Archive for the ‘Hormone Physician’ Category

February is Heart Awareness Month, which now makes the perfect time to educate yourself about arguably one of the most important parts of the body, likely only competing with the brain for top rank.

Without knowledge about our blood-circulating machine, we put ourselves at risk for mistreating our bodies and putting our health at risk and potentially leading ourselves to the possibility of a shorter life span and possibly even to expensive medical procedures down the line.

Heart disease and other cardiovascular issues do not arise in only older adults and can occur in any individual due to a variety of health factors. Our heart health is affected throughout our lives, and without proper treatment and care for the cardiovascular system, it is more likely that the onset of potential health struggles may occur faster than one might expect, and they are hard to reverse once the snowball effect of cardiovascular decline is set in motion.

High rates of obesity and high blood pressure are climbing in the younger generations of America and other countries, and this puts them at risk for heart problems at earlier ages. Some serious threats to heart health include tobacco use, mainly smoking tobacco, high blood pressure and high blood cholesterol levels.

Obesity puts stress on the heart and can cause other health issues that may add strain to the cardiovascular system, such as diabetes and physical inactivity, which both increase the likelihood of a more rapid decline in heart health.

Unhealthy eating patterns can lead to other unhealthy habits, which can start the aforementioned snowball rolling and exponentially increase your risk of heart issues at any age.

Some ways to take the best care of your heart include getting regular exercise, which can be helped by finding a set schedule you stick to keep yourself disciplined and well-motivated. If regular exercise has proven itself to be a difficult goal for you, finding a workout buddy or a certain activity you enjoy will make working out less of a chore and more of an enjoyable experience for you as well as your workout companion.

Hours of cardio are not required to keep your heart healthy, but some moderate exercise for at least 150 minutes per week will keep your heart healthy and happy. It may seem daunting to face 150 minutes head-on, but splitting that time into 30-minute blocks makes regular physical activity seem much more manageable and enjoyable. Regular exercise has also been proven to increase serotonin levels, which is known as the happy hormone.

Getting regular check-ups with a physician, usually necessary only once a year, is the perfect way to stay updated on the condition of your cardiovascular system. Remaining aware of the status of your heart health is vital in order to keep an eye on any potential conditions you may need to address and manage with your health care professional.

The food you eat plays a large role in the condition of your cardiovascular system as well. Keeping a diet full of whole grains, veggies and healthy fats while limiting your intake of processed sugars and saturated fat is ideal.

The rest is here:
Sustaining the art of the heart during Heart Awareness Month - Indiana University The Penn Online

San Francisco, California (UroToday.com) Dr. Piet Ost provided the radiation oncology perspective for the Best of the Journals in Prostate Cancer Session at the 2020 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU), discussing several important trials that published results over the past year.

The first trial Dr. Ost discussed was the trial of ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-prostate cancer randomized, non-inferiority, Phase III trial.1 The Scandinavian HYPO-RT-PC randomized controlled Phase III trial was initially presented at ESTRO 2018 and was subsequently published in Lancet Oncology. This trial randomized men with intermediate and high-risk prostate cancer to either conventional fractionating (n = 602; 78.0 Gy in 39 fractions, 5 days per week for 8 weeks) or ultrahypofractionated (n=598; 42.7 Gy in seven fractions, 3 days per week for 2.5 weeks).

The primary endpoint was time to biochemical or clinical failure. The estimated failure-free survival at five years was 84% (95% confidence interval [CI] 80-87) in both treatment groups, with an adjusted hazard ration (HR) of 1.002 (95% CI 0.758-1.325; log-rank p=0.99). There was weak evidence of an increased frequency of acute physician-reported RTOG grade 2 or worse urinary toxicity in the ultra-hypofractionation group at end ofradiotherapy(158 [28%] of 569 patients vs 132 [23%] of 578 patients; p=0.057). Based on these results, there has been support for the use of ultra-hypofractionated radiotherapy for prostate cancer.

The second trial Dr. Ost presented was the intensity-modulated fractionated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B) trial assessing acute toxicity from an international, randomized, open-label, Phase III, non-inferiority trial.2 Patients were either low-risk or intermediate-risk prostate adenocarcinoma (Gleason 4+3 excluded), and scheduled to receive radiotherapy were recruited from 37 centers. Participants were randomly allocated (1:1), stratified by center and risk group, to conventionally fractionated or moderately hypofractionated radiotherapy (78 Gy in 39 fractions over 7.8 weeks or 62 Gy in 20 fractions over four weeks, respectively) or stereotactic body radiotherapy (36.25 Gy in five fractions over 1-2 weeks).

The primary endpoint of PACE-B is freedom from biochemical or clinical failure. There were 874 men to conventionally fractionated or moderately hypofractionated radiotherapy (n=441) or stereotactic body radiotherapy (n=433). Worst acute RTOG gastrointestinal toxic effect proportions were as follows: grade 2 or more severe toxic events in 53 (12%) of 432 patients in the conventionally fractionated or moderately hypofractionated radiotherapy group versus 43 (10%) of 415 patients in the stereotactic body radiotherapy group (difference -19 percentage points, 95% CI -6.2 to 2.4; p=0.38). Worst acute RTOG genitourinary toxicity proportions were as follows: grade 2 or worse toxicity in 118 (27%) of 432 patients in the conventionally fractionated or moderately hypofractionated radiotherapy group versus 96 (23%) of 415 patients in the stereotactic body radiotherapy group (difference -42 percentage points, 95% CI -10.0 to 1.7; p=0.16).

The third trial Dr. Ost discussed was the short-term androgen deprivation therapy (ADT) continued with radiotherapy as salvage treatment after radical prostatectomy for prostate cancer (GETUC-AFU 16).3 This study included patients with stage pT2, T3, or T4a (bladder neck involvement only) and pN0 or pNx according to the TNM staging system, whose prostate-specific antigen (PSA) concentration increased from 0.1 ng/mL to between 0.2 ng/mL and 2.0 ng/mL after radical prostatectomy, without evidence of clinical disease. Patients were assigned (1:1) to short-term androgen suppression (subcutaneous injection of 10.8 mg goserelin on the first day of irradiation and 3 months later) plus radiotherapy (3D conformal radiotherapy or intensity-modulated radiotherapy of 66 Gy in 33 fractions, five days a week for seven weeks) or radiotherapy alone.

Randomization was stratified according to investigational site, radiotherapy modality, and prognosis. The primary endpoint was progression-free survival (PFS) in the intention-to-treat population. There were 743 patients randomly assigned, 374 to radiotherapy alone and 369 to radiotherapy plus goserelin. At the time of data cutoff, the median follow-up was 112 months (IQR 102-123). The 120-month PFS was 64% (95% CI 58-69) for patients treated with radiotherapy plus goserelin and 49% (43-54) for patients treated with radiotherapy alone (HR 0.54, 0.43-0.68; stratified log-rank test p<00001).

The final study Dr. Ost discussed was the STOpCaP systematic review recently published in European Urology.4 This systematic review included trials that randomized men to prostate radiotherapy and ADT or ADT only. The review identified one ongoing (PEACE1) and two completed (HORRAD and STAMPEDE) eligible trials. Pooled results of the latter (2126 men; 90% of those eligible) showed no overall improvement in survival (HR 0.92, 95% CI 0.81-1.04, p = 0.195) or PFS (HR 0.94, 95% CI 0.84-1.05, p=0.238) with prostate radiotherapy. There was an overall improvement in biochemical progression (HR 0.74, 95% CI 0.67-0.82, p < 0.0001) and failure-free survival (FFS) (HR 0.76, 95% CI 0.69-0.84, p < 0.0001), equivalent to 10% benefit at three years. The effect of prostate radiotherapy varied by metastatic burden-a pattern consistent across trials and outcome measures, including survival (<5, 5; interaction HR 1.47, 95% CI 1.11-1.94, p=0.007). In general, there was a 7% improvement in three-year survival in men with fewer than five bone metastases.

Dr. Ost concluded with several take-away points:

Written by:Zachary Klaassen, MD, MSc, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Twitter: @zklaassen_mdat the 2020 Genitourinary Cancers Symposium, ASCO GU#GU20, February 13-15, 2020, San Francisco, California

References:

1. Widmark, Anders, Adalsteinn Gunnlaugsson, Lars Beckman, Camilla Thellenberg-Karlsson, Morten Hoyer, Magnus Lagerlund, Jon Kindblom et al. "Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial."The Lancet394, no. 10196 (2019): 385-395.

2. Brand, Douglas H., Alison C. Tree, Peter Ostler, Hans van der Voet, Andrew Loblaw, William Chu, Daniel Ford et al. "Intensity-modulated fractionated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): acute toxicity findings from an international, randomised, open-label, phase 3, non-inferiority trial."The Lancet Oncology20, no. 11 (2019): 1531-1543.

3. Carrie, Christian, Nicolas Magn, Patricia Burban-Provost, Paul Sargos, Igor Latorzeff, Jean-Lon Lagrange, Stphane Supiot et al. "Short-term androgen deprivation therapy combined with radiotherapy as salvage treatment after radical prostatectomy for prostate cancer (GETUG-AFU 16): a 112-month follow-up of a phase 3, randomised trial."The Lancet Oncology20, no. 12 (2019): 1740-1749.

4. Burdett, Sarah, Liselotte M. Boeve, Fiona C. Ingleby, David J. Fisher, Larysa H. Rydzewska, Claire L. Vale, George van Andel et al. "Prostate radiotherapy for metastatic hormone-sensitive prostate cancer: a STOPCAP systematic review and meta-analysis."European urology76, no. 1 (2019): 115-124.

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ASCO GU 2020: Best of the Journals in Prostate Cancer - Radiation Oncology Perspective - UroToday

FOUNTAIN When a child protection caseworker told Crystal Bryant they were taking her 5-month-old boy, the young mother dropped to her knees on the hospital floor.

Take me, she pleaded. For my son to stay home, take me, I dont care.

She begged God and anyone listening, but they still took him, Bryant recalled, shaking her head and wiping tears as she recounted the worst moment of her life. Child welfare and police officers made Bryant and her husband, Jarvis Bryant, leave the Colorado Springs hospital room before a foster mother arrived to take their baby away.

Their lives were shattered.

The Bryants, who moved to Fountain when Jarvis was assigned to Fort Carson, were charged with felony child abuse, accused of breaking multiple bones in their only childs body. Crystals recently earned nursing certificate was revoked. Jarvis, a U.S. Army specialist, lost his security clearance, stripping him of his job in aircraft and vehicle supply and relegating him to paper shuffling.

Worst of all, baby Jace was gone. Their apartment seemed empty. They felt powerless, more than lost like death, Crystal said.

The Bryants son was one of 4,772 Colorado children removed from their homes by child welfare authorities and living in foster care last year. But their story isnt the typical tale of a child rescued from abuse or neglect. Its the opposite. The Bryants nightmare lasted 164 days, and its end arrived more like a ripped-from-the-headlines television drama than real life.

Baby Jace had been sick his whole life. He had severe acid reflux and a swallowing condition called dysphagia that caused milk to go down his windpipe instead of his esophagus, making him choke.

When he was 3 weeks old, he spent 31 days in the hospital and had a feeding tube inserted into his nose and down to his stomach to help him get enough nutrients to survive. At almost 4 months old, Jace had surgery on his esophagus and to place a gastrostomy tube in his abdomen, so his parents could send formula straight to his stomach.

Then, just before Thanksgiving 2018, Jace was diagnosed with a viral infection that was causing fever and diarrhea. While Crystal showered and did her hair upstairs in their apartment, Jarvis was giving Jace his second bath of the day. Jarvis laid the baby stomach-down along his forearm as he bent over the bathtub, pouring soapy water over Jaces back. The baby slipped sideways off Jarvis arm, his knee hitting the bottom of the tub.

Jace cried, and Jarvis picked him up to console him, he said. Jarvis said he was leaning into the tub when the baby fell into a small amount of water, enough to make a toy float. Jarvis didnt mention it to his wife.

Later that Sunday afternoon, though, Crystal noticed Jace was favoring his leg, that he held it up as he sat in his vibrating saucer-chair and flinched when she picked him up. She was bringing him back to the hospital anyway because the fever and diarrhea had not subsided, and while she was there Crystal asked the doctor if they could X-ray Jaces leg.

The baby had a fractured femur.

Crystal called Jarvis at home, and he told her then how Jace had slipped from his arm and hit his knee. As Jarvis drove to the hospital, Crystal told the doctor that her husband had dropped their son in the bathtub.

Instantly, they were suspects.

Medical staff at Memorial Hospital Central ordered a full-body workup. What they found was devastating: Not only did Jace have a broken leg, he had 10 fractured ribs and two fractured wrists. The leg fracture was fresh, but the rest were in various stages of healing.

The police came, interviewing Crystal, 24, and Jarvis, 27, in separate rooms. A caseworker arrived from the El Paso County child welfare division, and a pediatrician with training in child abuse examined Jace. A detective did voice stress analysis tests by recording and analyzing their voices, deciding both parents were deceptive Jarvis about knowing who caused Jaces injuries and Crystal about whether she hurt her son.

Jaces medical records as well as the child abuse charging documents, both reviewed by The Colorado Sun, do not mention unexplained bruises or burns red flags of child abuse. They do note marks on his chest, back and cheek, some of them crescent-shaped scratches. The Bryants told authorities one mark was a scar from his g-tube surgery and the others were likely from his parents or medical staff accidentally scratching him with fingernails or a ring while picking him up.

Because of Jaces feeding problems, nurses, physical therapists and occupational therapists all required by law to report any suspicion of child abuse had been to the Bryants home twice each week since he was 2 months old. They had stripped Jace naked weekly and weighed him on a portable scale placed on the table. Not one made any report of abuse or neglect.

The baby had been to emergency rooms multiple times, often to replace the tube down his throat when his arms flailed and pulled out the tube, common for babies. Each time, medical staff took an X-ray to make sure it was in the right place. As a first-time mom and self-described hovering parent, Crystal took Jace to the pediatrician at the first hint of illness.

Still, three days after she brought Jace to the hospital and asked for the leg X-ray, El Paso County authorities told the Bryants he wasnt going home with them their home, authorities said, wasnt safe for their son.

The Bryants returned to their apartment without their baby and gathered up everything they thought he might need at his foster home toys, clothes, his medicines for acid reflux, formula, shampoo, laundry detergent, Vaseline. They had no family nearby; Crystal is from Chicago, and Jarvis is from Louisiana.

The following morning, a distraught Crystal dialed the child welfare division. Five times. I am concerned. I am pissed off. Im angry, sad, frustrated, she said.

Its Thanksgiving. Can I see my son?

The answer was no. Crystal sat on the couch and cried.

Losing their son sent Crystal into heavy depression, so dark that she once opened the passenger door in their car as Jarvis drove 80 mph down the highway away from a supervised visit with Jace. I just wanted to jump out, she said. I couldnt believe I was still living on this Earth, without my son. It was hell on Earth.

There was no living for me.

Crystal stopped eating and drinking and grew so ill that Jarvis drove her to Evans Hospital on Fort Carson in early January, about a month and a half after Jace was taken away. But when Jarvis handed over his military ID at the checkpoint, the guard hesitated.

Do you know there is a warrant out for your arrest? the guard asked, Jarvis recalled. Did you not pay a ticket or something?

There was a warrant for Crystal, too. Felony child abuse charges, in addition to the civil case to determine whether to terminate their parental rights, had been filed against them. The class 3 felony is punishable by up to 16 years in prison.

The Bryants, neither of whom have any criminal history, were handcuffed and taken in separate military police cars and held on post for an hour and a half, when city law officers transported them to the El Paso County Jail. Mug shots. The whole orange jumpsuit. Everything, Jarvis said. They spent the night and were able to post bond the next morning.

While Crystal slipped further into depression, Jarvis was the fire.

He contacted the ACLU and the NAACP to see if they could help with legal defense, though Jarvis and Crystal were each assigned two public attorneys for the civil and criminal cases. He spent hours reading medical records and court cases. This is literally our lives, our sons life, our livelihood, our well-being, our mental state, pretty much everything that we could ever think of is at stake, he said. Im not going to sit here and let this happen. Its one thing if you know you did something wrong. But if you know you didnt do anything wrong, why are you going to go down innocent?

Jarvis went to every hospital and doctors office that had seen Jace, beginning with his May 22, 2018, birth at Evans Hospital. He collected 1,200 pages of medical records, along with discs of all of Jaces X-rays, including those taken before and after his surgery and tube placements.

They hardly slept. They fought, wondering if losing Jace would break them. They went to supervised visits at the Family Visitation Center, and signed up for individual therapy and parenting classes, trying to anticipate what the county would ask of them and speed up the process to getting their son back.

One sleepless night in March, Jarvis stumbled on a YouTube video of TV journalist Katie Couric interviewing two families in 2013 who were wrongly accused of child abuse after their children were found with broken bones. A Texas father was arrested after his 1-month-old daughter was found with nine bone fractures. Another father was accused of abusing his twin infants after they both had leg fractures. Both were eventually cleared because the babies all had a brittle bone disorder.

The video led Jarvis to a website called Fractured Families, a network for parents of children with unexplained fractures. And he fired off multiple emails titled Can you please help my family?

Through the network, Jarvis found contact information for more than a dozen physicians and radiologists who were experts in bone fractures and emailed all of them. We need help from a medical professional urgently to try and fight this matter properly and get our baby back and prove our innocence, he wrote. It just doesnt make any sense how a baby like ours has such a lengthy medical history and no one has done their due diligence to properly rule out everything before they automatically say child abuse. Please help us.

