Archive for the ‘Hormone Physician’ Category

A sugar stat to swallow: along with acne, weight gain, and mood swings, sugar can also play a part in triggering painful headaches.

You might assume they're triggered by too much sugar at one time (and you're actually right), but consuming too little sugar can also contribute to the problem, Dr. Anisha Patel, DO of Medical Offices of Manhattan, explains.

"Sugar-related headaches come from a rapid swing in your blood sugar level," Dr. Patel notes. "So it's not actually the sugar itself that causes the headache but the quick change in consumption."

That could explain why you might have experienced a headache after, say, intermittent fasting or eating a large bowl of ice cream with plenty of fudge topping.

According to Dr. Patel, glucose level fluctuations affect your brain more than any other organ, and it's normal for someone without a medical condition to experience a headache under these types of conditions.

Sugar-related headaches could also be symptoms related to hypoglycemia and hyperglycemia, which Dr. Patel says aren't diseases themselves but rather symptoms or indicators of a larger health problem.

Blood sugar dropping too low is known as hypoglycemia, which "can be caused by sugar withdrawals caused by very strict dieting (especially when the diet involves skipping meals), and delayed or irregular meals," Dr. Eric Ascher, DO, Family Medicine Physician at Northwell Health, explains.

"You may experience fatigue, moments of confusion, lightheadedness, and weakness, and many will complain of a headache sometimes migraine-like in nature. Although rare, if your body experiences hypoglycemia for too long, you are at risk for coma and death."

Dr. Patel adds that hypoglycemia is often associated with diabetes treatment and can also be a side effect although rare of medication, alcohol consumption, severe liver illnesses, or hormone deficiencies.

"If you think you're experiencing a hypoglycemic attack, you should go to the doctor immediately," Dr. Patel says. "Those with diabetes or hormone deficiencies should consult their physicians about long-term symptom relief plans, which generally include a structured diet."

Then there's a condition called "reactive hypoglycemia," more informally dubbed as "the sugar hangover."

"When we eat a carb-heavy or sugar-overloaded meal especially if our body is unfamiliar with that much glucose, our body will supply a rush of insulin to help combat all that excess sugar that is shocking our bodies," Dr. Ascher explains. "Sometimes this may cause glucose levels to abruptly drop really low. This may cause hypoglycemia-like symptoms. Perhaps that is why you feel drained after a meal that concludes with a rich and heavy dessert."

On the opposite side of the sugar spectrum is hyperglycemia, which could also result in headaches. "Hyperglycemia occurs when the body is not producing or using enough insulin, the hormone that absorbs glucose into cells to be used for energy," Dr. Patel says. She adds that this is typically seen in diabetics.

However, Dr. Ascher says if your headaches are associated with increased thirst, increased urination, and blurred vision, you should speak with your doctor so they can monitor your blood glucose levels.

It's important to note that Dr. Ascher says that nondiabetic individuals normally have ebbs and flows in glycemic levels, as the body has capabilities to deal with these fluctuations; however, those with diabetes need extra support with medication.

If you think you have a sugar headache that is related to diabetes, hypoglycemia, or hyperglycemia or simply deal with these headaches often you should reach out to your doctor.

It's also important to take into consideration what else you ate prior to this headache popping up.

"Some people find that certain foods cause headaches, like chocolate and caffeine," Jeff McGrath, RD at Westchester Medical Center in Valhalla, New York, says. "Foods containing chocolate and caffeine often have added sugar, and one might falsely accuse the added sugar of being the headache-causing agent."

If you do have a headache due to too much sugar, McGrath says to stop eating sugar for the rest of the day and to consider limiting your daily sugar intake moving forward.

"Experts recommend limiting your sugar intake to less than 10 percent of your daily caloric allowance (15 grams of sugar provides 60 calories, for reference). Otherwise, to reduce headaches, try to stay hydrated and limit alcohol consumption, especially at your holiday parties and gatherings."

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Sugar-Related Headaches Are Real Heres How It Happens - POPSUGAR

Falls are a risk for everyone during slushy winter months, but the risk is especially high for people with cancer. Memorial Sloan Kettering physical therapist Jillian Hobson walks readers through what they can do to minimize the chance of falling.

