all over again.

These lawmakers dont understand that these treatments arent just something trans people want; they mean actual life or death for a lot of us. This bill is a death sentence. It takes away peoples chances to live. I am happy with myself now I had top surgery last August. But theres always the thought in the back of my head, How much further could I be had I gotten a head start on hormones? My teenage years were mostly spent hating my body and isolating myself so I didnt have to be around people who saw me as a woman. I didnt get to experience having casual fun with my friends on the weekends. It took me years to get to the place where Im at now. I could have spent all those years being happy.

In the U.S., the National Suicide Prevention Lifeline is 1-800-273-8255.

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What If I Had Gotten a Head Start on Hormones? - The Cut

ONTARIO Jenny Swisher opened The CRU Clinic at the beginning of April. It is a business not so common in the area.

She said the diversity of CRUs services differentiate it from others. The clinic offers aesthetics services, IV hydration, testosterone replacement and weight loss programs.

CRU stands for contemporary, refined and unique. Swisher said the business goal is to provide contemporary care for refined wellness that is unique to each individual.

Richland Area Chamber and Economic Development held a ribbon-cutting ceremony for CRU on Thursday afternoon.

Richland Area Chamber and Economic Development held a ribbon-cutting ceremony for CRU on Thursday afternoon. Richland County commissioners Cliff Mears and Tony Vero and Ontario Mayor Randy Hutchinson joined the event and welcomed the new business.

Swisher, a certified nurse practitioner, said the IV hydration service is nutrient infusion therapy. Depending on the need, customers can get anything from calcium to vitamin B complex through the infusion.

When you take oral vitamins, you only get about 50 percent (of what you eat) if you have a good GI (gastrointestinal tract)absorption system. But sometimes, less than 50 percent is actually absorbed, Swisher said.

And with the IVs, you get 90 to 100 percent of what you get infused.

She said the service is rare in the area and some people have been driving to Columbus or Cleveland for it.

Those who are nutritionally deficient would benefit from the infusion, Swisher said. It can help rehydrate a hangover as well. For those who do weight-lifting or activities consuming a lot of energy within a short time, the infusion will help them replenish essential nutrients quickly.

Swisher said the aesthetics services have been popular since the clinic was open. It offers Botox injection, lip fillers and dermal fillers. The owner filled her own lips about a week ago to get rid of some wrinkles around.

She said she wanted to be able to experience what her patients go through during the process.

CRU also targets male customers with hormone replacement therapy. Swisher said men go through andropause just like women go through menopause. They might feel fatigued, be unable to gain muscle or have a decline in sex drive. The clinic can tailor the therapy and meet an individuals needs.

The CRU Clinic is located at 2293 Village Park Court. It opens from 8 a.m. to 5 p.m. on weekdays. Swisher said most services are provided through appointments, but walk-in IV infusions are available from 10 a.m. to 2 p.m.

Those interested can check The CRU Clinics website or call 419-775-5457 for more information.

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New Ontario clinic offers diverse health and beauty services - Richland Source

A month after Alegra Woodard received a diagnosis of stage 1 cervical cancer, she underwent a radical hysterectomy, a surgery that removes the uterus, ovaries, fallopian tubes, left and right pelvic nodes, cervix, tissue around the cervix, and the upper part of the vagina. She was just 36 years old, a wife and mother working as an information technology practitioner in Honolulu.

Her life changed overnight.

The next day I felt like another person, Woodard says. The change was drastic. I went into full menopause. I started sweating, my sexual desire (was) nonexistent, and intercourse became very difficult because it felt like someone had poured sand in my vaginal area.

Woodard isnt alone. A study out of Sidney Kimmel Cancer Center (SKCC) at Thomas Jefferson University in Philadelphia found that 87% of survivors of breast, pelvic, endometrial, prostate, bladder and rectal cancer said treatment affected their sexual function or desire. Although sexual side effects are more often reported by women, they affect men as well.

Steven Dupin, a personal trainer, comedian, author and patient advocate for the Prostate Cancer Foundation, (visit their site to learn more about the side effects of prostate cancer), lives in Los Angeles and was 42 when he started having problems with frequent urination and prostate pain. However, he didnt receive a diagnosis of prostate cancer until two years later, when his doctor ran a routine PSA blood test, which is used to screen for prostate cancer. Dupin says that his biggest fear, besides dying, was that he would have problems with sexual intimacy as a result of treatment. Both of these fears are common.

The No. 1 question I get from other men I talk to is Does the plumbing still work? Dupin says. I always say, Sure. The only difference is that now instead of ejaculate, fairy dust and glitter come out.

That last part, of course, isnt true. But the stories patients tell of sexual side effects resulting from cancer treatment are.

So, what causes these problems, and what solutions are available for survivors?