Two doctors agreed to help, for free.

Dr. Susan Gootnick, a radiologist in California who began studying alleged child abuse cases about seven years ago, looked at Jaces X-rays and noticed immediately that his bones appeared washed out because they werent getting enough calcium. It made sense, given Jace had not been able to eat by mouth for the first several months of his life. His scans were consistent with metabolic bone disease and rickets, she wrote in a report that Jarvis gave to his attorney.

Obviously, the baby wasnt getting the appropriate nutrients that he needed to grow, Gootnick said in an interview with The Sun. These bones break under stresses that a normal bone would not break under.

Whats more, Gootnick said, the age of the fractures made it likely that Jaces ribs and wrists were broken by medical staff during one of the many times they reinserted his nasal tube unsedated. An X-ray taken in September shows the rib fractures and the tube that went from Jaces nose to his stomach.

Its unpleasant, as you can imagine, sticking a tube down their nose, Gootnick said. You have to increase the strength of how you hold the baby still.

On one of the X-rays of Jaces wrist, Gootnick noted, an adult thumb bone is visible the technician holding down his arm for the scan.

Another doctor, Dr. John Galaznik, a retired pediatrician in Alabama who has testified for the defense in numerous child abuse trials, zeroed in on two acid-reflux medications Jace had taken since he was 3 weeks old Omeprazole and Ranitidine. They cut down on stomach acid, which is essential for absorbing calcium. Galaznik said it was likely that Jaces muscles so badly needed calcium that they were leaching it from his bones.

He cited the babys elevated levels of parathyroid hormone, which the brain secretes at a higher level when the bodys calcium requirement is not met, Galaznik said.

The doctor also noted that the fractured leg bone was consistent with a compressing force such as the bathtub fall Jarvis described. The fracture suggested no yanking, pulling, twisting forces as one might predict an abusing caregiver to inflict, he wrote.

Galaznik, who for 37 years was a physician in the University of Alabama system, said in an interview that the study of bone fractures in babies has evolved rapidly over the last 10 years, so much so that emergency department physicians who were trained 10 or 20 years ago are often not up to date.

In 2009, the American Academy of Pediatrics doubled the recommended vitamin D intake for babies, noting that vitamin D deficiency could lead to decreased calcium absorption and bone fractures. And in 2014, the academys Committee of Child Abuse and Neglect published a paper calling attention to the difference between fractures caused by abuse and those resulting from rickets or brittle bone disease, called osteogenesis imperfecta.

Galaznik is contacted by dozens of families each year and takes on some of the cases pro bono. He and Gootnick said they have noticed a societal bias against parents who are low-income and without higher education. If you come in and you are well-dressed and well-known and have no background problems, it may give the accusers more pause, Galaznik said. Just the allegation can destroy a career.

Gootnick said the cases she takes on lack sufficient evidence. There should be more investigation of whats going on with these kids in terms of their bone health, she said. I feel a moral obligation to help these people. If I can help them, I have to help them.

Jarvis printed out the doctors reports and gave them to his attorneys. And they waited.

Jace lived with the same foster family for 164 days. The Bryants counted all of them.

The baby, who was in the foster home from age 5 months to 10 months, seemed to know his parents less and less each week when they saw him for their two-hour supervised visit. One more of those and I feel like my son wouldnt even remember me, Crystal said.

They tried to move Crystals sister from Chicago so she could become Jaces foster mom, an arrangement the child welfare system calls a kinship placement. When she couldnt come, a couple Jarvis met at work offered to help. They became Jaces foster placement, and the Bryants were allowed to move into their house, under the condition that they were never alone with their son.

The arrangement lasted about two months, until the day last July when Jarvis and Crystal were to appear in civil court for their hearing on whether they could keep their son. Instead, the El Paso County child welfare division which in the meantime had deposed the divisions child abuse doctor in the wake of the pro-bono expert reports recommended they take their son home.

The Bryants, elated and relieved, took Jace home that night seven months after he was removed from their custody.

Three months later, in October, the criminal charges against them were dismissed. District Judge David Gilbert ordered the case sealed during the same hearing. It was like it happened and all of a sudden, it was wiped away, Jarvis said.

Crystal was in disbelief. I never would have thought in a million years that this would be our life, she said. I never thought this could happen to my son. But were still here. People would have thought we would have given up and turned on each other and Jace would stay in foster care. But I survived that. We survived that.

The Bryants, who are black, believe they were victims of a racial bias that exists in the child welfare system. A U.S. Department of Health and Human Services report showed that African American children are placed in foster care at almost twice the rate of white children, and they stay in foster care longer. Two studies in Texas found that even when African American families were assigned lower risk scores in child-abuse assessments, they were more likely than white families to have their children removed.

El Paso County child welfare officials declined to discuss the Bryants case, citing confidentiality laws. They said it is extremely rare that parents are accused of abuse and then exonerated, although they could not say how often it happens because the state child welfare data system does not keep track.

It is exceedingly, exceedingly rare, said Kristina Iodice, the departments public information officer. El Paso County investigated 6,633 child abuse and neglect allegations last year. Just more than 1,753 of those were founded. On any given day in 2019, about 360 children in the county were in foster placements.

Before a child is removed, the case is reviewed by a team that includes supervisors and medical professionals, said April Jenkins, intake manager for the countys Children, Youth and Families Services. A judge has to verbally approve a childs removal, no matter what time of day or night, and child protection workers have to present written evidence for the removal in court within 72 hours.

We are not making any decisions or assumptions or anything like that in a vacuum, Jenkins said.

On a recent afternoon, 20-month-old Jace squealed and giggled as he crawled into a play tent in the Bryants living room, where photos of Jace as a baby, the Bryants in military uniform shortly after they met at basic training in Missouri, and the couple on their wedding day hang on the walls. The Bryants have a new appreciation for days when the three of them are at home together, like when Jarvis made gumbo and they watched Louisiana State University win the national college football championship against Clemson.

Jace is eating by mouth now, after Jarvis and Crystal slowly introduced him to foods, starting with strawberries and other soft fruits. He is growing out of neonatal rickets and his bones are becoming stronger. And his g-tube is scheduled to come out in April. Jace doesnt seem to remember what he went through, but his parents think they will probably tell him, some day.

Crystal gave up on restoring her nursing certification the main reason she wanted it was to take care of Jaces g-tube. Jarvis is still waiting for the Army to restore his security clearance, and when it does the Bryants hope to leave Colorado for another Army post. The state where their baby was born has too many bad memories.

When they drive to Fort Carson, they avoid the guard station where they were arrested. When Jace was sick recently with a 104-degree fever, they hesitated before taking him to the hospital. Im sure as soon as you pull up his medical records, it says possible abuse, and everybody is looking at us now, Crystal said.

Wherever they live, the Bryants said they wont get over what they experienced during the past year. Theyre speaking out now to help other families who are falsely accused.

Its no hard feelings for us, but its anger, Jarvis said. This is what we actually had to live through. This is what our son had to live through. There should be due diligence before someones child is removed from their care. That is like, absurd, that you can take someones child and get a judge to sign off on it and you didnt even do your due diligence.

The Bryants said some of those involved in their case, including at the child welfare division, apologized privately for what they had been through. For Crystal, though, nothing can make up for lost time.

Im still grieving those days I didnt have my son with me, she said. We missed so many diaper changes, so many baths. I missed so much of his life.

This reporting is made possible by our members. You can directly support independent watchdog journalism in Colorado for as little as $5 a month. Start here: coloradosun.com/join

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Their baby was taken away and placed in foster care for 164 days. It turns out, he had a bone disorder. - The Colorado Sun

In the age of Instagram, self-care has actually ended up being associated with extravagances like massage therapies, facials, expensive items, store exercise courses as well as lush holidays.

That all audios fantastic if you have lots of non reusable revenue. But for the majority of us, investing severe cash money on self-care simply isnt reasonable.

The whole concept of self-care has really strayed from the original intent, and become a meme unto itself, claimed Kathleen Dahlen deVos, a therapist in SanFrancisco When I talk with my clients about self-care, rarely am I encouraging practices and habits that cost money. In fact, spending excessive money or funds we dont have In the name of self-care can actually be distressing, destructive and work against our mental and emotional wellbeing.

We asked professionals in the wellness area to share a few of the very best ways to practice self-care that are essentially totally free. Heres what they informed us:

Take a stroll around the block, being in the turf, trek a regional path or simply allow the sunlight radiate on your face for a couple of mins.

No matter where you live, you likely have access to an outside space, claimed Tiffany Lester, an integrative medication physician in SanFrancisco If its not in your neighborhood, think of a close space you can get to within 10 to 30 minutes. Getting outside and away from our devices calms our nervous system from the negative effects of everyday stressors.

When your home or workplace is a mess, it can take a toll on your psychological state, making you really feel a lot more stressed out, distressed as well as overloaded.

For some, a messy or disorganized space can activate their nervous systems and impact mental health wellness, claimed specialist Jesse Kahn, supervisor of The Gender & & Sexuality Therapy Center in NewYork If thats you, taking time to clean up your space can be an act of self-care and self-love, and may feel healing rather than like a chore you dont want to do.

Mindlessly scrolling with your social media sites feeds for hrs at a time is not just a time suck, however is additionally connected to reduced self-worth, rest problems as well as an enhanced fear of missing out, or FOMO.

Social media and the internet is a great resource to connect, cultivate support and community, but it can also be a place of overconsumption, distraction, and numbing out to what we truly may need in our lives, claimed McKel Hill Kooienga, a signed up dietitian in Nashville, Tennessee, as well as creator of the website Nutrition Stripped.

The apple iphones Screen Time function, Androids Digital Wellbeing devices or applications like Moment can check your social media sites use as well as assist you cut down. Other methods that might serve consist of disabling particular press alerts, switching over to grayscale setting or concealing your most attracting applications in a folder thats out your house display.

CSA Images by means of Getty Images

All you require is a pen as well as some paper to get going. Journaling can be a healing practice that aids you recognize believed patterns, overcome tough feelings, assess particular occasions or grow even more appreciation in your day-to-day life.

Sometimes I find it just as helpful as therapy and Im very pro-therapy; Im studying to be a therapist, claimed Lauren Donelson, an author as well as yoga exercise educator based inSeattle Journaling helps us externalize whats going on inside our heads, and it helps us to look at our thoughts more objectively.

Making an initiative to obtain the advised 7 to 9 hrs of high quality slumber can make a massive distinction when it involves your total wellness. Getting an excellent evenings rest on a constant basis uses advantages such as far better immune feature, enhanced state of mind as well as far better efficiency at the workplace. (If you require some ideas on just how to make it take place, we have actually obtained you covered.)

Maybe the self-care practice here is getting a certain number of hours a night, not exceeding a certain number of hours, getting to sleep by a certain time so youre able to wake up by a certain time or creating a ritual to help you calm your body, relax and go to sleep, Kahn claimed.

Practicing reflection is just one of the very best ways to bring back as well as reconnect with our body and mind, claimed Tamara Levitt, a Toronto- based reflection teacher as well as h ead of mindfulness at Calm.

As (writer) Anne Lamott said: Almost everything will work again if you unplug it for a few minutes, Lamott claimed. There is immense value in giving ourselves time and space to shift from doing mode to being mode. Meditation allows us to reconnect with the needs of our mind and body.

If you favor led reflections, you can take a look at the totally free variation of applications like Headspace or Calm, or discover video clips on You Tube. And, obviously, practicing meditation in silence is one more fantastic choice that does not cost a dollar.

At the very least once daily, otherwise even more, take a while to sign in with on your own. Pause to examine just how starving or complete you are, any kind of feelings you might be really feeling or check your body for locations of rigidity.

Simply asking yourself the question, How am I doing right now? is a gentle reminder to take care of yourself, Hill Kooienga claimed.

Malte Mueller by means of Getty Images

It could be dancing in your room to a fire playlist, doing squats in your living-room or taking part in a neighborhood yoga exercise course (which is usually much less pricey than a store health and fitness course).

However, if that still doesnt fit in your budget, there are many free online yoga videos on YouTube, Kahn claimed. One of my faves is Yoga With Adriene.

Texting as well as e-mail are practical types of interaction, however they do not please our deep demand for link in the means a lot more individual communications do.

Call a friend, take a walk with a colleague or cook dinner with a family member, Dahlen deVos said. Connecting with others we care for helps to shift us out of our heads, regulates our nervous systems and elevates our moods.

The needs of job, household as well as various other responsibilities use up the majority of our energy and time, leaving hardly any kind of space in our timetables for tasks we absolutely delight in. But taking time for our leisure activities also when we have a whole lot on our plate issues.

Most of us are too busy to make time for activities that are joy-filled and feel nurturing, Levitt claimed. Find a time each week to shut off your electronics, and engage in a hobby that rejuvenates your spirit; play music, write in a journal, take a cooking class. While electronics deplete us, our favorite activities nourish us.

During high-stress durations, we might go hrs or perhaps an entire day without taking a complete, basing breath if were not willful regarding it.

I like to take a few deep breaths in the morning and also throughout the day because it helps me to recenter and connect more with the present moment, claimed Jessica Jones, a San Francisco- based signed up dietitian as well as founder of FoodHeaven One strategy that I use to remind myself to do this is to take three deep breaths every time I go to the bathroom and wash my hands. Its easy, free and makes a huge difference in my daily stress levels.

Choose your reason, whatever it might be, and after that find out a method you can join in.

Engaging in altruistic acts and seeing our actions make a direct and positive impact in the lives of others is a surefire way to shift your mood and feel part of something bigger than yourself, Dahlen deVos claimed. This can help put our problems in context, or at least give us a break from stressors without numbing out.

Malte Mueller by means of Getty Images

Aim to place even more of your grocery store spending plan towards veggies as well as much less in the direction of ultra-processed junk food. Then, to up your consumption, reduced up some veggies at the start of the week as well as shop them in your refrigerator this way you can quickly get them when you require a treat or include a handful or more to improve your dishes.

Most of us are not consuming near enough whole foods let alone vegetables, which keep us nice and full because of prolonged satiety from the fiber, Hill Kooienga claimed. Vegetables nourish our physical bodies on a cellular level with fiber, minerals, vitamins, and antioxidants, and they can taste really delicious too.

Snuggle up alongside your companion, your youngster or perhaps your BFF.

Cuddling releases oxytocin, a feel good hormone, that also helps with reducing stress, claimed Lynsie Seely, a marital relationship as well as household specialist in SanFrancisco

Pets make fantastic cuddle friends, also. Plus, spending quality time with our fuzzy pals has actually been revealed to reduce anxiousness, anxiety as well as sensations of isolation.

If you dont have access to a pet, go visit adoptable animals at the local shelter, sign up to walk dogs for a service such as WAG or sip tea at a cat cafe, Dahlen deVos claimed.

We typically consider self-care as doing something additional for ourselves in addition to our typical daily tasks. But self-care can additionally have to do with what you pick not to do, Seely claimed.

One means to offer a healthy and balanced no? Start setup limits with individuals in your life.

So many of us are people pleasers and spend a lot of time doing things out of feelings of guilt and obligation, causing us to feel energetically drained and lacking the ability to focus on ourselves and what we truly want, claimed Sara Groton, a nourishment as well as consuming psychology instructor in SanFrancisco Any time I discover myself assuming I ought to do that or I have to do that, I take a minute to concern as well as obstacle that believed.

All the face masks, manicures as well as massage therapies on the planet can not reverse the damages of that extreme inner guide slamming, evaluating as well as scolding on your own all day.

If you do not understand where to start with self-compassion, Allison Hart a psychological wellness expert in San Francisco advised placing your turn over your heart as well as stating to on your own: I am struggling right now. Im in pain, Im angry or feeling out of the flow. May I be gentle and flexible with myself. May I be kind to myself and may I take a break from problem-solving just for a moment.

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16 Ways To Practice Self-Care That Cost Next To Nothing - The Union Journal

Catherine Burns Food4Thought

Published Feb 14, 2020 at 8:00 am(Updated Feb 14, 2020 at 12:30 am)

Bedroom benefits: adequate sleep improves everything and your diet can boost your sex drive

When I was 14 years old, I was given flowers on Valentines Day and they were beautiful.

For a few days, I existed in a bit of a spin wondering who this secret admirer could be. It turned out later that the flowers were from my stepdad, a clever move designed to improve my mums Valentines Day by not having a nobody-loves-me teenager in the house. (Genius, yes?)

By the time I found out, the world had moved on and I was too busy focusing on some other drama to be devastated. Decades later, theres no doubt that the day itself can be a little crazy. Hallmark have kinda run away with the concept, after all. But if you ask me, its always fun to focus on love!

Whether its cuddles on the sofa or bedroom Olympics, it helps to be in the mood. Thing is, many of us are so busy and stressed that our libidos tend to dive-bomb. Its hard to feel sexy when you still have to load the dishwasher and take out the trash. With work e-mails constantly pinging on our phones, toddlers reappearing long after bedtime and laundry coming out of our ears, we could be forgiven for choosing comfy pants and an early night.

So how, when we know in theory we would like to spice things up, do we actually make it happen?

Of course, clearing relationship grudges and confusion is always a good place to start. But chat to your friends or a therapist about that I wont pretend its my speciality area!