Why are people with cancer prone to falls?Older adults with a history of cancer have anywhere between a 15% and 20% greater risk of falling compared to the general population of adults age 65 or older. Thats because cancer treatments, such as chemotherapy and radiation, can cause side effects that increase the risk of falls. These include weight loss, muscle weakness, numbness or tingling in the feet, dizziness, changes in eyesight and fatigue. When you lose sensation in your feet, for example, its harder to find your balance during challenging situations, such as walking on a slippery sidewalk. Its harder to know how to find your center of gravity.

Are there warning signs that a person may be at a greater risk for a fall?There are several behaviors that suggest a person with a history of cancer may be at a greater risk for falling. The person may rely on furniture and walls for support when walking around the house. They may trip or have times when they almost fall. Someone who has fallen in the past or is at risk for falling may also avoid crowded environments, such as busy sidewalks, the grocery store or other peoples homes. At MSK, outpatient physical therapists ask every patient, regardless of age, Have you fallen in the past 12 months? If they say yes, we try to prevent it from happening again.

What steps can people take to minimize their risk of falling?There are many. First, secure throw rugs to the floor with nonslip backing. Clear hallways of clutter, and consider installing handrails in the bathroom or for outdoor stairs. Formulate a plan for snow removal during the winter, preferably before snow starts. During the winter, wear boots with good traction. People who are concerned about falling or have fallen in the past should speak to their doctor to see if physical therapy could help.

What should someone do in the event of a fall?Today, there are many smartphone apps that can signal a fall to emergency responders. Some smartwatches also have an alert system that can tell when a fall has taken place and can call 911 for you if you are unable. Its important that your cell phone stays with you at all times and stays on in case of an emergency.

In the event of a fall, people should contact their medical team immediately to determine if they need follow-up care or a referral to physical therapy. If physical therapy is recommended, the physical therapist will identify exercises that promote improved balance, strength and stability. And because falls are not entirely preventable, a physical therapist will also teach strategies for safely getting up from the floor if a fall occurs.

Information provided by MSK (Information) is not intended as a substitute for medical professional help or advice but is to be used only as an educational aid in understanding current medical knowledge. A physician should always be consulted for any health problem or medical condition. Use of the Information is further subject toMSKs Website Terms and Conditions.

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Winter Is Coming: How People with Cancer Can Prevent Slips and Falls - Curetoday.com

captionChildren, teens, and people at risk of heart rhythm problems should not try the keto diet.sourceBURCU ATALAY TANKUT/Getty Images

Compared to the low-fat craze in the 90s, the keto diet seems to go against all diet logic. Because instead of cutting out fat, you eat large amounts of it for every meal.

And research shows that this diet can be effective and help fight diseases related to obesity. That said, the keto diet is not for everyone. Heres what you need to know.

The ketogenic diet was first introduced in the 1920s as a way to treat epilepsy, a seizure disorder. Medical professionals used the diet for two decades until modern epilepsy drugs were developed and it fell out of favor by the 1950s.

That was it for the keto diet for over half a century. Then, about 15 years ago, the diet reemerged. This time as a treatment for obesity and type 2 diabetes.

But even people who are not obese or have type 2 diabetes have adopted the keto diet at some point, including celebrities like Halle Berry, Vaness Hudgens, and LeBron James.

The way it works is that you eat mostly fat and very few carbohydrates. A typical keto diet consists of 75% fat, 20% protein, and 5% carbs. Compared to the average American diet which is 33% fat, 16% protein, and 51% carbs. On keto, common foods include:

When you follow the keto diet, your body stops relying on carbs as the main source of energy, which sends your body into ketosis. Ketosis is when your metabolism changes to burn fat for energy instead. This can lead to a loss of body fat, which can help prevent or improve medical conditions related to obesity like type 2 diabetes.

Thats because, on keto, your body may also become more sensitive to insulin, a hormone that helps balance your blood sugar. A 2017 review of nine studies found that people with type 2 diabetes on a low-carb diet generally could control their blood glucose levels better than diabetes patients on either a normal or high-carb diet.

When following the keto diet, weight loss can vary from person to person, says Jeff Volek, a registered dietitian and professor at Ohio State University. When people with excess weight start a ketogenic diet, they typically lose about 6 to 8 pounds the first week, then about 1 to 2 pounds per week thereafter, Volek says.

However, some people who go on keto reportedly suffer from some initial side effects including:

The initial weight loss is partly due to losing water weight because you tend to retain less water on a low-carb diet. And some studies suggest that you may not continue to lose weight on keto long-term. Some call this the keto plateau which is when you stop losing weight altogether.