The SKCC study found that the most common sexual side effects were painful intercourse (73%), body image distortion (54%) and the inability to achieve orgasm (42%).

According to Ashley Arkema, a nurse practitioner in the Female Sexual Medicine and Womens Health Program at Memorial Sloan Kettering Cancer Center, the most common concerns reported by the patients she sees are low libido, sexual pain, diminished arousal and changes in body image. Fatigue, anxiety and depression can also affect sexual function. And she attributes these problems primarily to cancer treatment, including surgery, chemotherapy, hormone therapy and pelvic radiation, which often cause sexual side effects that are associated with hormone depletion. For younger patients this is especially true. Abrupt early surgical menopause or chemical menopause causes a rapid drop in estrogen, leading to more severe and sudden symptoms. Hormone therapy, including tamoxifen and aromatase inhibitors, commonly used in breast cancer treatment, can also have a negative impact on sexual function. And pelvic radiation can lead to menopause, vaginal narrowing and scarring.

Dr. Mindy Goldman, director of the Gynecology Center for Cancer Survivors and At-Risk Women at the University of California, San Francisco, who serves as the chair of the menopause panel and the co-chair of the sexual function panel for the National Comprehensive Cancer Network (NCCN), agrees that the lack of estrogen causes many of the most common forms of sexual dysfunction in women. However, there are other causes.

There are many aspects of cancer treatment that can cause sexual dysfunction, and the causes are often multifactorial, Goldman says. Vaginal dryness can lead to pain and decreased desire. Surgeries can lead to body image changes. Stem cell transplants can cause graft-versus-host disease that can lead to scarring, pain and decreased arousal. Radiation can lead to pain and scarring. The cancer itself can cause pain. And then (a lot of women) also have cancer-related stress, anxiety and depression that can affect their overall sexual functioning.

She says the key to treating patients is a multifactorial approach and finding safe and effective options, especially for those who shouldnt use hormone therapies.

Dr. Gregory Broderick, a urologist at Mayo Clinic and a professor of urology with Mayo Clinic Alix School of Medical Education in Jacksonville, Florida, sees male patients who have cancer whove experienced sexual dysfunction, incontinence (loss of bladder control) and urethral strictures (scarring that narrows the tube that carries urine out of the body).

Together, Goldman and Broderick co-chair NCCNs panel on sexual health. NCCN is a nonprofit alliance of 30 cancer centers that partner to improve cancer care and survivor issues by reviewing and updating guidelines. They want to make sure certain side effects (like this one) are not overlooked.

The most common problems he sees are erectile and ejaculatory dysfunction, loss of libido, incontinence or other urinary problems like climacturia (when a man leaks urine as he ejaculates). There can also be body image challenges, especially for men who live with a stoma or ostomy bag after colorectal or bladder surgery.

In terms of the prostate surgery, a significant risk to a mans erectile function status is whether or not the pelvic nerves that regulate erection can be spared at the time of surgery, Broderick says, noting that a more recent approach to the operation, called robotic prostatectomy, has advantages because patients dont require a large abdominal incision, have much less bleeding, and can get back to work sooner.

Dupin was able to have robotic surgery, and he is able to have sex and achieve orgasm. He doesnt have problems with a lack of libido or incontinence. The only sexual side effect hes experienced is the loss of ejaculate.

After Woodwards surgery in 1999, she was prescribed a topical vaginal medication called Premarin (conjugated estrogens) to lubricate and improve dryness. But this still left her unsatisfied.

All of the large guiding organizations say to use over-the-counter topical agents first, Goldman says. This includes things like moisturizers, pH balanced gels, soothing agents, oils and lubricants. Some of these things can alleviate symptoms if theyre used regularly.

Arkema says her first few recommendations include a variety of over-the-counter products, but these solutions dont always work for everyone.

Goldman notes there are vaginal hormones that can help treat dryness and sexual pain by targeting the tissue directly. The most common are vaginal estrogens which exist in a cream, a ring formulation and a suppository.

Furthermore, Goldman says there are now Food and Drug Administration (FDA) approved prescription medications that treat various types of sexual dysfunction. Osphena (ospemifene) and Intrarosa (prasterone) are approved for treatment of painful sex. Finally, there are also female versions of Viagra, as well as the FDA approved Addyi (fibanserin) and Vyleesi (bremelanotide), which are both approved for treatment of hypoactive sexual desire disorder in women.

I think theres a common misconception that nothing can be done, Goldman notes. Some providers assume the only treatment options are hormones, and for many breast cancer patients these are contraindicated (not advisable). Even so, there are lots of other options.

Broderick says that when meeting with a new patient, he starts by looking into how they were treated because the type of therapy often dictates the sexual side effects and recommendations. The primary treatment options include PDE5 inhibitors (which block the PDE5 enzyme, allowing blood vessels to relax and increasing blood flow), such as Viagra (sildenafil cirate), Levitra (vardenafil), Cialis (tadalafil) or Stendra (avanafil); penile injectable therapy; penile prosthesis; and the use of a vacuum erection device.