Where I can help you is with some nutrition tips that are surprisingly effective. What you eat and drink, likely has much more of an impact than you think. Read on!

Its not just what you do, its what you dont do

As promising as some supplements may be, you cant out-supplement a bad diet. If your libido is on the floor and you generally consume a processed diet full of junk, then no wonder. Theres no point taking zinc and essential fats with a burger and fries! Try and commit to a few weeks of clean eating and see how you feel on the other side. You might just feel so good that it motivates you to continue. And when you make dietary changes because you want to (not because you have to), then you have hit lifestyle gold. Its so easy!

Basic essentials

I mention zinc and essential fats for a reason. Both are important for healthy hormone balance, which is the foundation for a cracking sex drive. You can find zinc in pumpkin seeds, oats, oysters, turkey and shrimp. You can find essential fats in unroasted nuts and seeds, wild salmon, oily fish and avocados. If you dont like oily fish, then try a good quality fish oil supplement such as Nordic Naturals (Peoples), Life Extension (Rock On) or Innate Choice (Inside Out Wellness). If you are on medication for epilepsy, then fish oil supplements are usually contraindicated. This may be true for other meds (especially blood thinners), so always check in with your physician.

Balance your blood sugar

Key for hormone balance and mood. Also key for preventing the cravings that lead to sugar/junk food overload, which in turn leads to feelings of shame and regret, ie not feeling sexy! Try eating little and often through the day, only picking healthy carbs (eg wholegrains, root veg, fruit or beans/lentils) and always pairing those carbs with protein. A sample day: breakfast: vegetable omelette and a bowl of berries; snack: an apple and some almonds; lunch: salad with salmon or chicken, beans and olives; snack: carrots and hummus; dinner: quinoa with fish and green vegetables. If you need a little chocolate in your life, try some dark chocolate and a handful of nuts.

Stay hydrated

Its basic, but so important. The first sign of dehydration is fatigue. So if you dont have any energy, check you are drinking enough water. It also helps to prevent constipation, which can be the root cause of gas and bloating (a bit of a passion killer, lets face it).

Try collagen

Collagen is famous for improving skin health and elasticity including, (dont be shocked) the integrity of the vaginal wall! Pick a grass-fed collagen hydrolysate (eg the Great Lakes brand at Miles) and stir in 1 teaspoon at a time into tea or coffee. Goes fine in smoothies too. Its also good for phase 2 liver detox, gut health, hair growth and preventing wrinkles/cellulite. (Dont worry, the cashiers wont judge you although they might give you a wink!)

Sexy foods

Its not just oysters a good job, as I think theyre gross (each to their own!) but also bananas, watermelon, dark chocolate and high-quality protein can boost serotonin and your libido. Hooray!

Fenugreek

Often used to help improve breast milk production, fenugreek can also improve sex drive in men as it seems to regulate poor testosterone levels. Bumper breast milk supplies in women and an improved libido in men might lead to a somewhat bizarre or wet Valentines experience but . good luck! You can get fenugreek in supplement form or as a tea.

Sleep

Remember, adequate sleep improves everything. Specifically, though, men who only get four hours of sleep a night have the same testosterone level as men a decade older. Aside from that, we all need adequate rest for repair, memory, immunity and our sanity. So switch off Netflix and get into bed! In fact, try and ban all screens from the bedroom. If youre wondering how on earth you will wake up in the morning, then buy an actual alarm clock they do still exist!

I hope that helps! Looking forward to lots of November babies! Have a great weekend one and all.

Catherine Burns is a qualified nutritional therapist. For more details: natural.bm, 505-4725, Natural Nutrition Bermuda on Facebook and @naturalbda on Instagram

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Get in the mood for love! - Royal Gazette

We all experience annoying symptoms from time to time. Fatigue, anxiety, hair loss and weight gain are symptoms we might chalk up to stress, diet, lack of sleep, or aging.

Often, many of these issues can be resolved by eating a healthy, whole food diet, exercising more, reducing stress and getting enough sleep. But when symptoms persist, you may want to visit your primary care physician and get your thyroid levels checked.

An estimated 20 million Americans have some form of a thyroid condition. According to statistics, women are much more likely than men to have thyroid problems. Hyperthyroidism affects two in 100 women and two in 1,000 men.

The thyroid is the butterfly-shaped gland in the base of the neck that makes the hormone T4. When enters the bloodstream; it converts to T3, the most active form of thyroid hormone. Having sufficient levels of these hormones helps regulate body temperature, metabolism, blood pressure and heart rate.

When thyroid issues are left untreated, patients can suffer from cardiovascular problems, nerve injury, infertility and, in severe cases, death. Pregnant women with undiagnosed hypothyroidism have an increased risk of miscarriage, preterm delivery and severe developmental problems in their children.

The thyroid can become underactive, overactive, infected or cancerous. Here is a rundown of the most common thyroid issues:

Hyperthyroidism

Someone who has an overactive thyroid may notice some of these symptoms:

Irritability

Rapid heartbeat

Sweating

Hand and finger tremors

Fatigue

Osteoporosis

Anxiety

Insomnia

After diagnosis, an overactive thyroid can be treated with medication. Graves disease is a type of hyperthyroidism. Its an autoimmune, genetic condition that can cause the tissue and muscle behind the eyes to swell. While graves is a life-long condition, it is treatable. Some treatment options include medication, radioactive iodine and, in some cases, surgery.

Hypothyroidism

Another common problem facing many Americans is an underactive thyroid. Some of the common symptoms associated with hypothyroidism include:

Memory loss

Fatigue

Cold intolerance

Constipation

Dry skin

Fertility problems

Depression

Hair loss

Weight gain

Your doctor will likely start by testing the thyroid hormone levels in your blood. Once a doctor diagnoses a patient with an underactive thyroid, they may prescribe a hormone replacement, which can reverse the effects of hypothyroidism.

Cancer

Thyroid cancer occurs when the cells in the thyroid grow uncontrollably, forming a nodule or tumor. Approximately 62,500 people are diagnosed with thyroid cancer in the United States each year. The disease usually affects people between the ages of 20 and 55. Women are nearly three times more likely to develop thyroid cancer. Many patients have no symptoms, but some experience a lump in the neck, voice changes and painful swallowing. Fortunately, about 90% of thyroid nodules are benign, and one out of 10 is malignant.

Regular neck checks are an essential part of your wellness routine. During your annual exam, your primary care physician will check your neck. If you find a lump or experience any of the symptoms described above, schedule an appointment with your primary care provider to get it checked out.

Dr. Julio Santiago is board certified in family medicine, fluent in Spanish and is a member of the medical staff at Galesburg Cottage Hospital.

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Local Doctor: Keeping tabs on your thyroid - Monmouth Daily Review Atlas

Stix has ovulation tests and pregnancy tests for users to order online.

More than 6 million women in the US struggle to become pregnant or stay pregnant, according to the Department for Health and Human Services. They typically usehome ovulation tests and period-tracking apps to help them determine their best window to conceive. On Tuesday, female-founded pregnancy test provider Stix launched a new subscription service to help women determine their most fertile days -- without connecting to any app that could leak sensitive data.

Pregnancy tests and ovulation kits are readily available in stores or online. But Stix aims to make the purchase about more than just the transaction, co-founder Cynthia Plotch told CNET. Almost all of the products on the market are packaged as if everyone wants to get pregnant. Not everyone does.

Stix's tests detect the surge in luteinizing hormone in urine, which occurs a day or two before ovulation, signaling the fertile window when a person is most likely to conceive. Having this information can help people make the best choices for their own lives, whether or not they are trying to conceive.

The FDA-approved tests cost $17 for a one-time set of seven or $13 for a monthly subscription pack. Subscriptions are the best option for people who need tests regularly, Plotch said -- for example, those trying to get pregnant, or those who have irregular periods and want to better track their cycles. The tests have a three-year shelf life.

Read more: Fertility, pregnancy prevention and more: Why you should be tracking your period

Stix's test is shipped in a plain envelope, so no one but you knows what's inside. And on the topic of privacy, the company doesn't use an app, so there are fewer privacy issues at hand than there might be with other period-tracking apps.

Stix's privacy policy says that the only information the company collects is that needed to ship the items to your home. The site does allow for information to be collected, so it can advertise to you. Stix's policy says that your information will be shared with Shopify and Google Analytics, but provided a way to opt out of Google Analytics and a link to Shopify's privacy policy. Stix also gives ways for you to opt out of targeted advertising, tracking and data retention.

Stix's tests arrive in a discrete package for privacy.

Plotch said that Stix retains the basic information customers enter when they make an account and that the company works with third-party software to store the data securely.

While apps are convenient ways to interact with companies and products, they're not immune to data leaks. Last September, multiple period trackers were found to be sharing sensitive information with Facebook. The apps included Maya by Plackal Tech and MIA by Mobapp Development, My Period Tracker by Linchpin Health, Ovulation Calculator by Pinkbird and Mi Calendario by Grupo Familia.

More recently, in January, the period-tracking apps Clue and My Days were collectively sharing user data with at least 135 advertising-related companies. The data shared included GPS locations, IP addresses, details about gender, sexuality and political views.

Stix the company is just over a year old and run by Plotch and her co-founder Jamie Norwood. Plotch said that the team isn't planning to create an app, but if the consumer base wants one, nothing is off the table.

"Regardless of your age, location, or anything else -- all women deserve access to quality healthcare and health information," Plotch said.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

Link:
This home ovulation testing service thinks you shouldn't have to forgo privacy to get pregnant - CNET

Patients with cancer often want to know 'How long do I have?' Now they can take a look themselves at a newly launched and free online prognosis tool, CancerSurvivalRates.com.

It provides patients with a simple tool that can be customized according to their cancer type and specific characteristics such as grade and stage, as well as individual characteristics such as their age and gender.

Stephen Buck, CEO and cofounder of Courage Health, the company behind CancerSurvivalRates.com, emphasized that the goal of this tool is not only to provide information about prognosis, but to encourage patients to speak with their physician.

"We want the patient to do the research for the purpose of having a conversation the doctor," he told Medscape Medical News. "These are just statistics, based on their profile, but it provides the basis for further discussion."

Buck explained that it was developed as an aid for patients. "Once you hear something shocking like a cancer diagnosis, you can really be overwhelmed," he said. "And a lot of studies have shown that patients often don't understand what they are told about a prognosis. The physician, for example, may use language that may be hard for patients to understand."

Courage Health uses the same data as the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute (NCI), he said.

"The NCI does provide information on their website through the SEER [Surveillance, Epidemiology, and End Results] Explorer tool, but it's tricky for an inexperienced user," said Buck. "In this regard, our tool using the same underlying data is very similar. We just have an easier-to-use interface plus questions to ask your doctor."

In addition, this tool is a little more customizable, Buck added. "Someone with colon cancer, for example, may have a 5-year survival rate of 75% according to some data, but that might include all ages and grades. We try to tailor it a little to make it more exact."

Medscape reached out to oncologists to gauge their reactions to the new online tool.

"I believe if you ask 50 oncologists and 50 lay people about the utility of the tool, you'll get a variety of different responses," said Ramy Sedhom, MD, an oncology fellow at Johns Hopkins Medicine in Baltimore, Maryland. He emphasized that no algorithm, or a clinician's best judgement, will be correct all of the time.

"This is especially true considering that, as a society, we have not done our part to account for the variables that influence patient outcomes, including a lack of equity," he said. "However, I believe the training of oncologists is changing and allowing flexibility when it comes to how patient information is shared. And with the explosion of social media, Twitter, and patient advocates, there needs to be an openness to utilizing novel ways to share important information."

Sedhom said the new website provides information that is more user-friendly than other sites, as it allows for considering different variables, such as hormone receptor positivity. "Of course, the average person does not know that these statistics are meant for a population level and are not applicable for individual patients," he noted.

"With that being said, the tool is an excellent framework for a discussion about potential outcomes to allow a bigger conversation between patient and oncologist about prognosis, goals of therapy, goals of the individual patient, and potential outcomes," he said. "What I especially appreciate is the nod to palliative care, which is often taboo."

The American Cancer Society pointed out that it offers prognosis information on its own website. "The intention of the survival rate data we offer on our website and in our annual publications is to provide information about cancer survival at the population level, rather than provide data for the individual cancer patient, whose prognosis involves not only stage, grade, and age, but many other factors as well," the ACS said. "It is important to note that we also publish research studies that include more detailed survival analyses with additional prognostic factors."

While cancer statistics are available in many other places, this new website "represents the best, simplest tool that can be used by patients and providers alike," says Andrew Bruggeman, MD, an assistant professor of radiation oncology and section chief of the Radiation Medicine and Applied Sciences Palliative Care Service at the University of California, San Diego.

"This site has a simple, easy to use interface and has data for several different types of cancer," said Bruggeman, who served as an adviser on the CancerSurvivalRates.com project. "The data is highly reliable when looking at large numbers of patients with a certain type of cancer."

"If there are providers who are leery of patients using this website out of concern for the reliability of the data source, they should rest assured that the data comes from SEER data, so the models are based upon reliable, real-world data," he told Medscape Medical News.

Having said that, he emphasized that determining an individual patient's prognosis is much more nuanced than what can be captured in a single website. "There are no perfect tools for determining an individual patient's prognosis and that is a limitation of this and any other website or data source," he added.

[It] will be useful to both patients and clinicians. Dr S. Vincent Rajkumar, professor of medicine, Mayo Clinic

S. Vincent Rajkumar, MD, professor of medicine at the Mayo Clinic in Rochester, Minnesota, agreed that this website is very easy to navigate and is convenient for obtaining prognostic information. "It is well referenced and will be useful to both patients and clinicians," he said.

Elsewhere on the Internet, the "rates provided can vary widelyI checked out the myeloma rates with various parameters, and they are accurate, said Rajkumar, a myeloma specialist.

The site is intended for both for patients and physicians, and Rajkumar thinks that oncologists will find it useful as well. "And as they use it more, they may be more receptive," he said.

However, the problem with survival rates is interpretation, and he agrees that patients may not realize that these estimates are for populations. "No one can predict that for an individual patient," he said. "But it gives an idea, and that is useful for reassurance and for planning. Another factor is that the numbers depend on data that is a few years old. Outcomes with current therapy maybe better, and that should offer hope."

The simplicity of this tool may help oncologists put prognosis into better perspective when having that discussion with patients, commented Alex R. Menter, MD, an oncologist with Kaiser Permanente in Lone Tree, Colorado. He added that he has "played" with the NCI calculator in the past, but found it cumbersome to use.

"The version I used previously looked at overall mortality based on comorbidities, but did not look at cancer-specific mortality," he said. "I love this calculator because it allows me to share with my patients some real-world numbers and give them a rough idea of what they can expect with their cancer."

Menter noted that in practice, he finds it particularly difficult to discuss prognosis with older patients, as survival rates are frequently based on estimates from clinical trials that typically enroll younger patients with better prognoses. This tool includes SEER data for actuarial outcomes for patients with different cancers, which can give patients a better real-world estimate of what could happen with their diagnosis and at their age, he said.

"I also appreciate that I can pull it up quickly on the computer in the room or on my phone if needed," he said. "This does not take into account some subsets of cancer that may have a particular targeted therapy or a much better prognosis, but I can adjust my discussion with the patient based on their tumor characteristics."

"I typically try and describe best case, worst case, and average scenarios, and these points and estimates help facilitate that discussion and understanding," he added.

Thomas LeBlanc, MD, an associate professor of medicine at Duke University School of Medicine in Durham, North Carolina, said that, although there is a plethora of information available on the Internet, it can still be incredibly difficult for patients and families to know what might apply to them. Thus, a tool that allows some personalization is helpful.

However, the more important issue is that bulk of available data online does not account for the problem of "numeracy," he emphasized.

"Much like 'health literacy,' the concept of 'numeracy' relates to the functional understanding of numerical information and ability to apply it to one's life and decisions," LeBlanc said. "Evidence clearly shows that the average American layperson is not functionally numerate, meaning they aren't able to functionally understand, for example, what a '50% chance of remission' might actually mean for them."

Most of the data available about cancer outcomes are presented in exactly this way, and unfortunately clinicians are complicit in this problem, LeBlanc said. "We talk a lot, and we think we're doing a great job of conveying complex information, and often we're actually overwhelming patients and families, while presenting too much data and doing so in a way that isn't actually meaningfully accessible and actionable for those without high numeracy," he said.

"So, a more numeracy-friendly tool that is personalized and patient-facing is really a very welcomed advance in cancer communication," he said.

LeBlanc pointed out that multiple, high-quality studies have clearly shown that many patients with advanced incurable cancers still think their disease could be cured.

"So there's a huge gap here between what clinicians know and are trying convey, vs what patients and families hear/internalize from our encounters," he added.

"If we just continue doing what we have been doing, this gap will remain. If we figure out how to use a novel tool like this one, we might be able to more effectively help patients and families understand the likely outcomes, and have better conversations about goals, values, and preferences for treatment when they better understand the background and context for decision making."

The tool provides cancer survival rates for 30 types of cancer, and is available completely free of charge. The algorithm takes into account age, stage, grade, time since diagnosis, histology, and additional factors such as the Gleason score in prostate cancer. The 1-, 2-, and 5-year survival rates can then be calculated.

"Our models are Cox Proportional Hazard models, a very standard and widely accepted technique within academic literature for producing population-based survival rates," explained Buck, the Courage Health CEO. Both the modeling techniques and model output underwent expert review. "There is always some room for subjectivity in how certain things are done, but we feel strongly that our methods are in line with acceptable practices in developing survival rate models."