Volek says that the keto diet is safe for many people to try and that it may mimic the way early humans ate. However, Volek says that in some cases, you should proceed with caution. If you have diabetes and are using diabetes medications to control blood sugar, you should work closely with your physician in order to adjust medications appropriately.

The keto diet can be very restrictive and may be difficult for people to stick to, says Little. The average healthy person probably does not need to follow a keto diet but they could probably benefit from reducing their intake of refined/processed carbohydrates.

Keto isnt necessarily for everyone. Take kids, for example. Nutritionists recently told Insider that putting children or teens on the keto diet or basically any restrictive diet can lead to nutritional deficiencies and eating disorders.

Moreover, keto isnt great long-term if you have, or are at risk of, heart rhythm problems. A large 2019 study, published by the American College of Cardiology, that involved medical records of nearly 14,000 people reported that people who dont consume many grains, fruits, and starchy vegetables for years at a time, are at a higher risk of developing a heart condition called AFib.

Even if youre otherwise healthy, long-term keto could lead to vitamin B and C deficiencies, since many foods rich in these vitamins like beans, legumes, and fruit are also high in carbs. And if youre not getting the right nutrients, keto may actually lead you to gain weight, not lose it.

Bottom line: The keto diet is not for everyone and you should speak with a certified nutritionist before starting it, especially if you have a medical condition that the diet may affect.

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Everything you need to know about the keto diet - Business Insider

The first time I held my niece, it confirmed something I had been unsure about for over two decades: I wanted to become a parent. I was 31. The average age of first-time mothers in Canada is about 30. Nothing very out of the ordinary, right?

But, I had medically transitioned years ago. I had been on testosterone injections for seven years and had masculinizing chest surgery. My transition felt complete. Perhaps this is why I could begin to envision myself as a parent a father.

Kinnon MacKinnonMy fertility preservation journey took almost two years just to get started.

In theory, I could probably become physically pregnant if I discontinued testosterone, but it wasnt something I felt very open to though plenty of incredible men do carry their own children.

Fertility preservation seemed like a good option for me. I was about halfway into a PhD program and didnt want to take a parental leave. To give myself some more time and options, I decided to freeze my eggs.

I had also just learned that the Ontario Ministry of Health was funding fertility preservation for trans people through the Ontario Fertility Program (OFP). But I had reservations would my eggs still be good after all those years of weekly testosterone injections?

I made a visit to my family doctor, who specializes in trans care. She assured me that there is no clear evidence that testosterone negatively impacts egg reserve or egg quality. A recent study seems to confirm this, but more research is needed.

My doctor recommended a few fertility clinics in Toronto that had good reputations for working with LGBTQ people. I was referred to the Mount Sinai Fertility Clinic. I felt hopeful.

I was 31 when I had my initial consultation. By the time my name made it to the top of the list for funded fertility preservation, I was nearly 33.

For some trans people, fertility preservation is an important component of transition-related care. Psychologist and professor Dr. Damien Riggs believes that fertility preservation is a reproductive right for trans people.

A 2017 survey found that 97 per cent of trans people living in Toronto felt that they should be offered fertility preservation prior to beginning hormone therapy. The same survey found that only three per cent had banked sperm or eggs.

The most common barrier noted: Cost.

Ontarians receive provincially funded fertility preservation, while those who live in Nova Scotia (my home province) are on their own coverage varies by province. This inconsistent access to care simply isnt fair.

In regions lacking coverage virtually everywhere outside Ontario out-of-pocket expenses for egg retrieval and its associated medications often exceed $10,000. This price tag skyrockets when the procedure needs to be repeated to retrieve the number of eggs statistically likely to result in a live birth.

UniversalImagesGroup via Getty ImagesCosts for egg retrieval are out of reach for many Canadians. Stock image.

Tax credits are available in Manitoba, New Brunswick and Quebec, but the services must be paid for up front. This constitutes a major financial barrier for the majority of Canadians who would not have a $10,000 (or more) rainy day fertility fund.

On the surface, freezing sperm seems more manageable (under $1,000). But paying storage fees, whether for eggs or sperm, adds up. Yearly storage fees can vary and are not covered by the OFP. I paid $300 in 2018. I paid another $300 in 2019.