Although robotic surgery has come a long way, some men still struggle with incontinence, which quickly becomes a critical sexual side effect.

When a male patient comes to me with incontinence and erectile dysfunction, I start by asking where their partner is sleeping, because one thing Ive learned is that partners will not sleep in the bed with someone who is incontinent, Broderick notes. And theyre less likely to become intimate with someone who isnt in the same bed. So, you really need to address the incontinence first.

After a prostatectomy, Broderick says all patients go through a phase of neuropraxia (when the nerves arent working quite right). It takes time to return to normal erectile status. Generally, erectile function begins to come back after about six months. He says if it hasnt come back by 18 months, it probably wont.

Furthermore, radiotherapy, which is good at killing cancer, affects small-vessel blood flow, so patients who have been through radiation can have difficulty initiating and maintaining erections. Most of these patients, however, respond to PDE5 inhibitors like Viagra. On the other hand, a man who has lost nerve function from a prostatectomy needs direct vascular stimulants like penile injectable therapy.

So, I have a counseling plan for patients depending upon whether Im seeing him six, 12 or 18 months after his operation and his willingness to undergo rehabilitative strategies, Broderick says. Some patients come in and theyre part of a couple who are both in their 70s, and the erectile dysfunction is not as impactful for them simply because they werent all that sexually active prior to the surgery. Maybe his partner has gone through menopause and is less receptive of penetrative sex. What shes really looking for is the maintenance of their intimacy without penetrative sex. Sometimes my job is just getting the two partners to understand where they both are with all of that.

Although the range and severity of sexual side effects can vary greatly, one thing that helps across the board to increase treatment rates is talking about whats going on.

Findings from the SKCC survey of 400 survivors found that 87% said they experienced sexual side effects but most also said their oncologist had not asked them about these side effects. And patients often dont bring up the topic themselves, reporting that they feel embarrassed, think theres no help for the problem or dont know which type of physician to talk to about it.

Woodard says she wishes someone would have talked to her about what to expect before her surgery, but at the time she was being treated in a military clinic. She received her diagnosis from a nurse practitioner and then transferred to the hospital to meet with the surgeon and oncologist.

I remember that session when I met with the oncologist who looked at my chart and said, You have cancer? Thats odd, Woodard recalls. These conversations were never about gutting me out like a fish and what would happen afterward.

She went into surgery without any idea about what was coming.

Theres a stigma or discomfort for many physicians in talking about this, Goldman says. Theres a study that showed that if the patient feels discomfort coming from their provider, they often wont bring the issue up. So there (are) a lot of people who may assume that this is something they have to live with.

Goldman sees no reason that sexual dysfunction cant be talked about like the other side effects of treatment, such as neuropathy, hair loss and pain.

At Mayo Clinic, Broderick says they train their surgeons to do exactly that: talk about all the possible side effects.

Fortunately for Dupin, the possibility of sexual side effects was addressed. His doctor told him he may experience erectile dysfunction and gave him a prescription for Viagra that he decided not to use.

Sexual side effects of cancer treatment are common, and Goldman wants patients to understand this and feel comfortable asking about what treatments are available.

Woodard, who now volunteers with the National Cervical Cancer Coalition, (their website can help patients and survivors understand their side effects more and offers support), agrees that patients need to speak up.

My advice is to be more demanding, she says. Ask for resources. Often treatment is not only a physical procedure but one that affects your mental and emotional health. You should be in touch with an advisor or someone that can help you navigate the emotional part of this.

More importantly, Woodard wants patients to know theyre not alone. There (are) a number of us out here, she says. Seek help, ask questions, be persistent and dont give up. Dont give in.

For more news on cancer updates, research and education, dont forget tosubscribe to CUREs newsletters here.

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What Are the Most Common Sexual Side Effects Survivors of Cancer Face, And How Are They Treated? - Curetoday.com

BUFFALO GROVE, Ill., April 12, 2021 /PRNewswire/ --Tolmar Pharmaceuticals, Inc., a privately held specialty pharmaceutical company, announced the publication of a manuscript entitled "Impact of Late Dosing on Testosterone Suppression with Two Different Leuprolide Acetate Formulations: In Situ Gel and Microsphere An Analysis of US Clinical Data" in the February issue of Journal of Urology.

This retrospective analysis of real-world data is a more detailed follow-up of the results to "The Impact of Late Luteinizing Hormone-Releasing Hormone Agonist Dosing on Testosterone Suppression in Patients with Prostate Cancer: An Analysis of United States Clinical Data," which was published in the April 2020 issue of Journal of Urology. Leuprolide acetate is the most commonly used drug for androgen deprivation therapy (ADT) in men with advanced prostate cancer. The article reported the impact on testosterone suppression of late dosing of GnRH agonists in general.