All statistical models use SEER data from 2004-2015 and survival rates are cause-specific, not all-cause mortality.

"This website will paint with a broad brush to help give patients an idea of 1-, 2-, and 5-year survival for 'X' type of cancer," said Bruggeman. "This is information that patients often want to know but don't always get from their providers or know how to find. It is important for them to then follow up with their individual provider to help take that information and then discuss why their individual prognosis may be similar, better, or worse."

The tool is a work in progress, and is being tweaked as feedback comes in.

"Free, constructive advice for makers of this website" was offered up in a Twitter post from Vinay Prasad, MD, a practicing hematologist-oncologist and associate professor of medicine at Oregon Health and Science University, and also a Medscape contributor.

He suggested that "instead of 5-year survival, show the 20th and 80th percentile of survival (or 15th and 85th) to provide a range of outcomes most people experience," and added that it may be useful to also "provide the stat with and without therapy."

Buck told Medscape Medical News that he thought these suggestions were "a fantastic idea to explore."

"The treatment element is certainly worth exploring in a future phase," he said. "Difficult but useful."

Paulo Nassar, MD, PhD, an intensivist at the A.C. Camargo Cancer Center in Sao Paulo, Brazil, commented that he is "always discussing prognosis with oncologists" and that he has sent the tool to all his intensive care unit colleagues, adding that he intends to use the tool for patient cases.

Nassar also had some ideas for improvements. "If I could suggest anything, it would be to include a range maybe something like CI [confidence interval] 95% for the survival estimates, although I'm not sure it would help patients, but certainly doctors would be helped."

Buck told Medscape Medical News that he and his team of developers have already had conversations with three major national insurers/health systems about how to integrate into patient- and physician-facing tools. "All have expressed interest in working together," he said. "And based on feedback from oncologists, we're adding additional statistical details the percentiles for survival for the healthcare professional version only. We should have this ready soon."

Given that the tool only launched at the end of 2019, feedback from patients is still limited. Still, Buck noted, it has been interesting so far. "The number one email question/complaint we get is 'Why isn't my type of cancer included?' " he said. "These cancers usually pertain to brain, gallbladder, appendix, duodenal, and other leukemias."

There are two main reasons for not including them, at least for now. One is that the complexity and the number of individual factors involved are too numerous to provide useful comparisons. The second is the sample size. "Some of these types have less than 1000 patients a year," he said, "so building a model with multiple variables would have too much variability in survival rate estimates for subgroups."

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'How Long Do I Have?' New Online Tool for Patients With Cancer - Medscape

Whether youre hitting the online slot machines in Las Vegas, racing in an old-school video games like Mario Kart, or having an augmented experience on your cellphone via Pokemon Go, internet gaming is just about everywhere these days.

At least one person plays video games in two-thirds of American households, according to the Entertainment Software Association, and according to the American Psychiatric Association, about 160 million U.S. adults play internet-based games, one recent study estimates.

Its easy to see that internet games and video gambling can be quite entertaining, and it may be just as easy to get caught up in the thrill of the competition. But can playing these types of games truly be addictive?

Winning results?

A study published in September in the Journal of Addictions & Offender Counseling examined the relationships among personality, motivation and internet gaming disorder. According to the APA, the disorder is the persistent and recurrent use of the internet to engage in games, often with other players, leading to clinically significant impairment or distress.

Lead author Kristy L. Carlisle, an assistant professor of counseling and human services at Old Dominion University in Norfolk, Virginia, and her three co-authors noted that gamers social tendencies, as determined by personality traits, may play a role in developing problematic gaming habits and addiction.

Addiction is by definition continually engaging in a behavior despite harmful consequences, says Dr. Hallie Zwibel, director of sports medicine at the New York Institute of Technology in New York City. In the instance of gaming, prolonged uncontrollable game play results in depression and social isolation in addicted individuals.

When counselors understand the potential social context of clients situations, according to the study, they have more information to develop prevention and treatment strategies that treat the whole person and not just a diagnosis. But more research is needed to understand the full interplay among personality, motivation and IGD, along with demographic risk factors.

The study, which included 1,881 adults from various countries, found that predictors of IGD included being male, being neurotic, introverted personality traits, and having motivation related to achievement.

The prevalence of IGD varies based on the source of the information, but a few things are clear, Zwibel says.

Males are more likely to be diagnosed as having gaming disorders compared to females, he says, adding that some studies have shown men being four to 10 times more likely to demonstrate gaming addiction, and a few characteristics can often be good predictors of IGD, Zwibel says.

Individuals with mental health disorders such as substance abuse, depression and anxiety are risk factors, he says. Friends and family members who have gambling addictions can increase ones risk. Also, individuals with less emotional support or who are more socially isolated or more likely to be predisposed to gaming addiction.

Gender vs. gender

Its important to note that, according to the APA, gaming addiction was described in its Diagnostic and Statistical Manual of Mental Disorders to determine whether the condition was a unique mental disorder or the best criteria to classify it at the time that the DSM-5 was published in 2013.

Dr. Donnie Sansom, associate medical director at Sierra Tucson, an addiction and behavioral health care center in Tucson, Arizona, says IDG is only under study at this point The APA does feel at this point, however, that there is a growing body of literature to suggest that internet gaming disorder be further studied and has thus included a potential diagnosis.

Online video games have been shown to elicit more craving-related activations in the brains of male subjects in studies as compared to female subjects, and this may be why so many video games are designed for males, he says.

Men have generally, starting in childhood, had games that involve risk and competition, Sansom says. This tends to be true in virtually every culture. Think about this: for men of a certain age, we remember running off into a field or through the neighborhood playing cops and robbers or army or the like. Now, youngsters are supervised and have play dates from the time they are young with far less autonomous play away from the watchful eyes of parents. So boys now go and seek that competition and risk online or at a video game station that connects to other players online.

Women are generally less prone to such competition, so they may engage in betting against the house or the dealer more than sports betting or playing in person, and so online gambling becomes a more attractive option, according to the gambling marketing site GamblingSites.com, Sansom adds.

Some data also suggests that women advance from regular gamblers to IGD faster than men do, a concept thats referred to as telescoping, says psychologist Erica Fortune, an associate professor of psychology at Arcadia University in Glenside, Pennsylvania.

For gambling, research indicates that women tend to be drawn to gambling machines, which would include video poker, while men tend to prefer card games, casino games and sports betting, she says. This could be a result of their personal motivations for gambling some gamble to avoid negative mood, some gamble for excitement, some gamble for socializing purposes, etc.

The finish line to success

Zwibel says there are multiple negative impacts on health from playing too much internet video games and participating in online poker or gambling.

Gamers at the college level are having increased levels of body fat and decreased levels of muscle mass compared to their peers, he says. Gamers often use LED monitors, which suppress the sleep hormone melatonin which can lead to insomnia. Sitting for prolonged periods of time can result in neck and back pain, while the repetitive movements on the keyboard mouse or controller and results in elbow pain and carpal tunnel syndrome.

Fortune says those who gamble tend to be in poorer health overall.

The correlation between gambling and poor health is quite clear. Higher BMI, higher incidence of cardiovascular issues, as well as a high prevalence of comorbid mental health disorders like anxiety and depression as well as comorbid addictions alcohol, tobacco and drugs, she says.

I could imagine that you might see some of the same health issues in those who game: poorer physical health due to a rather sedentary lifestyle and poorer mental health due to lack of social interactions/withdrawing from society, she adds.

When it comes to addressing IGD, specifically internet gaming in men and video poker and gambling in women, Fortune says its wise to keep open the lines of communication.

The best thing people can do is simply talk about it, she says. Disorders like these often fall to the wayside. Parents know they need to talk to their kids about things like drugs, drinking and sex, but they often forget about things like gambling and gaming, which look very innocuous at first blush.

}Sansom adds that in both cases, it is often difficult for men and women to recognize or address the problem themselves.

Some of these issues can be treated as an outpatient with cognitive behavioral therapy, support groups such as Gamblers Anonymous and individual therapy, he says. Seek the help of a mental health professional or your primary care physician and start the dialogue. More studies will need to be done, but now that is on the APA radar, that will likely help.

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Game Reset | Health - Olean Times Herald

Dr. Sheerene Idriss explains one of the biggest factors thats aging you that you may never have heard of before.

As the saying goes, new year, new you, right? It depends on who youre speaking with, but if youre asking your dermatologist, they might explain that its not that simple. Theres no magical serum or cream that can completely turn back the hands of time, but with the recent innovations in cosmetic procedures, it is easier than ever to help your skin age gracefully. Fillers especially are one of the most popular options for people who are looking to lift, firm, or otherwise minimize obvious signs of aging, like fine lines and wrinkles.

There are always new research and innovations within the world of dermatology, so we sat down with top NYC dermatologist Dr. Sheerene Idriss to get the 411 on the most exciting breakthroughs for 2020. From the two new filler formulations to the most requested cosmetic proceduresplus one of the biggest factors thats aging you that you might never have heard of beforethis is what we can look forward to in the skin-care market in the year ahead.

What has been the most requested procedure in the past few months, and what do you expect to continue throughout 2020?

A lot of jawline addressment, wherein people want a more rigid, firmer, or more defined jawline. Not a different-looking jaw, which I have to re-educate some people aboutyou have to work in sync with the face. A strong jawline definitely saves the face as we age, since our chins and our jawlines sag. But your jawline has to align with your mid-face. It has to co-exist in a way that makes sense.

Why do you think that is becoming such a popular request?

I think its Instagram. Its both a blessing and a curse. People are oftentimes seeing versions of themselves that are maybe not real. But even if you think of the big-name celebrities, like Kim Kardashian or Jennifer Lopez, they have very strong jawlines. They are associating it with being beautiful. Some patients are coming in with that mind-set, versus being an actual candidate for that procedure. Its really up to the physician to be true to themselves so that people dont start morphing into these caricatures were seeing. [Some of] these crazy jawline fillers almost look like theyve gotten an implant. It really doesnt match the face.

What about in terms of filler innovations?

There was a rumor about Velitte [coming] out in 2020. Itll be interesting to see how a lightweight hyaluronic filler can replenish moisture in the dermis. [Its] a lighter effect that helps with the texture of the skin. I also heard that Revance, the approved form of Teoxanewhich is a resilient form of hyaluronic acid, meaning its longer-lastingitll be interesting to see how well incorporate it when using various fillers in the face. Theyve been using it outside of the United States for a while now. With regards to Teoxane, they have four different ones, three of which have been FDA-approved in the US, and theyre all indicated for different areas of the face. The fourth one is still going through approval. Its like having different paintbrushes in your toolbox.

Is there anything that doesnt yet exist that youre hoping to see developed within the world of fillers?

I think that facial anatomy is so complicated when it comes to structure. There is no miracle product, like in skin care. I dont think it would be good to have a filler that could address all of your problems, because when you think of the face, you want everything to work a little differently. You want it to be sturdier around the jawline to hold the face up, or along your cheekbones. You want it to be malleable along the cheeks or where you smile, so your face can move. It doesnt make sense to have a miracle filler, in my mind.

What about longer-lasting filler?

It makes sense to me to have a long-lasting filler; however, it comes with a caveat. I dont think that having super long-lasting filler is really beneficial because our bone structure changes so much as we age, especially in our 40s. So if you have a long-lasting filler over an ever-changing face, things can start to look wonky over time.

If you look at [cheek] implants, you would have these patients come in, and there are a few who are a bit older because its not as trendy now or en vogue, but their cheeks are sitting [higher] and everything is aging around it, [so] they have a Cruella de Vil look because its not moving. With an aging face, you have to be malleable; you have to work with an aging face. You cant be rigid.

Illustration: Meghann Stephenson... Read More

How much bone density are you losing when you start to age? What is the average percentage per decade?

It starts in your 20s. There is a study from 2012 [stating that] bone structure reduces about 90 percent after menopause. Aging is associated with the decrease in the growth hormone secreted in the pituitary gland. Its decreasing at 14 percent per decade. I dont know if this is associated with bone resorption, but its significant. It cant be overlooked. [Which is why] I feel strongly about not using semi-permanent fillers in the face. I think you can use them in different areas of the face to your benefit, but in the midface, area thats actively changing, you have to grow with the face.

Along with jaw filler, what is another type of treatment that youre seeing more often with your patients?

Younger and younger women are asking for under-eye [filler]. I think it has to do with the filter effect [thats] going on, where people think they shouldnt have a little line under their eyes when they smile. Id say thats normal. Sometimes you definitely should [explore under-eye filler] if the wrinkle is a little deeper, but Id say those two [are the most popular].

What is the process for using the filler under the eye?

Its a tricky area. I think more people think they need it, that theyve lost volume in the eye area, when really their face is dropping. Its better to lift the face laterally with filler around the eye, in my opinion, without really going for the under-eye filler. There are two ways you can do filler: with a blunt-edge needlea cannulaor a sharp-edge needle. But it really depends on what the physician is comfortable using.

Always [use] a lightweight filler for under the eye. I personally dont do the eye without addressing the rest of the face. If youre scared of fillers, you can always do the PRP [platelet-rich plasma] injections, which take your own blood and separate the growth factors. Its still an invasive procedure, but its coming from yourself.

As fillers have become more socially acceptable, do you think people are shying away from more invasive procedures, or are they fatigued by fillers and are searching for something else long-term?

Im very biased because I only see my patient population. The first question I always ask an older patient is Are you someone who wants to get a face-lift in this lifetime, or are you completely against it? The person who is OK with it, Im looking at their skin quality and anatomy and seeing if theyre a candidate for a face-lift. I would push them to get one, and then we can maintain it when they come back to me. A lot of people ask me to reverse or fix work. I think, unfortunately, there are a lot of people out there who just listen to exactly what their patient wants, and that can result in unnecessary amounts of filler to the face, without thinking about the surgical procedure as a choice.

I always think about whether or not this age [at which to recommend a face-lift] will be pushed back because of all of the advances weve made to tighten and resurface the skin. I think that the age of having to get a face-lift is going to be pushed back over time. [Right now] people start to take it seriously at 55-plus.

What is the average age of the first-time filler user in your practice?

Ive noticed three main peaks. The first one is 30 to 33, where they feel like over the past six months their face has shifted. The second one is 39 to 42, where the change happens more dramatically, maybe over a month or so. And then again, in your late 40s, where I get told over and over again, I woke up one morning and I dont recognize myself. Help. Volume loss starts to happen in your late 20s, early 30s, which makes sense if youre thinking about bone density and all of that. Youve probably lost weight, gained weight, et cetera.

For a client whos coming in and saying I dont understand why I look older, but I do. Please help. What is your strategy?

I really look at the face. When youre looking at aging, its a number of things. Its volume loss; its if you have any built-in wrinkles in your face; its the color of your skin; its how elastic your skin is, and your bone structure. I will start with one and see if it works. Some people want Botox but have no lines. I try to tell them, You dont need it yet. There are women out there that listened to their moms [to take care of their skin] and look like little fairies and look impeccable. But theres always the one beginning sign of [aging].

Photo: Shot on site at 6 Columbus, a Sixty Hotel. On Jonelle: Necklace, Baker & Black,Catbird; Hair, Angela Soto; Makeup, Andriani.

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Dr. Shereene Idriss Shares 2020 Filler Innovations and Trends - coveteur.com

Five-year-old Emlee jumps high, runs fast and likes to pirouette around the living room in her white ballet slippers.

Her mom, Karalayne Maglinte, calls her a miracle. Indeed, Emlee is the embodiment of the word: Shes one of the reasons Maglinte is alive today. Another reason: High-risk pregnancy physicians and cancer specialists at UCI Health were able to help the Fontana woman when no one else could.

Cancer during pregnancy is a rare event, occurring approximately once per 1,000 pregnancies annually, according to the National Institutes of Healths World Journal of Oncology. Fortunately, we have plenty of experience treating patients who need a multidisciplinary approach, says Dr. Rita Mehta, a UCI Health oncologist.

Mehta has cared for several pregnant women with cancer, including Michelle Clark-Salib, who was just 28 when diagnosed with breast cancer. Her son Caleb is now 7, and Clark-Salib is cancer-free.

But the situation was touch-and-go for a long time, just as it was for Karalayne and Emlee Maglinte. Their poignant story began to unfold in 2013 when Maglinte was 15 weeks pregnant. She was 36 years old and had two boys at home: Ian, 6, and Isaac, 18 months.

Because I was pregnant, I was much more aware of my bodys cues that something wasnt right, and I was quicker to react than I might have been otherwise, Maglinte says.

My hands and feet were itchy, she says, so itchy I wanted to tear them off. She consulted Dr. Google and read that it might be a liver issue.

At first I thought perhaps it was because I was pregnant with a girl, and the other two were boys, Maglinte recalls. But it got so intense that I began to worry. I didnt want to endanger her. The itchiness began on a Friday. By Monday, she was convinced she needed to call her doctor.

An arduous round of tests, physician appointments and hospitalizations ensued as several Inland Empire doctors tried unsuccessfully to diagnose and treat Maglinte. In addition to the itchiness, she developed jaundice. After four days at a community hospital, she was taken by ambulance in the middle of the night to UCI Douglas Hospital, in Orange.

A team quickly assembled, including high-risk maternal-fetal expert Dr. Julianne Toohey, gastrointestinal endoscopy specialist Dr. John Lee, and pancreatic cancer surgeons Dr. Aram Demirjian and Dr. David Imagawa.