These costs are out of reach for the many trans Canadians, who live in poverty due to rampant employment discrimination.

When I first started transitioning nine years ago, I remember my university health clinic physician encouraging me to think about fertility preservation options. This is considered standard medical practice with trans people who are considering hormone therapy or lower surgeries today.

At the time, delaying starting testosterone by another several months for egg retrieval felt impossible. For trans people beginning medical transition, this can feel like having to choose between fertility or transition.

Im fortunate that going off testosterone to prepare for egg retrieval was not difficult for me, emotionally, psychologically or otherwise. I knew it would be time-limited, and it was for a worthwhile cause.

However, its good practice to assume that discontinuing hormone therapy may be hard for myriad reasons, even when self-motivated by the idea of one day becoming a parent. Health-care providers should be mindful of, and responsive to, this reality, and the many other challenges that LGBTQ people experience with respect to fertility.

Once my ovulation cycle resumed, my fertility treatment resembled that of a cisgender female. I began medications that stimulated my ovaries. I also had regular bloodwork and ovarian follicle tracking to see how many follicles were growing.

Many people report symptoms of hormonal mood issues when taking fertility drugs. This was not the case for me. I did have a difficult time with the daily subcutaneous injections into my stomach, however. After years of weekly testosterone injections, I was confident they would be a total breeze. I was wrong.

The actual egg retrieval was the hardest part of the entire experience. I anticipated discomfort it was agony. I was right to shy away from pregnancy. I was not built for the pain of childbirth! But the procedure was over quickly. Thankfully, my partner was at my side the whole time. Relative to the procedure, the recovery was simple and painless.

Despite seven years of testosterone, the eggs we retrieved went on to produce high-quality embryos. We now have several frozen embryos rated AA, the best possible score, ready for whenever we are.

UniversalImagesGroup via Getty ImagesWith high-quality embryos frozen for preservation, my partner and I have more options to start a family. Stock image.

So, to transmasculine people out there: do not let concerns about testosterone treatment deter you from egg retrieval. Age, overall health and genetic factors might be better predictors of egg quality and fertility.

For me, egg retrieval was largely a positive experience. But this didnt happen through luck alone. It started with Ontarios policy decision to fund fertility preservation procedures, and continued through to the trans-inclusive medical care I received at my primary care provider and the fertility clinic.

I asked Nurse Practitioner Eileen McMahon, who coordinated all aspects of my fertility care at Mount Sinai, what the clinic did to improve their capacity to work with trans people like me. She told me they had created a trans community advisory committee who made several suggestions. Following the advisory committees lead, the clinic provided trans-inclusion training to all staff; revised clinic intake and consent forms; and updated their website and patient handouts to be inclusive of diverse gender identities, bodies, sexualities and relationships.

This is the kind of care and attention that trans people need and deserve in fertility clinics and, more broadly, in all health and social services.

As a patient on the receiving end, I couldnt help but wonder how things could have turned out differently if I had wound up at a clinic that hadnt been so sensitive to my needs. If I had been misgendered upon arrival at the clinic, could I have seen the process through to the end? While I dont have a clear answer, I do feel grateful for the experience that I did have.

After completing egg retrieval and creating embryos, my partner and I now have more options to eventually start a family one day.

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Not All Trans People Have Access To Freezing Embryos. I Am One Of The Lucky Ones. - HuffPost Canada

December 24, 2019 Cover

The Laughlin resorts offer a variety of dining and entertainment specials for New Years Eve.

Long before there was Motown, several black groups in the early 1950s struggled to make a difference on the music scene. To a world dominated by white artists, the deep soulful harmonies and soaring vocals of R&B were a little unsettling. The powerful music couldnt be ignored for very long, simply because it was that good. Proving that point on every level The Platters.

When Jazzin' Jeanne Brei decided to call her group The Speakeasy Swingers, it seems appropriate for the kind of vintage song and dance shows they deliver, or so one would think.Yet people in a younger age bracket didnt know what a speakeasy was, while others idea of swinging had nothing at all to do with dancing. A speakeasy used to mean an illicit establishment that sold illegal alcoholic beverages mostly during the Prohibition era in the 1930s, when the music was usually jazz-tinged and the dancing and fashion was considered a bit risqu for the time.