Androgen deprivation therapy (ADT) is the standard of care for the treatment of advanced prostate cancer. It aims to reduce circulating testosterone (T) to castration levels in order to remove the 'fuel' that simulates cancer cells to grow. The goal is to reduce testosterone (T) to <50ng/dl, however there is a strong body of evidence recommending <20ng/dl as the benchmark.

"This new study reflects Tolmar's ongoing commitment to furthering research on the treatment of advanced prostate cancer through peer-reviewed publications," said David Crawford, M.D., Clinical Professor of Urology, University of California San Diego

This study was supported by Tolmar Pharmaceuticals, Inc. For more information, please click here

About Tolmar and ELIGARD

Tolmar is a fully integrated pharmaceutical company focused on the technology-driven development, approval, manufacturing, and commercialization of specialty pharmaceuticals. The Company's lead product, ELIGARD, is a luteinizing hormone releasing hormone (LHRH) agonist indicated for the treatment of advanced prostate cancer.

"Tolmar" refers to Tolmar Holding, Inc. and its wholly owned operating subsidiaries, Tolmar Inc., Tolmar Therapeutics, Inc., and Tolmar Pharmaceuticals, Inc. ELIGARD was developed and is manufactured by Tolmar Inc. Tolmar global headquarters, product development and manufacturing facilities are based in northern Colorado, while TOLMAR Pharmaceuticals' U.S. commercial business is based in Buffalo Grove, Illinois. For more information about the company, please visit http://www.TOLMAR.com. Information about ELIGARD is available at http://www.eligard.com.

IMPORTANT SAFETY INFORMATION

ELIGARD (leuprolide acetate for injectable suspension) is a medicine for the treatment of advanced prostate cancer. It works by reducing the amount of testosterone in the blood. It is not a cure.

ELIGARD should not be used by anyone who is allergic to any of the ingredients in ELIGARD or to any medicines that reduce testosterone the same way. ELIGARD should not be used by women who are pregnant or may become pregnant. ELIGARD can cause pregnancy loss or harm to an unborn baby if used in pregnant women.

Severe and possibly life-threatening reactions called anaphylaxis have occurred in people receiving ELIGARD.

Increased risk of heart attack, sudden death due to heart problems and stroke have also been reported in men taking ELIGARD. ELIGARD may also affect electrical activity in the heart that can cause an irregular heartbeat. Your doctor will monitor you for heart conditions.

Elevated blood sugar and an increased risk of developing diabetes have been reported in men receiving ELIGARD. Your doctor will monitor blood sugar levels.

ELIGARD causes an increase in testosterone during the first few weeks of therapy and some men may experience new or worsening symptoms of prostate cancer e.g., bone pain, urinary symptoms, or nerve problems such as numbness, during this period. If your cancer has spread to the urinary tract or spine, urinary blockage or pressure on the spine that can lead to paralysis may occur. Your doctor will discuss with you the benefits and risks of taking ELIGARD.

The most common injection site reactions are transient burning and stinging, pain, bruising, and redness. The most common side effects include hot flashes/sweats, fatigue, weakness, muscle pain, dizziness, clamminess, testicular shrinkage, decreased erections and enlargement of breasts. Other side effects, including thinning of bones that may lead to fracture, and rare but serious problems with the pituitary gland in the brain, have been reported with ELIGARD.

Please see Full Prescribing Information for additional important safety information.

Media Contact Information:

Julie Ferguson[emailprotected](312) 385-0098

SOURCE Tolmar Pharmaceuticals, Inc.

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Tolmar Publishes Study in the February Issue of Journal of Urology on the Impact of Late Dosing on Testosterone Suppression with Two Different...

Last Friday, a bill that would ban transgender athletes from competing in middle, high school, and college sports passed in the West Virginia legislature. At least 20 different state legislatures have introduced transgender athlete bans in 2021. While South Dakotas governor Kristi Noem vetoed a proposed ban, Tennessee, Arkansas, and Mississippi have signed these changes into law.

Arkansas governor, Asa Hutchinson, did, however, veto legislation that would have banned gender confirming treatments or sex reassignment surgery for transgender youth under 18. That bill would have been the first in the country to ban this practice. Meanwhile, last Monday, GOP legislators in North Carolina introduced a bill that that would prevent doctors from performing sex reassignment surgery for transgender people under the age of 21.

This flurry of state billsa month ago LGBT advocacy group Human Rights Campaign had counted more than 80has once again provoked impassioned fighting, much of it centered around children. Its led to questions of fairness in youth sports, if adolescent judgement and diagnosis should be trusted, and what role and what say parents should have in how their children express their gender.