Lee an authority in diseases of the liver, pancreas, bile ducts and gallbladder examined Maglinte using endoscopic ultrasound. His findings led to a biopsy of her pancreas. He also implanted a bile duct stent to alleviate her jaundice. Although complex, each procedure was minimally invasive and safe for the baby.

But the diagnosis was daunting: Maglinte had an aggressive form of pancreatic cancer. Its strange that she would have had cancer at that age, Lee notes. Statistically, almost all pancreatic cancer patients are older than 45, with the average age at the time of diagnosis being 70. Maglinte was only about half that.

She was devastated. I kept walking around the halls of the maternity ward saying: How the heck did I get here? This is crazy.

There werent many options. Early delivery meant the baby would not have survived, as I was only 19 weeks pregnant, Maglinte explains.

But she also had two children at home to consider. She and her husband, Dennis, discussed it. He said it was my choice, Maglinte relates. I wanted to fight for her, but I also needed to fight for myself.

The physicians worked together to save both mother and child. Taking care of a high-risk patient with cancer involves careful communication with the whole team and, of course, the patient, Toohey says. Karalayne was very involved in decision-making.

A week after the diagnosis, Demirjian operated, performing a seven-hour Whipple procedure, or pancreaticoduodenectomy, to remove the tumor. But Maglinte didnt have chemotherapy, which would have jeopardized Emlees survival.

We watched the babys growth and ended up with a planned delivery at 39 weeks, Toohey recalls. This is rather unusual with cancer patients we usually deliver several weeks earlier in order for chemo or other treatment to begin as soon as possible.

Happily, 7-pound, 1-ounce Emlee was born without complications. Her mom says shes a little lifesaver because only 20 percent of pancreatic cancers are diagnosed early, mainly because symptoms abdominal or mid-back pain, jaundice, weight loss and indigestion can overlap with those of other conditions. Without Emlee, I probably wouldnt have reacted to my symptoms the way I did, Maglinte says.

She and Emlee received the kind of advanced care thats usually only available at an academic medical center like UCI.

Oncologist Dr. Rita Mehta, whose research over the past 15 years has led to many advances in treating some of the most aggressive forms of breast cancer with lifesaving results, stands in front of an inspirational quilt that hangs on display at the UCI Breast Health Center in Orange. Photo: Steve Zylius / UCI

Oncologist Mehta, who joined the faculty in 2001 as a clinical professor of medicine, lauds the university, saying, One of the great things is that not only can you do research here, but you can apply what you learn from that research to treat high-risk pregnancies with cutting-edge techniques. Thats not possible in a community hospital setting.

That distinction was as important to Michelle Clark-Salib as it was to Maglinte. In 2012, at age 28, she was diagnosed with an aggressive 8-centimeter breast tumor. After undergoing nearly three months of chemotherapy with a community oncologist in Riverside, Clark-Salib found out that she was 23 weeks pregnant with her son Caleb.

The North Fontana woman consulted with an obstetrician, who discovered that her amniotic sac contained almost no fluid, a side effect of one of her chemo drugs that posed a serious threat to the developing fetus. The doctor sent Clark-Salib to the high-risk maternalfetal physicians at UCI Health, where he had trained as a resident.

Mehta, an international expert in metastatic breast cancer, eventually took over the case. Michelle is an amazing young woman, Mehta says. She was at a very critical stage when she came to us but wanted to save her babys life and her own life. Abortion wasnt an option for her.

The drug that was causing the amniotic fluid problem was discontinued, and Mehta devised a modified cancer treatment plan that avoided the more toxic drug Herceptin until the infant arrived.

As soon as the baby was delivered, we put her back on a chemotherapy regimen, and her cancer went into complete remission, Mehta recalls. Caleb was born healthy at 37 weeks gestation.

Mehta finds this an exciting time in her field: Survival rates are so much improved since I began working in oncology. Sometimes the steps are small; sometimes theyre bigger. But overall, each step adds to the next, and rates keep improving.

Over the last 15 years, her research has led to many advances in treating the most aggressive breast cancers. In a groundbreaking study published in 2012, Mehta showed that a combination of the drugs anastrozole and fulvestrant was superior in controlling cancer and improving patient survival to anastrozole alone or anastrozole followed by fulvestrant in treating hormone receptor-positive metastatic breast cancer in postmenopausal women. A long-term update of the study, published in March 2019 in The New England Journal of Medicine, confirmed the increase in five-year survival rates for advanced breast cancer patients.

Mehta was also one of the first to use chemotherapy combined with Herceptin on women with breast cancer before surgery rather than only after to help shrink tumors.

Now, more than seven years after Calebs birth, Clark-Salib remains cancer-free. And Maglinte has been cancer-free for more than six years.

I dont know what I would have done without UCI, Maglinte says. We were at the right place at the right time with the right teams. Everything just fell into line. Everyone we needed to be there was there.

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Saving Mother and Child - UCI News

If you have a kid who wets the bed, you may be wondering if theres an underlying psychological issue. Why do kids wet the bed? Is it because they have some hidden trauma affecting their bladder control? Heres what you should know about bed-wetting and how to support a child who cant seem to wake up dry.

Its very common for kids to pee in their beds at night. According to Mayo Clinic, Bed-wetting also called nighttime incontinence or nocturnal enuresis is involuntary urination while asleep after the age at which staying dry at night can be reasonably expected. Dont be alarmed. In fact, at any given time, about 5 million children (in the US alone) have problems with bed-wetting. Not surprisingly, there are many potential reasons some kids cant stay dry overnight.

Here are some possible factors:

At age five, approximately 15% of kids tend to wet the bed according to the Nationwide Childrens Organization. Boys are two times more likely to have bed-wetting problems than girls. As kids grow older, most have fewer instances of waking up wet. By the time they reach age 14, only 1-2% of kids still struggle with nighttime bladder control.

Waking up wet can be traumatic for any kid, so resist the urge to scold your little one for wetting the bed again. They arent doing it on purpose and need your support and understanding. Reassure them that they havent done anything wrong and help them understand that many children wake up wet in the night. Soothe them instead of punishing them and remind yourself that their body may not yet have the physical maturity required to remain dry through the night.

You can also try the following to support your child through this challenging stage of life. You can take many steps to help them, depending on the underlying issue. If youre looking at their water intake or drinking habits, consider:

If your childs bedwetting is suspected to be tied to their behavior, you can:

If youre exhausted by constantly waking in the night and cleaning up wet bedding, take comfort in knowing most kids grow out of this behavior by the time they reach age seven. If your child doesnt grow out of it by then, or shows other symptoms of an underlying problem, it may be time to talk to your doctor.

The American Family Physician Organization says administering bed-wetting medication from your pediatrician should be your last resort, Medicines arent a cure for bed-wetting. The medicines work in two ways. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. The medicines may have side effects.

Take your child to the pediatrician if you notice that her nighttime urinating is accompanied by other behaviors or problems, such as pain while peeing, sudden bed-wetting after months of staying dry, swelling in the ankles and feet or snoring loudly at night. There may be a treatable medical condition at the root of the cause.

Wetting the bed is something many kids and parents go through. The key is to face the challenge together, with plenty of support, encouragement, and patience until the phase passes.

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Why Do Kids Wet the Bed? What Parents Need to Know - Parentology

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Letters to the editor tile(Photo: Argus Leader)

Letters to the Editor for Feb. 2:

The Hippocratic oathis a commitment all physicians make to our patients. Whether its ordering tests, recommending treatment plans, or communicating with families, we take this oath into consideration in all aspects of our medical practice. As a pediatrician, I take very seriously the need to protect children. It is the foundation of our profession. However, I cannot ignore the devastating consequences to children that are being proposed in HB 1057 all in the name of protecting children."

This bill ignores evidenced-based gender affirming care that is supported by organizations such as the American Academy of Pediatrics, American Medical Association, and American Academy of Child & Adolescent Psychiatry and criminalizes doctors who provide this care to patients. Studies show that gender affirming care is linked with lower odds of suicidal thoughts over the lifetime of young transgender people and the physical effects of supportive treatment are not permanent if treatment is stopped. Complex care decisions for the transgender and gender diverse youth are not made on a whim. It is a process that requires lengthy evaluation and counseling with the child, parents, and the medical team to ensure that the wellbeing of the child is at the core of the decision. Turning over that sacred and confidential trust to the legislature to determine is not good medicine.

As a pediatrician and advocate for all children, I believe HB 1057 is harmful to the wellbeing of our children. It creates a precedent where policy makers dictate medical practice that is not based on evidence but on personal opinions. Furthermore, it is government intrusion into the private patient-family-doctor relationship. To support HB 1057 is equivalent to a vote of no confidence in our physicians ability to care for children. It should be rejected by our lawmakers.

Richard Vo, MD, Sioux Falls

I own many guns and am an avid hunter. I am also an honorably discharged Vietnam Veteran (drafted) and very active in South Dakota's National Alliance for Mental Illness (NAMI). With this said I must say I amvery disappointed in our current legislature. I have approached a number of legislators asking if they would sponsor a simple bill. It would prohibit the future sale of any magazine clip which has the capacity to hold more than five bullets. It would not impact the ownership of any firearm or these clips, but would prohibit any future sale. There are similar laws already in place - you must have your shotgun plugged so it can only hold three shells when hunting waterfowl.

We have been fortunate here in South Dakota not to have encountered any mass shootings . If limiting the number of bullets within any firearm saves one life, it is good legislation. It is apparent the NRA wields so much power, influenceand money that any common sense gun control legislation is doomed.

I am attempting to do something but cannot find a single sponsor. This discussion must occur before we have our own tragedy. If there is one legislator willing to discuss, please contact me.

David Braun, Pierre

The state legislature is a good few weeks into itssession. Sadly, it appears that this year will follow the usual muddle of bills as some legislators are off to a mean start with the transgender bill (at least Fred Deutsch has moved the proposal out of the bathrooms this year) and the inane ban on a ban of plastic bags.

Come on people!! This state needs to focus on the big deal stuff: increasing Medicaid, providing assistance for the rapidly growing list of nursing home closures, increasing pay for teachers and state employees, looking at alternate ways to provide income to the state such as legalizing sports gambling and hemp production, revamping the trust laws, and yes, just maybe calling for a small personal income tax and (gasp) corporate income tax. One can hope that during the next few weeks, some of this will be accomplished.

And we (thats you and me, folks) can make a difference: get to the cracker barrel sessions, email your legislators, call your legislators. Put pressure on them to do what is important. Let them know we will no longer abide legislators who idle away our tax dollars by squandering time on these waste makers.

Mary Richards, Spearfish

Im a female veteran who served in the United States Army and strongly support Senator Bernie Sanders for President. As a member of the Army Medical Specialist Corps, I cared for active duty and retired military and their families at Walter Reed and Tripler Army Medical Centers, an honor of which I am extremely proud. Military members valiantly don uniforms, in exchange for their lives, to defend our country from harm. Families unselfishly stand by their military members and country.

More than 6,900 US troops have died in Iraq and Afghanistan; over 52,000 have been wounded. Studies have shown 13-30% of returning troops screen positive for PTSD. It is reported that 17 veterans commit suicide every day. Thousands of military families lost a loved one or have a loved one return from deployment who can no longer function as a father, a mother, a son, a daughter, a significant other, due to war-related trauma. These tragedies are largely suffered by us, working class families, the backbone of our military, who believe in defending our country and in politicians who ask of us the ultimate sacrifice.

Senator Sanders understands the weight of such requests. In 2002, he voted against rushing into war with Iraq without proof of weapons of mass destruction. Too many brave lives have been lost or damaged and the human destruction continues to this day. Yet, politicians, Democrats and Republicans, are raising questions about entering into another war with Iran. Who pays for these decisions? Our working-class families do, in life, limb and mind. Senator Sanders has stated, I will do everything I can to stop a war with Iran."

Senator Sanders will honor our military, during and after active service. I stand with Senator Sanders for President.

Mary Dugan, Hot Springs

I am compelled to write this letter as I just read the disturbing news of another inmate succeeding in committing suicide by hanging under the watch of our county jail system. I now know of twohuman beings in eightmonths committing suicide by hanging in our county jail. My niece succeeded in May of 2019. I have to ask myself:how can this happen?Are there not enough qualified staff to protect those that might be a danger to themselves? Orare some of these mentally ill people thought of like "frequent flyers" that they don't need to be watched?

I am saddened for the family of the man who died in jail on Wednesday Jan 29. I can not tell you how much a family is hurt from the issue of suicide. Please if you know someone who is struggling with mental illness, please say something to anyone. Let it be known. For those who are struggling please get some help anywhere. Ask someone. I pray for peace.

Kaylynn Montis, Sioux Falls

Once again, the South Dakota Legislature is obsessed with all things transgender. After failed attempts to ban transgender kids from bathrooms and sports, Representative Fred Deutsch is attempting to ban those same kids from appropriate medical treatment. He found a gullible House after his exhaustive review of the internet and comparing treatments the what the Nazis experiments did in Auschwitz.

Maybe its time for a reality check:

1) Are there any doctors or surgeons in South Dakota that perform gender confirming surgeries? According to Blue Cross/Blue Shield the answer is NO.

2) Are there ethical guidelines for gender confirming treatments that must be followed for any counselor, doctor, endocrinologist, or surgeon? The answer again in YES. If Representative Deutsch had done his homework, he would have learned of International guidance called WPATH that among other things requires the transgender patient to undergo counseling and be certified by two counselors with a diagnosis of gender dysphoria.

3) Are there counselors certified under the WPATH guidelines? YES, but, there are few certified counselors available. As an example, there are only two in Sioux Falls; however, there are many that advertise services to transgender individuals. In my opinion, this is the area where there are significant weaknesses and the State should be more active is policing those that offer services without certification.

4) Who can administer hormone therapy necessary under the guidelines? Appropriately the answer is an endocrinologist. Again, looking at Sioux Falls, there are a very limited number of these doctors available with months long waiting lists for treatment and who also require referrals from the counselors noted previously.

5) What else should you know? Hormone blockers are provided to identified youth as they enter puberty to pause puberty and is totally reversible. This is a collaborative effort between the patient, their parents, doctors, and counselors. A reasonable person should be able to draw the conclusion that there is an extremely long process before a minor could receive any treatment.

6) Are there other requirements to legally change names and gender? YES, but this also requires some of the services listed above.

These kids have the highest risk of harming themselves or committing suicide. They are at the highest risk for being homeless by outing themselves to their parents. They are the highest risk group subject to bullying as well. You should understand that these individuals dont want to be outed because of the risks of abuse. If you think undergoing treatment is a choice you should know that this is probably the hardest choice a person could ever make. The question you should ask yourself and your representatives is would you rather provide treatment to these individuals or risk a child committing suicide?

Once again Representative Deutsch is leading the charge to discriminate against a small population of vulnerable kids. We should be better than this.

Steve Marty, Sioux Falls

Read or Share this story: https://www.argusleader.com/story/opinion/readers/2020/02/02/transgender-bill-goes-against-medical-community-your-letters-editor-feb-2/4624945002/

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Transgender bill goes against the medical community: Your Letters to the Editor for Feb. 2 - Argus Leader

Ah, hormones. Such an easy scapegoat. And for good reason: They can be responsible for everything from mysterious weight gain to hair loss to crazy hunger. When things get a little out of control in that department, an endocrinologist might be able to help you. (In as little as 30 days, you can be a whole lot slimmer, way more energetic, and so much healthier just by following the simple, groundbreaking plan in The Thyroid Cure!)

But before you make an appointment, read on to find out what they think you should know.Simply put, "we're hormone doctors," says Marilyn Tan, MD, an endocrinologist at Stanford Health Care. "The three most common diagnoses we make are thyroid problems, diabetes, and osteoporosis," she says. Other common conditions they treat: menopause, hypertension, and infertility. And while endocrinology might be a specialty in itself, these docs sub-specialize. Some may focus on weight loss, others on thyroid abnormalities, some on diabetes or reproductive health. That means you should see the one that fits your health issue to get the most targeted treatment.

First of all, you might not even need to see one."For straightforward issues, like basic thyroid problems or diabetes, your primary care physician [PCP] is equipped to handle them in generally healthy people," says Tan. They're the ones who will order lab work to check initial hormone levels, and they're the ones who will treat you first. There's another upside to sticking with a PCP: Unless you live in a bigger city, specialists often require you to travel farther away for an appointment. "It's often not worth the drive when you can get good care from your regular doctor," she says. But if your blood sugar or thyroid levels become difficult to control, your PCP will send you to a specialist.

MORE:8 Things That Happen When You Finally Stop Drinking Diet Soda

Or you might have a one-and-done visit.Endocrinologists like to think of themselves as partners in crime in your care. "Often, we'll schedule one-time visits with a patient to help them learn about their disease, but their PCP will take the reins in managing it," says Tan. "Our visit becomes more focused on education rather than treatment." And that can be just as critical in getting well. Research shows that in diseases like diabetes, educational programs can help patients gain better blood sugar control, as well as lose weight and improve cholesterol levels.

They might be able to guess what's up just by looking at you...As many as 15 million people suffer from undiagnosed thyroid conditions. The thyroidthe butterfly-shaped gland on your necksecretes hormones that are involved in metabolism, body temperature regulation, and the functioning of your organs. Usually lab workups will confirm a diagnosis, but an endocrinologist might first spot uncontrolled, progressed conditions, says Tan. For example, in hypothyroid (a sluggish thyroid), you might look fatigued and your face may be swollen. In hyperthyroid (an overactive thyroid), severe disease may show up as bulging eyes and unexplained weight loss.