Frankie Valli & The Four Seasons are still in high demand. Even in their soaring Sherry days, Valli and his Seasons werent stars of Broadway and subjects of a marquee show in Vegas. But thanks to the musical Jersey Boys, Valli and the Four Seasons have become cultural icons and subjects of art as well as artists themselves.There is a tribute show making a return visit for a series of shows Thursday-Monday, Dec. 26-30 (8 p.m.) at Harrahs Laughlin that goes after some of that Four Seasons magic in the form of a tribute show called Oh What A Night!

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Baby-led weaning can be a confusing and complicated process. When Juno DeMelo's daughter went from drinking almost a liter of breastmilk a day to wanting nothing to do with it, the new mom was left physically and emotionally unmoored.

The first time I stuffed my bra was in middle school. It was actually a swimsuit, and I used shoulder pads that I had to keep wringing out by crossing my arms. The second time, I was of advanced maternal age, and I lined my nursing bra with cabbage leaves.

I was already popping maximum-strength Sudafed and chugging peppermint tea to cut off my milk supply. By that point Id been breastfeeding for almost a year, and my output was nourishing not just my daughter but also an adopted infant and the preemie recipients of my frequent donations to the local milk bank.

At first, I had trouble getting any milk to come out. For close to a week, I produced only colostrum, and despite the lactation consultants reassurance that newborns stomachs are the size of a walnut, I feared my daughter, Margot, was starving.

I struggled despite the fact that Id taken an all-day breastfeeding class and read a 352-page book that laid out breastfeeding in seven easy steps. I flailed even though I set up my pump while I was still pregnant and bought a nursing pillow called My Brest Friend. In the hospital, I received hands-on coaching from a nurse who made my nipple into a supposed sandwich. Everyone stood around in the hospital room watching the frog baby whod just emerged from my vagina covered in slime try to suck on the one sexualized body part that hadnt yet been mommified (its worth noting that spell check would like this to say mummified).

And then, on day seven, we achieved liftoff. It finally rainedand then it poured. My boobs ballooned to an F cup. Margot started nursing for eight hours a day, according to the app I used to time how long she spent on each side. When I pumped, I would fill two, sometimes three, bottles, a freakish amount. (Breastfed babies take in an average of 25 ounces of breast milk over the course of a day. I once pumped 16 ounces before 6 a.m.) I froze the extra milk in bags, dated and labeled with the number of ounces they contained.

I got clogged ducts that made it feel like someone had slipped dice into my breast tissue. I shoved heart-shaped reusable bamboo pads into my bras, which were already bursting at the seams. I soaked through them, so I switched to disposable ones with waterproof backings that crinkled every time I moved. I woke up each morning looking like Id slipped my pajama shirt on over a wet bikini top. Nonetheless, I kept at it. The American Academy of Pediatrics recommends breastfeeding until one one year. Determined to do motherhood right, I made this my goal. Well ahead of reaching it, though, I began worrying about having to hurry Margot along to the next milestone.

Even as an egg, her pace had never matched mine. It had taken me forever to get my period again after going off of birth control, then long enough to get pregnant that I made a fertility appointment I cancelled at the last minute, after finally seeing a blue line on the pregnancy strips Id bulk-ordered from Amazon.

I didnt start getting contractions until five days after my due date, and my labor lasted 20 hours, ending only when my OB-GYN plunged Margot out by the head. Margot nursed leisurely, taking long, slow gulps for half an hour long after everyone said she would speed up.

So when she refused to nurse one evening around 10 months old, I chalked it up to a fluke, probably an illness, definitely not a sudden spurt of baby-led weaning. By that point Margot had already had two bouts of hand-foot-mouth disease, bronchiolitis that landed her in the emergency room, and a weeks-long spell of projectile vomitingat a baby shower, birthday party, and restauranttriggered by anything that wasnt breast milk. We had ointments and drops for eczema, pink eye, and diaper rash. We were intimately acquainted with the thermometer and a plastic contraption that allowed us to suck the mucus out of her nose using the force of our breath. What fresh hell is this? is something I asked myself often.

When she refused to nurse one evening around 10 months old, I chalked it up to a fluke, probably an illness, definitely not a sudden spurt of baby-led weaning.

My husband wondered whether Margot, crying hysterically by this point, had broken a bone, thats how surprising it was when she refused to nurse. The mom friends I met that night for dinner had another idea.

Well, shes done breastfeeding, one said. Mine started to lose interest around this age too.