Mark Yarhouse is a pyschology professor at Wheaton College and the director of the Sexual and Gender Identity Institute. His books include Understanding Gender Dysphoria and most recently, Emerging Gender Identities. He joined global media manager Morgan Lee and editorial director Ted Olsen on this weeks episode of Quick to Listen.

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The transcript is edited by Yvonne Su and Bunmi Ishola

What is the same and what has changed in the conversation around gender over the past five or six years?

Mark Yarhouse: The conversation around gender has become more pronounced and centered into cultural discussions.

You see an increase in the number of people who identify as transgender or what I refer to as emerging gender identities. There's a splintering of gender categories into different experiences, different language for describing people's experiences.

Things have become more polarized as well. You saw that with the reaction to legislation like the bathroom bill, and you see that now with the law passed in Alabama. 20 or more states have gender identitychange laws in place for minors to keep that from happening. Theres an increase on both sides of a divisive topic.

What led to this development?

Mark Yarhouse: When I wrote my first book on understanding gender dysphoria, I was trying to introduce evangelical Christians to the concept of transgender experiences. Gender dysphoria is this experience that's distressing when a person's gender identity doesn't align with their biological sex.

When I talk about emerging gender identities, it's beyond that basic framework of transgender. Young people say that theyre gender-expansive, theyre gender-creative, theyre bi-gender, theyre pan-gender and the different identifiers go from there.

It helps us as Christians to be thoughtful in how we engage in a culture that's shifted so dramatically and where language has been shifting. You're interacting now with younger people for whom these are taken-for-granted realities and the generation that went before them had a limited scope of categories and language. Theres a real high likelihood of our misunderstanding and talking past one another.

Do the lessons about transgender issues from before map onto the emerging gender identities?

Mark Yarhouse: Some of the lessons learned will map onto that. It's challenging to know exactly how to, as Christians, enter into this conversation because we have had norms around sexuality and gender that we want to be able to articulate.

But sometimes when we articulate those norms, we can do it in ways that seem to cast doubt on the experience of other people around us, who don't use those same norms as anchor points that we do. It ends up becoming more of a risk of speaking past each other or being entrenched in not understanding.

You can both teach norms around sexuality and gender and recognize that there are exceptions to those that are likely the result of a fallen world and the challenges that people face in that space. There are also clinical differences and issues from a classic transgender presentation and some of the emerging gender identities.

To seek common ground, is it helpful to talk about how we also have dysphoria or dont conform to cultural or biblical notions of what it means to be male or female?

Mark Yarhouse: There are an upside and a downside to that approach. Christians would hold that we have so much in common as we bear the image of God and we should start there. People are beloved by God. God wants a relationship with people. Theres so much in that sense as a starting point for shared human experience.

But if you overplay that, you look past how some people's experience is so far on the margins that you might not fully appreciate the challenges that they're facing, particularly when it is dysphoria, a painful experience that you've never experienced.

There are also people saying that this is willful disobedience on your part. We're not speaking the same terms here about people's experiences.

How do you define gender dysphoria? Is the term interchangeable with the idea of transgenderism?

Mark Yarhouse: Gender dysphoria is the discomfort or distress that's associated with the lack of concordance between someone's biological sex, usually thought of in terms of chromosomes, genitalia and gonads, and the person's gender identity, their experience as a man or a woman or a different gender identity than that.

When that's distressing to them, it's dysphoria versus euphoria, a positive emotional state. It's a negative emotional state. I don't think of that as synonymous with transgender but many people who would identify as transgender would report gender dysphoria. It can vary in severity from mild to severe, and it can ebb and flow in severity in a person's life.

Historically, gender dysphoria was thought of as having an early onset. A boy or a girl is aware of their gender between ages two and four, developmentally. They're aware that they're a boy or a girl, or they're going to express a different experience than that.

What we've seen in the last six years has been a remarkable increase in the number of cases that we would call late-onset. That means at or after puberty, the person is reporting dysphoria that they didn't appear to have much evidence of, if at all, in childhood.

That's what's concerning to some mental health professionals and others. Theres not been a satisfying explanation that accounts for that increase.

Is it true that, before the last five or six years, people that were saying Im trans most likely started feeling those feelings well before puberty?

Mark Yarhouse: Most of the cases had been what we would call early onset. Parents would wonder if their child was going through a phase. They would probably go to a specialty clinic when that child turned six or seven, maybe when they were going to preschool or kindergarten, when the comparison would be their peer group, rather than at home with their family.

Historically, that would be the more typical presentation. It was more often biological males rather than females, at about a four- or five-to-one ratio that would be referred to these specialty clinics. That was probably the result of having a narrower box for what a boy can be like.

If they're outside of that expectation, then it raises more flags for parents. Whereas girls can have a little more latitude in how they present; and if they're gender atypical in some ways, you have positive language for that. They could be tomboyish and no one's going to be particularly concerned.