MORE:16 Signs Your Thyroid Is Out Of Whack

...or by touching you.

They want to hear about your hot flashes.

Highwaystarz-Photography/Getty Images

If you're menopausal and having hot flashes, hormone treatmentsandother natural options are ways that your endocrinologist may help mitigate symptoms.

MORE:Are You Bummed Out...Or Depressed?

And they think a lot about your bones.

They'll want to talk to you about vitamin Dbut probably not test you for it.It might be called a vitamin, but vitamin D is actually a steroid hormone, says Liu, which is why endocrinologists are so concerned with your levels. Andas you well know by nowthere's been a lot of chatter surrounding D because it boasts a never-ending list of potential health perks. Some experts advocate for routine screening of D levels, but Liu does not. "The tests are expensive," he says, and largely unnecessary; doctors can often guess if you're running low. If you live in northern latitudes, chances are you have a vitamin D deficiency, even if you're drinking milk, Liu says. On the other hand, if you live in, say, Florida, where you get a lot of sun, you probably have normal levels. Bottom line: If you live in a northern climate, you might want to pop a supplement. Experts can't agree on the exact amount, but the National Institutes of Health recommends getting 600 IU per day.

MORE:7 Reasons You're Tired All The Time

There are some things they can't fix.Another reason to keep your PCP in the loop: They take a bigger-picture look at your health, so they can spot other causes of problems, whereas a specialist like an endocrinologist is more laser-focused on your hormones, says Ranit Mishori, MD, a professor of family medicine at Georgetown University. After all, exhaustion and stress can cause similar symptoms as a thyroid condition. "I have patients in their 40s who are desperate for me to say their weight gain, mild depression, and fatigue is a thyroid condition that I can fix with a tiny pill," she says. "But oftentimes it's the crazy lifestyle and stress," says Mishori. An endocrinologist knows a lot about your health, but sometimes what you need is a little self careexercise, a healthy diet, and taking time to recharge from the madness can go a long way.

Read more:
8 Things Every Hormone Doctor Wants You To Know | Prevention

Some of South Dakotas most vulnerable teenagers could be denied critical health care if the legislature passes a proposed law.

State lawmakers are considering a bill that would make it a criminal offense for doctors, physician assistants, or nurse practitioners to provide gender-affirming health care to transgender youth under age 16. House Bill 1057, misleadingly titled the Vulnerable Child Protection Act, makes it a misdemeanor to prescribe puberty blockers or hormone replacement therapy, as well as prohibiting any gender-affirming surgery.

Far from protecting vulnerable teenagers, this bill could put them in danger.

Trans youth experience some of the highest rates of depression and suicidal thoughts; some estimates show that more than 40 percent of transgender people in the US have attempted suicide. The American Academy of Pediatrics published a study on January 23 that shows that trans people who underwent puberty-blocking treatment experienced a lower rate of suicidal thoughts than those who wanted the treatment but were unable to obtain it, meaning that denying access to gender-affirming health care can be a life-threatening issue. Previous studies have shown that access to puberty-blocking treatment at a younger age results in improved mental health in later years.

Despite opposition to the bill from the ACLU of South Dakota, medical professionals, and many parents and children in the state, the bills proponents are determined to fast-track it. Sponsors introduced it on January 14 and originally scheduled the committee hearing to take place less than 72 hours later.

This would have left little time for South Dakotans to learn about the bill, let alone have an opportunity to contact their representatives.

As someone born and raised in Brookings, I was particularly disappointed to see that our House representative, Doug Post, co-sponsored this bill. His decision to do so is exceptionally frustrating considering significant efforts in recent years by local leaders in Brookings to make the community a safer and more affirming place for LGBT people.

I was proud to see the Human Rights Campaign, a national organization, feature Brookings earlier this month as a champion for LGBTQ equality. In just five years, the town increased its score on the organizations Municipal Equality Index from 12 in 2013 to a perfect 100 in 2018. Though South Dakota has lagged behind other states in promoting equality for the LGBT community, Brookings seemed to be a bright spot for LGBT rights in the state. Either Rep. Posts position is not in line with the views of the majority of Brookings residents, or the town needs to rethink its celebration of its perfect 100 from the Human Rights Campaign.

HB 1057 is just the latest iteration of more than a dozen anti-LGBT bills introduced in the state in recent years. Prominent examples include the Bathroom Bill passed by the legislature but vetoed by then-Governor Dennis Daugaard in 2016, and legislation signed into law in 2017 allowing adoption agencies receiving state funding to discriminate against same-sex couples.

HB 1057 is the latest attack on trans kids in the state and poses a serious threat to their health and rights.

The decision to undergo puberty-blocking treatment and other forms of gender-affirming health care is not a decision taken lightly. Youth and their parents make this decision in close consultation with their doctors. Medical professionals should not be forced to choose between turning young patients away and providing necessary, sometimes life-saving treatment, risking up to a year in jail.

The bill passed out of committee on January 22 and will come to the House floor on January 27. South Dakota legislators who believe in promoting equality, preventing discrimination, and upholding the rights to health and life should reject this bill and other anti-transgender legislation. In doing so, our legislators will take a vital step toward defending the rights of trans youth and making South Dakota a place where the dignity of all people is protected.

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Reject the Bill to Block Critical Healthcare for Transgender Youth - Human Rights Watch

Ah, inflammation. That catchall, nebulous term we've come to know and avoid at all costs. We recognize that inflammation is generally "bad," but the Perlmutters explain just how it decreases our brain function.

They note that it's not just chronic inflammation that does the dirty workeven acute levels of inflammation are enough to influence our decision-making. "Inflammation changes our thinking kind of right away. It doesn't require years of exposure," Austin says. "When you induce inflammation, people's decision-making is compromised. They start looking at the world from a present-focused instant-gratification model as opposed to a long-term-oriented thinking style."

It's a dangerous cycle, they explain, because the more you make those present-focused decisions, the more you demonstrate unhealthy behaviors that increase inflammation. And the more inflammation you experience, the more impulsive decisions you'll make.

So, how does one escape that inflammatory cycle? The father-son duo encourages you to figure out what behaviors are at the root of your inflammation (note: There may be more than one!).

"Inflammation might be augmented by your poor sleep quality, by your dietary choices, by your lack of exercise, or by the level of stress in your life. However you get there, it tends to compromise your decision-making that leads you to make more impulsive decisions that continue then to foster inflammation," David explains.

That said, optimizing your eating and sleeping habits and the ways you cope with stress can, in turn, affect your levels of inflammation. As with most aspects of well-being, many factors are connected and dependent on each other, so even just one small change has the power to (quite literally) shift your thinking!

Continued here:
3 Reasons We Make Bad Decisions And How To Reverse Them - mindbodygreen.com

Everyone sheds about 100 hairs each day as part of the normal hair growth cycle, but excess loss is usually a distressing development.(iStock)

Hair loss is typically considered the domain of aging men, but this equal-opportunity condition which has many causes can affect virtually anyone.

Alopecia is the medical term for hair loss, and it doesnt only happen on the scalp. Some illnesses and medications can trigger balding over the entire body, though genetics account for most cases on the head, according to theCleveland Clinic.

PARTY DRUG MDMA A STEP CLOSER TO LEGALIZATION FOR PTSD THERAPY

Everyone sheds about 100 hairs each day as part of the normal hair growth cycle, but excess loss is usually a distressing development. Americans spend more than $3.5 billion each year trying to treat it, according to theAmerican Hair Loss Association.

Most peoples hair grows about a half-inch per month, and about 90 percentof your hair is actively growing at any given time, with the other 10 percentin dormant phase. After two or three months, this dormant hair falls out and its follicles begin growing new hair as other follicles begin a dormant phase.

Shedding hair is different from hair loss, when a hair falls out and doesnt grow back. People often shed hair during stressful events, such aschildbirth, a breakup or divorce or during times of grief.

It still doesnt feel good, and it takes the hair [awhile] to reach a certain length where you perceive its presence, said Doris Day, a board-certified dermatologist New York City and an attending physician at Lenox Hill Hospital, also in New York. So it feels like a hair loss, but its not a hair loss.

Aside from heredity, noticeable hair loss can be caused by wide variety of factors, including:

Harsh hairstyles or treatments: Hairstyles that consistently use rubber bands, rollers or barrettes, or pull hair into tight styles such as cornrows, can inflame and scar hair follicles. So can incorrectly used chemical products such as dyes, bleaches, straighteners or permanent wave solutions. Depending on the degree of damage, resulting hair loss can be permanent.

Hormone imbalances: In women, hormonal shifts from birth control pills,pregnancy, childbirth, menopause or hysterectomy can induce more hair follicles than normal to enter the dormant phase.

Illness or surgery: The stress from sickness or surgery may prompt the body to temporarily cease nonessential tasks such as hair production. Specific conditions can also trigger it, including thyroid disorders,syphilis, iron deficiency,lupusor severe infection. An autoimmune condition called alopecia areata, which has no cure, causes rapid body-wide hair loss.

Medications and vitamins: Cancer chemotherapy, which attacks hair follicles in its attempt to kill all fast-growing cells around the body, is a well-known reason for hair loss. Other medications side effects include hair shedding as well, such as some that treat high blood pressure andgout(a painful joint condition caused by a buildup of uric acid). Excessive levels of vitamin A also contribute.

Nutritional deficits: Heavy dieting or eating disorders such asbulimiaandanorexiacan temporarily stun hair follicles to cease growth. This can also occur from insufficient protein, vitamin or mineral intake.

Aging: A natural effect of growing older is slowed hair growth.

Women usually dont go completely bald, but lose hair on the top of the head or the temples. Men tend to lose hair on their temples, and are more likely than women to go completely bald, Day said.

Dermatologists will examine the persons scalp and take a history of medical or stressful events to see whats been going on in their life and their world, Day said.

HELICOPTER-SHARING APP BLADE PAIRS WITH NYU LANGONE TO SPEED TRANSPLANT ORGANS

The dermatologist may take a biopsy a small patch of skin that includes the hair follicle and send it to a pathologist to determine if an autoimmune disease, such as lupus, is the cause of the hair loss.

Examining the hair and follicle can also determine whether someone has a bacterial or fungal infection, Day said.

Hair loss remedies range from the mild to the extreme and the inexpensive to the costly. Much depends on how much hair is gone and how high a priority it is to mask its absence or replace it.

According to the Cleveland Clinic, treatments include:

Hair weaves or wigs: Typically expensive, wigs and hair weaves either completely cover the head or add to existing hair, restoring the appearance of a full head of hair. They are especially practical for cancer patients and those whose hair loss is temporary.

Topical creams and lotions: Over-the-counter minoxidil (also known as the brand name Rogaine) can restore some hair growth, especially in those with hereditary hair loss. It is applied directly to the scalp. Prescription-strength finasteride (Propecia) comes in pill form and is only for men. According to theAmerican Academy of Family Physicians(AFP), it may take up to six months to tell if these medications are working.

Anti-inflammatory medications: Prescription steroid-based creams or injections can calm follicles damaged or inflamed by harsh chemicals or excessive pulling.

Surgery: Men tend to be better candidates for surgical hair-replacement techniques because their hair loss is often limited to one or two areas of the scalp. Procedures include grafting, which transplants from one to 15 hairs per disc-shaped graft to other locations. Scalp reduction removes bald skin from the scalp so hair-covered scalp can be stretched to fill in the bald areas. Side effects include swelling, bruising and headaches.

Hair-growth laser treatment can also help stimulate hair follicles and improve growth, Day said. People often see results when they combine laser treatment with another intervention, she said. Treatments range in price from $30 and up for Rogaine to about $3,000 for laser treatment, she added.

According to theNational Institute of Arthritis and Musculoskeletal and Skin Diseases(NIAMSD), alternative therapies may not help hair regrow and many are not supported by medical research. However, other treatments that reportedly improve alopecia areata include Chinese herbs, acupuncture, zinc and vitamin supplements, evening primrose oil and aroma therapy.

Viviscal, a natural supplement, has also shownmore hair growthin men compared to those who took fish extract in clinical trials, Day said.

The NIAMSD recommends discussing any alternative treatments with physicians before use.

The drug Tofacitinib is approved to treat adults witharthritis, but a growing number of cases suggest that it can also treat alopecia universalis, a condition in which people lose all of the hair on their body because theirimmune systemattacks hair follicles,Live Science previously reported.

The finding occurred after doctors prescribed a 25-year-old man with alopecia universalis the drug because they had heard it had treated a similar condition in mice,according to a statement from Yale University. After three months of treatment, the man had completely regrown the hair on his scalp, and he had visible eyebrows, eyelashes, facial hair, as well as hair elsewhere on his body.

Its exciting, said Day, who did not treat this particular patient. There seems to be a real effect here.

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Its unclear how Tofacitinib (brand name Xeljanz) works, but researchers hope to determine its mechanism soon. This data may help them learn which biological pathways lead to hair loss.

There are now clinical trials taking place around the country to test the safety and efficacy of the drug for hair loss conditions. One such study lasting 3 months gave Tofacitinib to 66 people with alopecia areata (an immune system condition that causes hair to fall out in patches). Half of the people regrew some hair, and one-third had more than 50 percentof the hair on their scalp grow back, according to the 2016 study, published in the journalJCI Insight.

However, researchers are still working to determine the best dose needed, whether the results are lasting, and whether they can develop a topical form of the drug, Day said. She added that patients should be aware that Tofacitinib has side effects. Its already associated with an increased risk of serious infections, as well as stomach and intestinal tears, according to Pfizer, the manufacturer.

Besides investigating Tofacitinib, researchers are also looking at ways to clone hair or use stem cell therapy to treat alopecia, Day said.

This article first appeared on LiveScience.

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Alopecia: What causes the hair loss condition? - Home - WSFX

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Like everyone else, I wonder all the time: Why am I always tired? But sometime last fall, I started getting extra droopy every afternoon. Even when Id done all the right things slept eight hours, eaten a healthy lunch, exercised Id be fighting to keep my eyes open by 4 p.m. On one of those days, as I waged war against my thousand-pound eyelids, a friend started complaining to me about her new glasses, which shed been forced to buy because contact lenses irritated her eyeballs in the dry winter air. As a fellow contact-lens wearer, I realized that perhaps my 4 p.m. sleepiness problem wasnt that I was tired maybe my eyes were. When I tested my theory and used Visine drops in the afternoons, my midday nap attacks went away.

Of course, most fatigue problems arent so easily solvable. Even the simplest fix to sleep more can be hard to come by, especially when theres an underlying problem in the mix. Unfortunately, most tiredness feels about the same; Lyme disease doesnt really give you a different flavor of exhaustion than, say, an iron deficiency or garden-variety night of tossing and turning. But if you look at other symptoms accompanying your fatigue, you might find clues to where its coming from.

If your tiredness is chronic and inexplicable or just feels off you should consult a doctor, as it could be a red flag for something more serious. And either way, its a problem you should be able to solve. To understand more about the different types of fatigue, I spoke to Dr. Jaclyn Tolentino, a primary care physician at Parsley Health, as well as Dr. Richard Firshein, a general practitioner and insomnia specialist who runs the Firshein Center in Manhattan. Here are the most common culprits of exhaustion, and how to treat them.

Hormone fluctuations can turn anyone into a nap machine, as anyone whos ever had PMS knows. But chronic hormonal imbalances can make you sleepy and grumpy all month long. The good news is that doctors can test for the presence of most hormones, so they should be able to diagnose an imbalance if you have one; most are also largely treatable with medication and/or nutritional changes. One common issue is underproduction of estrogen or progesterone, which can cause tiredness, irritability, unpredictable periods, and night sweats. (If you wake up feeling like youve just run a marathon in your pajamas, this could be your issue.)

Other hormones that can disrupt your sleep if they get out of whack are melatonin and cortisol, which are produced by your pituitary glands. You can get supplements of the former from almost any drugstore, but Dr. Tolentino recommends taking no more than 3 milligrams. The amount of melatonin your body produces is tiny compared to the melatonin supplements you can buy, so most people are actually taking much more than the body needs or should have, making the imbalance worse, she says. In other words, taking melatonin supplements to help you sleep at night could actually be contributing to your overall tiredness during the day the irony, I know!

If your tiredness coincides with weight gain, dry skin, and constantly feeling cold, you could be having issues with your thyroid, which produces hormones that regulate your metabolism, among other things. Hypothyroidism is one of the most common conditions associated with fatigue, says Dr. Tolentino. Other symptoms of hypothyroidism include constipation, hair loss, and irregular menstrual cycles. If youre experiencing any of these symptoms, its best to consult a doctor as soon as possible.

Take it from someone whos frequently anemic no matter how much steak I eat: The tricky part of getting enough vitamins and minerals is that certain nutrients are essential for the absorption of others so if you arent getting enough of one, then youre probably missing out on a bunch. Common deficiencies that cause fatigue include iron, magnesium (which contributes to the bodys absorption of iron as well as other nutrients), B vitamins, and vitamin D (which your body produces when its exposed to sunlight which doesnt happen much in the winter). Your doctor can test for all of the above, but for what its worth, Ive been taking magnesium powder every night before bed for the past six months, and it has made a huge difference in how I feel every morning. Dr. Tolentino says she recommends it to many of her patients, because it binds to melatonin and supports its production in your body.

You cant sleep because youre staring at the ceiling, ticking through all the things you messed up that day and didnt get done, and now youre extra stressed because youre stressed, and if you dont get to sleep soon then youll be even more stressed tomorrow, and blah blah stress is bad and we all need to manage it better. But in addition to making you miserable and annoying, chronic stress actually causes the overproduction of cortisol (see No. 1), a hormone that disrupts sleep. Ignore the problem and it spirals, causing weight gain, more sleeplessness, and a whole host of other issues.

You know what youre supposed to do for stress: Take breaks. Exercise. Cultivate supportive relationships. Meditate. And get enough sleep. But those things take time and energy, which seem in short supply when youre dealing with a firestorm at work (or just normal life). Dr. Firshein recommends what he calls mini-meditations, which he practices himself. Its a huge luxury to be able to set aside 30 minutes or an hour to meditate, but if you take just a few moments throughout the day, it can have a similar effect, he says. In between every patient, I take ten or 20 seconds to breathe deeply, do some visual imagery, and relax my muscles before I move on. By the end of the day, it adds up to 15 or 20 minutes of meditation. He urges patients to do the same every time they check their phone, for example, or get a text from a certain person, or get up from their desk at work. If you reset your mind consistently throughout the day, then it can keep anxiety from sneaking up on you.

Its true: Certain genes have been linked to chronic fatigue issues, including a specific one known as the CLOCK gene (yep), which is linked to faulty circadian rhythms. People with wonky CLOCK genes have issues with their metabolism, body temperature, blood pressure, and liver functions, among others. Luckily, its very rare.

A more common genetic mutation that could disrupt your sleep is one that affects your bodys ability to process alcohol, says Dr. Firstein. Alcohol causes a lot of sleep problems in itself, but some people are predisposed to be even more sensitive to it.

A doctor can test for these genes, although it can be expensive to do so and insurance may not cover the lab costs. Before you go down that rabbit hole, look at your family history do any of your relatives have similar bad reactions to alcohol, or other symptoms of the CLOCK gene? While you cant change your own genetic makeup, identifying a genetic issue can help you and your doctor come up with a plan to treat the problems that stem from it.

Speaking of alcohol and sugar, caffeine, your phone, your laptop, your TV screen, your neighbors music, your roommates music, LED lighting, your newborn kid, or the fries you just ate, you are surrounded by things that cause you to sleep poorly and be tired the next day. Both Dr. Firshein and Dr. Tolentino said that lifestyle is usually the No. 1 cause of tiredness, but the good news is that you can do something about it.

Weve become a little bit lazy around sleep, says Dr. Firshein. Good sleep hygiene begins hours before you actually go to bed. It takes discipline to power down at the end of the day, turn off the TV and the computer, and cut back on external light, noise and stimulus. If youre not able to do all that (because, come on), he recommends at least wearing blue-light-blocking glasses, dimming the lights, and not eating or exercising within two to three hours of bedtime.

And finally, pony up the $20 to buy an actual alarm clock and put your phone in another room before you go to bed. Ive personally found this helpful not only for falling and staying asleep, but also for getting out of bed in the morning. Instead of snoozing my phone a million times and then lazing around scrolling through garbage, I actually get up and brush my teeth and start my day after my alarm goes off, for the most part. One other tip: I sleep with a white noise machine and earplugs. (I live next to a fire station, so.)

Does your bedmate frequently shove you in the middle of the night to get you to pipe down? Do you have allergies or get a lot of sinus infections? You might have sleep apnea, a deviated septum, or another issue that inhibits your breathing and stops you from getting the kind of deep sleep that makes you feel truly rested. There are various solutions for these problems, ranging from special breathing machines to surgery; youll want to consult a doctor if you suspect you fall into this camp.

Hopefully not! But fatigue is often the most obvious symptom of autoimmune conditions like lupus, fibromyalgia, and Hashimotos thyroiditis, says Dr. Tolentino. The same goes for chronic infections like Lyme disease. Often these conditions are accompanied by other symptoms. But just like with sleep apnea, dont waste time trying to self-diagnose and get to a doctor.

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What Kind of Tired Are You? - The Cut

High school and college athletes in Kentucky would only be allowed to compete in sports that align with their biological sexand not their preferred gender identityunder a bill that a state lawmaker filed Friday.

Sen. Robby Mills, R-Henderson, introduced Senate Bill 114 and titled it the "Save Womens Sports Act."

The bill calls for students to only participate in sports and use athletic facilities that correspond with the sex listed on their birth certificates.

If astudent's birth certificate has been edited or if the student's biological sex is officially challenged, then the student would have to undergo a medical examination performed and signed by a physician, physician's assistant or advanced practice registered nurse.

The examination would establish the student's sex based solely on "internal and external reproductive anatomy," testosterone levels and an "analysis of the student's genetic makeup," according to the bill.

Mills could not immediately be reached for comment.

More: Lawsuit: Louisville Christian school,conservative writerouted 'rainbow cake girl'

SB 114 would allow students who have been "deprived of an athletic opportunity" or who have suffered "any direct or indirect harm" or privacy violations due to violations of the bill's regulations to school districts and universities within two years "after the harm occurred."

Chris Hartman, executive director of the Louisville-based Fairness Campaign, an LGBTQ advocacy organization, said the bill is "once again a solution in search of a problem" and "a plea for votes in an election year."

"This is clearly part of a politically motivated (and)expanding slate of hate that's being introduced in the state targeting all LGBTQ people but with particular emphasis on transgender students," Hartman said. "...Imagine how hard it is for trans kids already on a daily basis. This bill tells them they shouldn't be participating in athletics."

"Transgender kids want to join sports teams for all the same reasons any other student does," Hartmanadded.

The Kentucky High School Athletic Association currently has a policy that recognizes the ability of transgender student-athletes to compete in sports "free from unlawful discrimination based on sexual orientation."

But some still view the KHSAA policy as restrictive, as it requires transgender athletes to undergo sex reassignment surgeryeither before or after puberty inorder to compete in sports based on their gender identity.

If reassignment surgery occurs after puberty, then transgender student-athletes in Kentucky must demonstrate that they've taken or are taking hormone therapy "for a sufficient length of time to minimize gender-related advantages in sports competition," according to the KHSAA policy.

As The Courier Journal reported last year, Kentucky was one of nine states with such policies for transgender high school athletes.

Southern Pride:LGBTQ athletes in Kentucky face challenges as an 'invisible minority'

Hartman said "few, if any" transgender students can currently meet the KHSAA guidelines, making Mills'bill unnecessary.

"I guarantee that Sen. Mills doesn't have a single instance in Kentucky athletics that this bill would address, not a single one," Hartman said. "If he can bring a witness to the table whom this applies to...I'd be shocked."

The topic of transgender athletesin Kentucky came up during the 2019 gubernatorial race between DemocratAndy Beshear and then-Republican Gov. Matt Bevin when aconservative political action committee released an ad claiming Kentucky boys are changing their gender to participate in high school sports.

The ad from the Virginia-based Campaign for American Principlesfeatured a narrator saying that Beshear the state's attorney general at the timewho is now governor after beating Bevin in November's election "supports legislation that would destroy girls' sports."

It showed a male competitor portraying a transgender girl and passinga group of female runners tofinishfirst.

The new proposal from Mills related to high school and college athletes is not the only bill in the 2020 legislative session that deals with transgender students.

House Bill 132 would bartransgender students from usingrestrooms that alignwith their gender identities.

State Rep. David Hale, R-Wellington, is the lead sponsor of the bill, which is titled the "Kentucky Student Privacy Act"and says non-transgender students could suffer"potential embarrassment, shame and psychologicalinjury" by using the same restroom or changing room as their transgender peers.

LGBTQ advocates have called Hale's bill "dangerous" and warned it would contribute to depression and suicide rates among transgender youth.

A similar bill has been introduced inpast General Assembly sessions, including one proposal in 2015 that would have allowedstudents to sue aschool for $2,500 ifthey encountered a person of the opposite biological sex in a bathroom or locker room and staff hadallowed it or failed to prohibit it.

State Sen. C.B. Embry Jr., R-Morgantown, proposed the2015 version of the "Kentucky Student Privacy Act" in response to a 2014 controversy at Louisville's Atherton High School in which the principal allowed a transgender student who was born male but identifies as a female to use the girls' bathrooms and locker rooms.

A bipartisan group of Kentucky lawmakers are also behind a push to ban conversion therapy in the Bluegrass State.

On Politics:Can conversion therapy ban pass if top Kentucky lawmakers don't understand it?

This story may be updated.

Reach Billy Kobin at bkobin@courierjournal.com or 502-582-7030. Support strong local journalism by subscribing today: courier-journal.com/subscribe.

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Katherine Streeter for NPR

Katherine Streeter for NPR

Sarah Edrie says she was about 33 when she started to occasionally get a sudden, hot, prickly feeling that radiated into her neck and face, leaving her flushed and breathless. "Sometimes I would sweat. And my heart would race," she says. The sensations subsided in a few moments and seemed to meet the criteria for a panic attack. But Edrie, who has no personal or family history of anxiety, was baffled.

She told her doctor and her gynecologist about the episodes, along with a few other health concerns she was starting to notice: Her menstrual cycle was becoming irregular, she had trouble falling asleep and staying asleep, and she was getting night sweats. Their response: a shrug.

It wasn't until Edrie went to a fertility clinic at age 39 because she and her partner were having trouble conceiving that she got answers. "They were like, 'Oh, those are hot flashes. It's because you're in perimenopause,' " she says.

If you haven't heard the term "perimenopause," you're not alone. Often when women talk about going through menopause, what they're really talking about is perimenopause, a transitional stage during which the body is preparing to stop ovulating, says Dr. Jennifer Payne, who directs the Women's Mood Disorders Center at Johns Hopkins University.

"Technically, menopause is only one day in a woman's life, which is exactly when she has not had a period for 12 months," she says. "It's the period of time leading up to menopause that causes all the trouble."

And it can start earlier than you might think. Many listeners wrote to us in response to our call-out for individual experiences with menopause to say that they struggled to get medical support for perimenopause in their mid-30s and early 40s.

When Edrie went back to her OB/GYN with the fertility clinic's conclusion, she says the doctor shrugged again and told her that menopause is a normal part of life. She wasn't satisfied with that answer. "Yeah, it's a normal part of life, but it would be great if we could talk about it and figure out strategies."

With that spirit in mind, we reached out to endocrinologists, gynecologists and psychiatrists for advice about navigating this major life transition.

How early can perimenopause start?

It's quite possible for women to start to notice things changing in their mid-30s. Most women arrive at menopause between the ages of 45 and 55, but perimenopause can start as much as a decade beforehand. And about 1% of women in the U.S. reach menopause at age 40 or younger.

How do you know if you're starting perimenopause?

The most telling symptom is changes in your menstrual cycle, says psychiatrist Hadine Joffe, the executive director of the Connors Center for Women's Health and Gender Biology at the Brigham and Women's Hospital in Boston.

"It's the menstrual cycle pattern that really defines this lead-up to menopause," she says. During perimenopause, periods "might be shorter, then a long one, or then a skipped one, or then the flow might be different," says Joffe.

There's no blood or hormone test that can "diagnose" perimenopause. Joffe says a hormone test isn't helpful because hormonal cycles become erratic and unpredictable during this stage.

"There's not really one point in time when a hormone test is done that can be definitive," she says. Even if you took several tests over time, "you might get a very different readout."

Surprisingly, sometimes doctors aren't prepared to help women recognize the start of this life phase. Edrie was upset at her doctors' responses or lack thereof. "I felt so disappointed in the medical industry. How many women has my OB/GYN seen and not recognized the symptoms of perimenopause?"

What symptoms to expect

Be prepared for your PMS symptoms to possibly shift, becoming either more or less extreme, says Dr. Cynthia Stuenkel, a founding member of the North American Menopause Society and a professor and endocrinologist at the University of California, San Diego, School of Medicine. "Women might not get the same kind of breast tenderness or mood shifts that they may have noted in the past," she says.

Mood problems like depression can spike during perimenopause, especially among women who have previously experienced them. Many of our listeners wrote in to say that during perimenopause, they felt incredibly irritable and quick to anger in a way that they had never experienced before.

And of course, many but not all women experience hot flashes, though they may not recognize them. "It's hard, because no one sits us down and teaches us, 'Here's what a hot flash feels like,' " Stuenkel says. "I've seen women who think they're having panic attacks, or heart palpitations. That can be frightening."

Other common symptoms include more frequent urinary tract infections, difficulty sleeping through the night, vaginal dryness that can make sex painful, night sweats and a decrease in libido.

What treatments are there for symptoms?

Some symptoms, like heavy or irregular periods, can be managed with an oral contraceptive, which can "shut down the body's own erratic hormonal fluctuations," says Stuenkel.

"This can kind of be a lifesaver," she says. Such medication may help with hot flashes, too.

In some cases, doctors may prescribe menopausal hormone therapy, or very low doses of hormones to supplement estrogen levels. Stuenkel says it's not a fit for everyone, but it doesn't deserve the bad reputation it has in some circles. She says there was an "exodus" from the use of hormone replacement therapy after the Women's Health Initiative trial halted a study over safety concerns in 2002. But many clinicians now feel much more comfortable using hormone therapy again and usually recommend low doses, selectively, for shorter periods of time.

For people who cannot take estrogen therapy, or choose not to, Stuenkel says some drugs in the antidepressant family, such as SSRIs and SNRIs, can help with hot flashes. Stuenkel says, "While they're not perfect, they can take the edge off and help enough so that women can get a better night's sleep."

There are an abundance of nonhormonal, nondrug treatment options for managing symptoms, some of which have significantly more evidence backing them than others. In 2015, a North American Menopause Society panel found that cognitive behavioral therapy and hypnosis were significantly effective in treating hot flashes. The same panel also found that popular herbal remedies (like black cohosh, dong quai and evening primrose) are "unlikely to help," although some NPR listeners who wrote in said they got relief from some of those treatments.

For depressive and anxiety symptoms, women may want to seek out professional counseling or a psychiatrist.

When do I need to see a doctor?

You might not need to at all. Some people sail right through menopause with little trouble. But if you are experiencing symptoms that are interfering with your life, it's worth making an appointment. Some of these symptoms could indicate other problems that need treatment, such as fibroids or even cancer.

Ways to cope with symptoms

For people approaching this stage of life or who are already going through it, here are four steps for making this transition more manageable.

1. Get educated

"Information is key," says Joffe. She suggests that people approaching perimenopause age empower themselves with knowledge.

The Massachusetts General Hospital Blum Center has a curated list of suggested books. The National Women's Health Information Center has a section on menopause and perimenopause. The American College of Obstetricians and Gynecologists also has a perimenopause FAQ.

2. Monitor your health

Joffe encourages people to track symptoms: "menstrual patterns, hot flash patterns, mood issues, major life triggers." Using a paper calendar or an app to monitor symptoms can make it easier to give your doctor details that can be otherwise hard to remember.

"Knowing that information, somebody can say, 'Well, over the last six months, I only had two periods or I had hot flashes almost every day,' " Joffe says, "or, 'My mood was as bad as it gets for only two days or for a third of the time.' "

And if you bring a thorough health history to your physician and they still give you a shrug, consider a specialist. "There are OB/GYNs that specialize in perimenopause and menopause," Joffe says.

3. Practice smart self-care

Joffe encourages women to protect themselves from things that might worsen their mood or well-being. This includes reducing stress when they can and making sure they get enough sleep.

"Sleep is critical," she says. "Getting a good night's sleep, and making sure it's not broken in the middle of the night."

There are lots of online tools and apps to help with sleep, she adds.

And familiar health advice like getting enough exercise, eating well and moderating alcohol consumption apply to perimenopause too, says Dr. Steven Goldstein who is the co-author of Could It Be ... Perimenopause? and a professor of obstetrics and gynecology at the New York University School of Medicine.

At her doctor's suggestion, Edrie developed a mindfulness practice. She says, "I thought it sounded a little 'woo-woo' at first, but being able to pay attention to what my body is doing and why helps me separate those symptoms from what I need to get through my day. So I'm not overwhelmed by what my body is putting me through."

4. Cultivate community

Most of the women who wrote to NPR about their experiences going through perimenopause said that they felt alone and isolated during this transition.

Having a community to talk to can make it easier to cope with the changes, says Payne, who's going through perimenopause herself. She says she has found support from a few close friends from college.

"To be able to reach out to a group of women who are our same age and say, 'Did you go through this? And, you know, it does provide support. I think that's another version of a coping skill," she says.

Edrie says she joined a few Facebook groups dedicated to perimenopause and found one in particular where she got tips on coping with one of her most troublesome symptoms: brain fog. The conversations made her feel understood and validated.

"I can post about it in this group, and, you know, 10 women will be like, 'Oh, last week, that totally happened to me,' or like, 'I forgot my kid's computer on the top of my car and drove away,' " she says.

She says that being able to commiserate helps her get through symptoms "that maybe don't have a magic pill." Some of her online friendships have even taken shape offline. Edrie has met up with some of the Facebook group members while touring the country with her band.

Now she's a big proponent of finding community and speaking out. "As we get older, we get more and more quiet about what's going on with our bodies and ourselves and our lives. We kind of just, buck up and deal with it."

"And I feel like if we talked more about the things that are happening to our bodies even if we can't actually do anything about some of these things it would just be better for society in general if we were more vocal about it."