That probably accounted for that ratio, but now you're seeing quite a flip. Now we're seeing not just the late-onset cases at a higher rate, but also seeing it among biological females at a higher rate than you do males. We don't understand what's going on with that switch.

How do you distinguish between someone who expresses themselves outside the cultural understanding of masculinity or femininity, versus someone who feels uncomfortable being a particular gender?

Mark Yarhouse: When you meet with somebody to make a diagnosis of gender dysphoria, you rule out that they're within the range of what a boy or girl, or a man or a woman, would be like. They maybe have different characteristics, different presentations, different ways different interests, and so forth that are gender atypical. They don't fit into maybe stereotypes, but they're not gender dysphoric.

So how do you make that distinction? Several things go into that. You can have a conversation with an adult and theyre telling you. It's harder when you're trying to make that determination with a child who might not be able to pull all that together. But there are certain criteria that you follow around what they're able to say about their gender identity.

It's usually their response to primary and secondary sex characteristics. It's the desire for the sex characteristics of the other gender. These things aren't for a few weeks or a few months; it's over time and it's significant. It's significant in their body image and how they experience and see themselves. It's distressing to them.

What advice would you give to adults who have recently learned that a young person in their life is trans?

Mark Yarhouse: Christians typically have this skill set. We are used to applying it to other groups of people whose individual characteristics are different than our own. For example, we don't seem to have difficulty relating to our agnostic neighbors, even though their characteristics around their religious identity are different than ours.

We have a sense of how to relate to that person who's different in terms of racial or cultural background. When people's characteristics vary from ours, we can relate to them, talk with them, recognize God's love for them, value them as a person, to encourage them to bring all of their experiences into the relationship that we're forming with them as an acquaintance and maybe a friend.

You use the same skill set here. It's doesn't have to be more difficult than that.

I don't normally speak into the lives of adolescents around me unless I have a relationship with them and I'm invited into that space. It would run a significant risk of me overstepping the nature of the relationship I have with them, and then likely speaking past them. Then what they may know about me is that I'm a Christian whos now a witness to them. I have this top-down approach where I'm telling them that they're at-risk or they're doing something wrong.

I would probably take the position more with an adolescent than I do as a neighbor, as a family friend, or something like that. To listen more about what their experience has been like, remember that they're navigating at their age.

Their generation has a lot more categories for language around categories and linguistic constructs around gender and sexuality than my generation did. They're probably deeply shaped by what's been made available to them and they're interacting with those categories and they're making sense to them, or they might not make sense to me.

I might have a reaction to that, but it would be better to understand how the language functions for an adolescent rather than begin with the place that they're wrong or that they need to be corrected. That kind of mutational strategy does not work with adolescents period. It doesnt work in this conversation because our connection to their language has been so different and they've been exposed to so many different categories.

How do you counsel people on the basic questions of name and identity?

Mark Yarhouse: If a person is able to live in a way that reflects their birth sex, its going to be less complicated.

There are so many layers of complexity. Some people are in this place where they're considering a social transition or a partial transition, and they're trying on different names and pronouns.

If the person's trying to do that because they've been suffering from gender dysphoria and it's been distressing to them, and they've used other strategies to manage that (like the clothing they wear, the way they keep their hair, and these things have taken the edge off that dysphoria and been helpful to them), but it's sufficiently distressing that they think that using pronouns that they would prefer might be helpful to them, then I'd like to understand what's behind the request and how it's functioning for them.

That's not an uncommon strategy that people use. They try to use these strategies usually in a trial-and-error way and in a stepwise fashion. They can always reverse and go back to their original pronouns.

They can always do that; they're trying to figure this out. I don't want to be overly reactive to that. I want to meet them where they are. I want to have a sustained relationship with them. I err on the side of hospitality towards somebody to be in a relationship with them rather than do things on the front end that would sever the tie that they might otherwise want to have with me.

What advice do you have for parents as they try to understand where their child is coming from?

Mark Yarhouse: When you have early onset, parents are not that surprised when a child says to them, I'm transgender, or I experience my gender identity differently than most people do, or however they frame it. Parents knew something was going on. They just didn't have language for it. But when you have late-onset cases, it is blindsiding. Parents feel like their world has been rocked and there's no reference point for what their teenager is saying. There's little or no history to understand it.

There has been some concern that there might be teens who have other issues going on in their life and they're finding a sense of identity and community in something that has such social salience today. It's moved to the center of some of the cultural discourse around sexuality and gender, where some time ago, being gay had occupied that space.

The transgender conversation has moved into that space culturally and maybe a generation ago, a young person might've landed in a different area and explored different aspects of themselves. But today this has the kind of salience that might be appealing to some people where they might not have gender dysphoria.

There may be other things going on and they're finding something in this space. I want to be careful when I say that because I don't think that's most of what I'm seeing in my clinic. Some people have been trying to research that as a possible phenomenon.