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What Is Perimenopause And How Young Can It Start? : Shots - Health News - NPR

Jazz Jennings of TLCs I Am Jazz has had a long road to self-confidence. The trans rights advocate began hormone blockers under a physicians supervision when she was just a child, and the trans teen has been open with followers and viewers ever since about her journey to gender confirmation surgery.

Along the way, the 19-year-old activist has struggled with her mental and physical health, as well as three complicated surgeries. But recently, the I Am Jazz star showed off her scars from bottom surgery in a poignant Instagram post about her transition and body positivity.

On Jan. 3, Jennings posted two photos of herself in a bathing suit on the beach with visible scars on her legs. She added the snapshots to both Instagram and Twitter.

These are my scars on full display in #2019, the I Am Jazz star and LGBT rights activist wrote in her caption. Im proud of my scars and love my body just the way it is. I call them my battle wounds because they signify the strength and perseverance it took to finally complete my transition.

Her family, who has always strongly supported her throughout her journey to personal and public acceptance, immediately jumped in to offer their support. Your strength is changing the world and makes me so proud to be your brother, wrote Jennings older brother, Sander Jennings, on Twitter. Thank you for inspiring me everyday.

No one has been more supportive and protective of Jennings than her mom, Jeanette Jennings, who commented under the post on Instagram: My sweet girl, you are the strongest and bravest of all the souls Ive even known and Im blessed to be your mom. Your scars are just as beautiful as the rest of you. I love you with all that I am. You make me proud everyday.

Of course, Jennings family members and loved ones werent the only ones to praise the advocate for bravely sharing her story. Instagram commenters flooded her post with gratitude and support.

Proud of you, Jazz! Scars are a sign of courage and strength, wrote one Instagram user. Youve earned them twice over.

Another supporter added, Youre really really strong Jazz, stronger than I ever will be.

One parent thanked Jennings for being so open about her struggles and triumphs alike. I know we are all strong in our own ways, but I hope my little girl is strong and brave as you when she grows up, she wrote. Wear those scars with pride, we all have some scars to deal with.

Although it looks like Jennings gender confirmation surgery might now be behind her, the upcoming season of I Am Jazz will feature her third harrowing surgery after complications from the two previous ones required her to get yet another intense procedure.

I Am Jazz Season 6 premieres on TLC on Jan. 23. In addition to deciding on a future college, planning a drag show fundraiser to support her friends gender confirmation surgery, and wrestling with the aftermath of her breakup from ex-boyfriend Ahmir, viewers will watch Jennings return to the hospital herself. It looks like the long road of Jennings transition may finally be coming to an endbut not with difficulties and challenges along the way.

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'I Am Jazz': Jazz Shows Off Her 'Battle Scars' in Bathing Suit Photos - Showbiz Cheat Sheet

UC partnerships with faith-based health systems such as Dignity Health, Catholic Health Initiatives undermines the quality of patient care in our hospitals.

It is not news to anyone that our current healthcare system struggles to meet the needs of millions of patients in California and across the country. This care gap is especially wide for brown, black, poor and queer communities that have been consistently excluded from accessing the same resources that others are given freely.

It is because of these inequities that I find it especially alarming that the UC currently has existing contracts with Dignity Health, despite the massive outpouring of opposition to affiliations with Dignity by students, physicians and Californians across the state earlier this year. UC contracts with faith-based health systems represent a blatant disregard for the UCs own stated mission of public service and undermines patient autonomy in healthcare decision making.

UC affiliation with faith-based health systems such as Dignity and CHI will severely restrict the scope and quality of health care that providers can offer, even when a patients life is threatened. According to the Ethical and Religious Directives for Catholic Health Care Services (ERDs), physicians in Catholic hospitals are barred from providing basic reproductive health care services such as contraception, abortion and in vitro fertilization. It also prohibits the provision of gender-affirming services such as hormone therapy, hysterectomies and mastectomies. These types of sweeping and biased care restrictions are immoral in any scenario and unacceptable in the setting of a publicly-funded institution.

In particular, limiting access to reproductive and gender-affirming health care can be life-threatening. Research consistently indicates that nearly every restriction on abortion access yields a corresponding rise in injury and death as a result of people attempting to self-abort. When folks are not allowed to access gender-affirming care, it undermines their right to self-determination, exacerbates mental health conditions and increases their risk of experiencing violence.

As a life-long resident of California and a future physician, I am ashamed that the UC system, an institution intended to represent the strength and future of our state, is taking a step back from its progressive vision by allowing religious institutions to restrict the quality of medical care that patients receive in our hospitals. As a student, I am outraged that the UC would detract from the quality of my medical training by agreeing to offer fewer services when it has the resources to provide more.

Patients deserve nothing less than wholly inclusive, evidence-based care that addresses every aspect of their health.I urge UC leadership to reject the influence of religious institutions on our healthcare system and instead consider the many opportunities available to increase patient access to high-quality, comprehensive health care services.

Written by: Caitlin Esparza

Caitlin Esparza is a second-year medical student and co-president of Medical Students for Choice at UC Davis.

To submit a guest opinion, please email opinion@theaggie.org

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Religious initiatives have no place in the UC health care system - The Aggie

The thyroid plays a huge role in the body. Its a part of the endocrine system whose core function is to help your bodys metabolic hormone stay in line at all times. Problems associated with the thyroid are very common, especially in women. According to a survey by the U.S Department of Health and Human Services, one in every eight women is likely to develop a thyroid problem in her lifetime.

Since there are so many factors that may contribute to a thyroid problem, here are nine signs that may indicate that someone has a thyroid problem.

Constant fatigueA core function of your thyroid is to help metabolism. When theres an issue with metabolism control, the body is bound to feel sluggish. A constant state of tiredness and diminishing energy can be one of the most apparent indicators of a problem with the thyroid.

Weight loss or weight gainRapid weight loss when you are not actively trying to lose weight or rapid weight gain without any change in activity or diet may be a tell. The absence of a functioning thyroid slows down the bodys metabolism, and consequently, a reduction in the rate the body expends energy.

Night sweatsIf youre waking up at night with chills and soaked sheets, its time to see the doctor.

A rapid change in appetiteSince there is a problem with the thyroid, you may feel less enthusiastic about eating as each day passes. This often comes with rapid weight loss or, in some cases, weight gain.

Your cycle changesIf you start experiencing irregular periods in conjunction with other symptoms, it might be a function of your thyroid malfunctioning.

Changes in bowel movementsConstant constipation or, in some cases, severe diarrhea can result from thyroid issues.

Constant Mood ShiftsA general hormone imbalance could occasionally change moods. The same can be said where there is a thyroid problem.

While this list is not exhaustive, some of these symptoms may be common indicators for other health problems along with thyroid issues. You must consult your physician if you have any of these symptoms in conjunction with each other for a prolonged period of time.

Read more:
7 Signs You Might Have a Thyroid Problem - YouBeauty

The direct to consumer testing market comes in many flavors these days, with companies like 23andMe dominating headlines with their genetic/ancestry tests targeting folks eager to learn more about themselves. Also joining the fray are tests designed to help women in theory, at least assess fertility by counting the number of eggs left in their ovaries.

Sounds like a great idea. Just one problem: egg counts may not be such a great indicator of fertility, according to the American College of Obstetricians and Gynecologists.

Still, that doesnt mean these tests have no value. A new study suggests they can empower women. And thats especially true for those who do not fit into the binary gender categories that health insurers may require for covering clinical versions of the test that cost ten times as much.

At-home tests for reproductive health for women have been around since the first home pregnancy kits hit the market in 1978. In 1989 came the first DIY ovulation predictor kits.

Tests to measure ovarian reserve how many eggs are left dont have the track record of these older tests. And they may not even be accurate for women who havent had difficulty conceiving or are taking birth control pills.

But do they still have value?

Moira A. Kyweluk, a fellow in the department of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania, decided to find out. She interviewed 21 women, of diverse backgrounds and circumstances, to tap their thoughts about direct-to-consumer (DTC) testing of ovarian reserve.

The women were recruited from social media, community center notice boards, and listservs, in Chicago during the first half of 2018. The findings appear in Social Science & Medicine.

Egg counters sold to consumers are part of the FemTech market. I view DTC testing as an entry point into what I term the new (in)fertility pipeline for women today. Because it is low cost and widely available, its reaching a larger demographic, people of diverse identities and backgrounds, and raising awareness of more advanced procedures and technologies like egg freezing, Dr. Kyweluk said in a news release.

But she questions the accuracy of these tests. Consumers continue to desire these tests, and theyre attractive, but they dont deliver on their promise.

The number of immature eggs in the two ovaries dwindles as a female ages.

Seven to eight million tiny undeveloped eggs are already present in a 20-week female fetus. That means, curiously, that a pregnant woman houses the cells that, when fertilized, will become her grandchild.

By birth, about a million oocytes remain, and that number is halved by puberty. Then by the start of menopause, around age 51, only 1,000 or so eggs remain. Over her lifetime, a woman ovulates 300 to 400 eggs.

Each egg occupies a chamber called a follicle. Each month between puberty and menopause, the largest egg pops out in response to a crescendo of luteinizing hormone thats ovulation. Meanwhile, anti-Mllerian hormone (AMH) suppresses release of the other, smaller eggs.

Its seemingly simple: The more AMH, the more eggs are left.

Measuring AMH is the basis of clinical tests used to predict ovulation in women undergoing in vitro fertilization (IVF) or egg freezing, presumably because theyve been unable to conceive. But the accuracy of AMH level to predict ovarian reserve among women who are fertile isnt known.

And so in 2019, the American College of Obstetricians and Gynecologists (ACOG) issued a statementthat consumer kits to measure AMH arent ready for prime time. The products are too variable and not standardized.

Serum anti-Mllerian hormone level assessment generally should not be ordered or used to counsel women who are not infertile about their reproductive status and future fertility potential, according to the statement. It includes a hypothetical case that illustrates misinformation about AMH testing:

A 26-year-old woman comes in for a wellness exam and the provider mentions the effects of aging on fertility. Im not ready to become pregnant now, but I would in the future. My friend recently took a blood test to check her egg count, so she knows how much longer she can wait to have a baby. Can I have that test?

If she meets criteria for infertility, her insurance might fork over a large part of the $1,500 cost for such a test. Thats why a DTC test kit that requires a pinprick of blood and costs $79 to $199, without requiring evidence of anything or an uncomfortable meeting with a health care provider, is an attractive alternative if it provides useful information.

The website for an ovarian reserve test kit from Modern Fertilitydoes comport with the ACOG statement.

Want kids one day? the opening page announces, like asking if you want to order a pizza. Women are invited to join a weekly egginar for information before they dive into the science that helps you do you.

Clicking ahead shows clear warnings that the test wont reveal infertility, but will indicate if a womans egg count is more or less than is average for her age. It sounds like peering into an egg carton to count whether it has all 12 expected eggs.

The test measures AMH, FSH (follicle stimulating hormone), and E2 (estradiol). Thats important to know, because a search for ovarian reserve testing on Amazon yielded first theEverlyWell ovarian reserve test egg quantity indicator, which measures only FSH not the important and telltale AMH.

The Modern Fertility test is also quite clear about what it can and cant do. A woman can discuss the results with her physician and ask about further testing and possibly pursuing IVF or egg freezing. Or, if she only has half a dozen in the egg carton analogy, she might expect to experience menopause sooner than shed thought.

Countering the ACOG statement is the LetsGetChecked product. The Ovarian Reserve Test is for anyone who is curious about their fertility status, according to the website. It costs $139.

The website for LetsGetChecked has a helpful list of conditions that can accelerate the whittling down of egg number, which a consumer can bring to a physician to explore further. These include polycystic ovary syndrome, chromosomal abnormalities such as Turners (XO) syndrome and fragile X, endometriosis, ovarian tumors, autoimmune disorders, and pelvic injuries. The woman would already know if shed had chemotherapy or radiation, which can damage eggs.

Dr. Kyweluk designed a study that would take a real-world view of the issues that might prompt a woman to take a DTC ovarian reserve test. Her paper is a series of vignettes.

The research differs from standard medical studies in that it is ethnographic, taking into account race and ethnicity, relationship status, insurance, sexual orientation, and socioeconomic group, because the reasons for seeking ovarian reserve testing go beyond biology. Dr. Kyweluk interviewed the women as they were deciding whether or not to take a test. She had a grant that paid for those who wanted to go ahead, using one company that provided access to a nurse practitioner to interpret findings.

Of the 21 participants, aged 21 to 45, 14 were white, 14 heterosexual, and 7 bisexual or queer. Three different scenarios of women seeking the DTC test indicate the variability of need.

Yvette was a 37-year-old African-American who had been trying with her husband to conceive for a decade. Their health insurance was quick to cover birth control, but assessing fertility, not so much.

When Yvettes ovarian reserve results were normal, the nurse suggested an ovulation predictor to better time intercourse and have her husband have a semen analysis.

Naomi was typical of a high-income, highly-educated white woman, who was stressing over whether she really wanted to have a baby. Would an ovarian reserve test indicate that it wasnt in the cards? Then she could stop thinking about it, or freeze eggs, which she could afford to do. Many women cant.

Josephine was 35 and African-American. A devout Catholic, she had just ended a long-term relationship. Her faith prompted her to ask, was I meant to be a parent? and she felt that the ovarian reserve test, if she had too few eggs, might reveal no.

Several women reported that taking the ovarian reserve test empowered them. Caroline, for example, was a 30-year-old queer white woman with a female partner. Medicaid had denied them coverage of any elective tests, and they didnt meet the diagnostic criteria for infertility because they were not a heterosexual couple.

The DTC test made me feel Im in control, like I can want some information, pay for it, and then get it. I didnt have to rely on a doctor to decide it was necessary for me to know this information. This is information that Ive wanted forever, Caroline told the researcher.

In one confusing case, the cisgender female partner (Breanne) of a transgender man (Tal) discovered, using a DTC test, that her ovarian reserve was quite low, something shed suspected from her age and irregular menstrual periods. The couple had planned to use a sperm donor and Breanne would carry the pregnancy. But if Breanne didnt have enough eggs, what would they do?

They had an idea. Did Tal still make eggs?

Hed been receiving testosterone injections for a decade as part of gender-affirming treatment and sported a full beard. But the DTC ovarian reserve test revealed he was still making the normal number of eggs for a cisgender woman his age. Hed carry the pregnancy!

But when Tal went to a clinical lab to repeat the ovarian reserve testing, the medical staff continually misunderstood their situation. Ultimately, Tal felt that inexpensive ovarian reserve testing was simply a foot in the door to other, more costly procedures, Dr. Kyweluk writes.

The bottom line: A DTC ovarian reserve test can give a woman a sense of control, but at the expense of an incomplete, confusing, or even meaningless clinical picture.

From a broader perspective, is egg counting an example of the medicalization of the range that is normal reproductive biology? Will it create the patients-in-waiting scenario that describes newborn screening that identifies genetic diseases well before they cause symptoms?

Steve Jobs is famous for inventing things that we didnt know we needed the iPod and then the iPhone. To paraphrase and take him a bit out of context, A lot of times, people dont know what they want until you show it to them.

Just as it took years for so many of us to realize that we couldnt live without smartphones, it will take time for data to accrue that improve the accuracy of DTC ovarian reserve tests in predicting infertility. Until then, it might be just one more thing to worry about.

Ricki Lewis is the GLPs senior contributing writer focusing on gene therapy and gene editing. She has a PhD in genetics and is a genetic counselor, science writer and author of The Forever Fix: Gene Therapy and the Boy Who Saved It, the only popular book about gene therapy. BIO. Follow her at her website or Twitter @rickilewis

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How fertile are you? 'Ovarian reserve' DTC tests that count your eggs offer mixture of control and misinformation - Genetic Literacy Project

By far, the most popular forms of intermittent fasting are the 18:6, 16:8, and 14:10 time-restricted eatingplans, in which you abstain from food for 18, 16, and 14 hours per day, respectively. While breaking these types of fasts doesn't require quite as much planning as breaking an extended fast, there are still some general recommendations.

First and foremost, stick to whole foods and opt for a mix of macronutrients when you break a fastyou don't want a straight shot of carbohydrates (especially refined carbs) on an empty stomach.

"Definitely avoid carb-loaded meals and sugary drinks as they will cause a blood sugar roller coaster, raising your insulin levels and making you feel even more hungry," says Amy Shah, M.D., who uses intermittent fasting in her practice. "Additionally, having lots of sugar will make fasting for the next day even harder because your hunger hormones [like ghrelin] will be raised."

So what should you eat?"For a standard 16:8 plan, one could break a fast with a low-glycemic meal of choice," says Ali Miller R.D., L.D., CDE, registered dietitian and functional medicine practitioner. "If you're going to have carbs, ensure that they're balanced with protein and fat. A salad with protein, eggs with avocado and vegetables, a homemade protein shake, or a leftover protein and roasted veggies could all work as meal number one."

Portion size matters a bitparticularly when you get into the more intense time-restricted eating plans like 18:6 or 20:4. Even though you may be quite hungry when breaking your fast, particularly if you're new to IF, avoid eating a huge meal or you might overload your digestive system and experience symptoms like bloating. Typically, "hefty snack or small meal is best," says Miller.

Some specific foods you can mix and match to incorporate into your first post-fast meal include:

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Intermittent Fasting? Here's The Right Way To Break Your Fast - mindbodygreen.com