Is that something that is trending among adolescents and we should be cautious about? I want parents to be wise and discerning to check things out with a provider, someone who has expertise in this area and to realize there could be multiple things going on here and it would take discernment and time to figure out what's going on.

Are there important ways that we should differentiate between dysphoria and transgender issues, versus same-sex attraction issues?

Mark Yarhouse: They are different experiences. When someone describes themselves as gay, they're talking about their attraction towards the same sex and their orientation towards the same sex. When someone says that they're transgender, they're talking about their experience of their gender identity as a man or a woman or a different gender identity than that.

Gender identity doesn't have to do with who you're physically, emotionally, or sexually attracted to. A lot of times when people are wrestling with dysphoria, they're often being asked about their sexual orientation. That's a confusing topic for some people.

They're not sure what they could even say about that. They're trying to figure out what's going on around gender. Sometimes Christians are more preoccupied with sexual behavior. I don't think that's where a lot of people are when they're figuring out gender. That's a different thing for them. Distinguishing that is helpful. S

Some Christians see that Scripture speaks more to the question around sexual behavior than it does to gender identity. That complicates this conversation more. It's not that Scripture doesn't say anything about gender, but it doesn't certain passages that stand out around sexual behavior. It's not quite as clear if you're looking for direct scriptural passages.

What effect do you expect banning surgery for young people to have?

Mark Yarhouse: There are several things that minors might consider, like whether to block going through puberty. That's right at the beginning of the development of puberty. Then young people might consider using cross-sex hormones at some point, maybe a year or two later. If they did the puberty-blocking intervention, then that becomes a consideration. Some of the legislation may be looking at that. There are surgical procedures as well.

On both sides of this debate, people have young people's best interests at heart. They're both trying to address vulnerable young people that they're concerned about, but they're landing diametrically in places to express their concern. Those who are saying we shouldn't allow these types of procedures are saying young people dont have the capacity to make these kinds of decisions, to understand the consequences of these decisions, and what that could mean for them five or 10 years out.

Other people believe that young people are at great risk and that these are the kinds of things that medical and psychiatric providers think should be on the table and considered for a young person. They can make that decision.

What are some of the consequences that people proposing these bans are concerned about? To what extent are they valid or exaggerated?

Mark Yarhouse: With the use of cross-sex hormones, this would be a lifelong regimen that a young person would have to take to have the clinical effects of using the other hormones of the other sex. If you stop taking the hormone, you stop having that clinical benefit.

We don't have the kind of long-term research on the effects of an adolescent using cross-sex hormones over 30 years. The greatest risk would be the risk for sterility.

Another topic that people are concerned about is that a young person at 16 or 17 doesnt understand what that would mean in 10 years. Do they understand the risks that they're taking there?

I'm not a fan of legislating around these complex clinical issues on either side. Once you move towards legislation on either side of these complex issues, ultimately, it ends up not being nimble enough to respond to the needs of the next person in front of you. I'd love for those needs to be met more by the mental health profession and the people who are working with them.

Those that regulate the mental health professions, that's where typically complaints would be adjudicated. It would be through the people who were licensing the providers to provide services rather than through legislation that creates a statement that's applied to everybody across the board. That doesn't end up being as flexible on members as we would.

Have you seen any examples of school districts figuring out how to have trans girls and women play in youth or collegiate sports without resorting to laws?

Mark Yarhouse: We need more time to research how to measure advantage and what that looks like. When you develop a policy like the NCAA has tried to, looking at the length of time to be on hormones, there's good intention to try to figure that out. What gives someone a competitive advantage? How do you safeguard that without excluding people from being able to compete when this is what they have trained to do?

They're good at this, and you want to allow them to do this. There have been controversies at every level of competition; this is not going to be resolved quickly. There hasn't been enough work done on clarifying what those standards would need to be across the board. Maybe they need to be applied more on a case-by-case basis than having one length of time that's applied to everybody. I wonder if it's more complicated than it's been made out to be.

How should we understand stories of people who have transitioned, then transitioned back? What kind of attention should they get?

Mark Yarhouse: Sometimes it's referred to as de-transitioning. I haven't seen a very well-designed study that would show us how common that is. In the Netherlands, they recently published a report on 30 years of people using different interventions, including surgical procedures.

The rate of regret continues to be low. I don't think that you're seeing a dramatic rise in regret that would typically correspond with de-transitioning. You could have regrets about surgery and elect not to be transitioned. We need to study that more to see how common that is, but based on the rates of regret that were published more recently, I don't see a rise in that.

I am concerned that we could see a rise in that for the reasons that I've talked about: atypical presentations, late onset, the gender ratio flip towards more cases of female adolescents with later onset. Where will they be in five or 10 years? We don't know yet.

Most actually don't make medical transitions at this point, but if they were to, would we see a rise in regret? I'd be curious.

How do you recommend we pray for people who are experiencing gender dysphoria?

Mark Yarhouse: We pray for God to continue, if He's already been speaking to them, to continue to speak to them; to speak to me, to guide me, to help me know best how to see the person, to love this person, that they would know that they are loved by God. For me and them to have wisdom and discernment moving forward. For wisdom and discernment on how I relate to them as someone that God cares deeply about.

Those are the types of prayers that I pray. I also provide ministry outside of my role as a psychologist. That's been helpful to me in walking with people. I mentioned that most people don't make a medical transition at this point. I think in the last transgender survey, about 44% of something like 26,000 transgender persons had indicated that they were using hormone treatment and only about 25% had used any type of gender confirmation surgery.

That's been a helpful conversation to have in the back of my mind.

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Why the Transgender Conversation Is Changing - ChristianityToday.com

Diabetes is a chronic condition where the body doesnt make enough insulin or use insulin properly. Insulin is a hormone that allows sugar to enter the bodys cells, where its then used for energy.

When the body doesnt make enough or use insulin properly, sugar accumulates in the bloodstream. This leads to high blood sugar.

Uncontrolled diabetes or high blood sugar can cause a range of problems such as nerve damage and kidney damage. But these arent the only side effects of diabetes. Some people with diabetes may also develop a metallic taste in their mouth.

The reasons for taste disturbance vary, but might include medication or poor oral hygiene. Sometimes, a metallic taste in the mouth is also an early sign of diabetes.

Here are a few causes of a metallic taste in the mouth related to diabetes.

Metformin is an oral medication commonly prescribed to treat type 2 diabetes. It reduces the amount of glucose (sugar) produced by the liver. This helps lower blood sugar levels to a safe range.

But although Metformin can stabilize blood sugar thus reducing the risk of serious diabetes complications some people who take this medication complain of a metallic taste in their mouth.

The reason isnt quite clear, but this taste disturbance is likely due to the prescription drug excreting into saliva.

The good news is that this taste problem is often temporary, with taste returning to normal after 1 or 2 weeks.

Parageusia is a taste disorder that can occur alongside diabetes. Its also known to cause a metallic taste in the mouth. But, whats the connection between parageusia and diabetes?

Simply put, your central nervous system (CNS) affects how your brain perceives taste, and its possible that uncontrolled diabetes can affect your nervous system.

Prolonged high blood sugar slowly damages the nerves in your body. This can include the nerves in the:

Parageusia occurs when injury or damage to the CNS distorts taste and smells. Taste disturbances such as a metallic taste in the mouth develop when the nerves that affect taste become damaged.

Oral health issues are another common cause of a metallic taste in the mouth.

Many people think of diabetes only affects blood sugar. But too much sugar in your blood can cause problems with your mouth, too.

High blood sugar also increases the sugar level in your saliva. And if your saliva contains more sugar, youre at a higher risk for cavities, gingivitis, and periodontitis. The latter two can cause a metallic taste in the mouth.

Diabetic tongue is another oral health problem that can cause a metallic taste in the mouth. This occurs when a combination of too much sugar in your saliva and a dry mouth triggers oral thrush.

Thrush develops when a fungus that occurs naturally starts to grow out of control. It can affect the gums, tongue, and the roof of the mouth.

A metallic taste in your mouth due to diabetes might improve over time. It all depends on the underlying issue.

If you take the drug Metformin, a metallic taste should subside after a few weeks once your body adjusts to the medication. If taste disturbance doesnt improve, see a medical professional.

Adjusting your dosage or finding an alternative drug might improve your taste.

If a metallic taste is due to sugar in the saliva, controlling your diabetes can also help improve your taste. Additionally, if you develop an infection due to poor dental hygiene, seeing a dentist and treating the infection might improve taste.

If taste disturbance occurs due to nerve damage, the severity of nerve damage may determine whether your taste returns to normal.

Even if you adjust your medication, improve your oral hygiene, and take steps to control your blood sugar, a metallic taste in your mouth might not improve immediately.

As you wait for your condition to improve, here are a few tips to help your food taste better:

See a doctor if a metallic taste in your mouth does not improve after a couple of weeks. Its important that you dont ignore this taste disturbance, as it can indicate problems with blood sugar control.

If you havent been diagnosed with diabetes, yet you notice a metallic taste in your mouth, see a medical professional. This taste disturbance is sometimes an early sign of diabetes.

A metallic taste in your mouth can distort the taste of foods and beverages, making it difficult to enjoy your favorite foods. Although taste disturbances have different underlying causes, its important to see a doctor for symptoms that dont improve.

This can be an early sign of diabetes, as well as blood sugar that is not in target range.

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Diabetes and a Metallic Taste in the Mouth: Causes and Treatments - Healthline