They were mothers of two, more experienced and less fazed by the unexpected than I was. My baby, I insisted, was not theirs. Our bond was an airtight latch between rosebud mouth and nipple. There was no slow leak, and there was certainly no precedent of what amounted to a sudden flat tire on the freeway.

The next morning, I pumped before going to the gym, and my husband gave Margot the breast milk in a bottle. Then we packed up the car for our first road trip, to the Oregon coast. She slept most of the way, waking up just as we pulled onto the unpaved road leading to our cabin.

Ingrid Frahm, Getty Images

We were, as was my wont, early. The woman cleaning the place suggested we kill time by checking out the beach. It was a short, steep hike away, down a dirt path lined with blackberries we popped into our mouths as we walked. When we got to the shore, I plopped down on a piece of driftwood and pulled out my boob. Id seen friends doing this on Instagram, nursing on grey, deserted Oregon beaches. I felt like Margots trusty goatskin of cold white wine.

But her mouth, stained purple, would not open. She thrashed around as if my nipple were antimagnetic. Seagulls were squawking, waves were crashing, and it was, as it always is on Oregon beaches, cold and windy. How can someone concentrate under these circumstances? I asked myself. A small part of me, though, started to worry my friends were right.

We walked back to the house, and a few hours later, I tried nursing Margot again on the couch, facing the ocean. She looked at my nipple as if shed never seen it before, plucked at it with her tiny fingers, and laughed. I was fucked.

She looked at my nipple as if shed never seen it before, plucked at it with her tiny fingers, and laughed.

Already, my milk felt like Tetris blocks stacking up with alarming quickness in my boobs. I texted my mom friends that they had, in fact, told me so. They replied telling me to go cold turkey in order to shut down my supply ASAP. They tried to contextualize my shock and prepare me for more of it.

Think of how many times our kids will do something were not ready for between now and when they go to college! one wrote.

Oh, God, just think. After running ahead and doubling back for so long, Id finally been left in the dust by Margot. How else would she surprise me? And how could I, someone who cannot float down a river without trying to use my flip-flops to steer myself into the current the whole time, learn to go with a flow that trickled and then gushed and now needed to be dammed? Id hurried Margot all her short life, worried shed get left behind, or more accurately, that shed slow me down. I wanted her to hit one developmental benchmark after another ahead of schedule, untilwhat, she leaves the house the day she turns 18? She gets to her grave? She buries me in mine?

I couldnt control Margot or myself. After tracking my ovulation for over a year, spending 10 months pregnant, and then nursing for nearly another year, Id looked forward to the end of nursing as the opportunity to get my body back. But my body kept doing its own thing. I couldnt keep it from making milk, which a physician assistant warned me could continue for up to a year. My identity was shifting yet again, from possibly infertile to with-child to milk machine to something akin to a used condom, and it was disorienting. My daughter had outgrown me literally overnight, and my torn and leaking body was outlasting its utility. Shed been ripped from my body a second time, only this time shed done the ripping, and that hurt worse.

My daughter had outgrown me literally overnight, and my torn and leaking body was outlasting its utility.

I called my hospitals mother-baby center, which had been incredibly helpful to me when I was struggling to breastfeed. The woman who answered sounded stunned that anyone could need help quitting their goal, as if I were trying to get less fit. Maybe its because the U.S. Department of Health and Human Services is working to get the proportion of infants who are breastfed at one year up to (a mere) 34.1 percent.

A lot of my friends breastfed for that long, but 60 percent of moms quit sooner than theyd intended to. Some never really like it as much as they wish they did. Others dont have time to pump once they go back to work, or their milk dries up, or their babies never latch properly.

No matter when they quit or why, most breastfeeding mothers feel conflicted. The emotions around weaning are layered and nuanced and can be contradictory, says Pooja Lakshmin, M.D., a reproductive psychiatrist and clinical assistant professor at the George Washington University School of Medicine. You can be joyful that you have your body back to yourself, but you could also have grief about not having that close, connected time with your infant.

One thing thats fairly universal: The belief that breast is best. The whole birth-industrial complex is devoted to women only so long as theyre doing whats best for their babies. Youre a relative princess when youre pregnant. Other people carry your bags. You have a dedicated clinician who sees you every week toward the end of your pregnancy, and, if youre lucky, a lactation consultant.

The problem is that no one is there to help you dismantle all the scaffolding youve built to support another human being. Postpartum, you carry the bags and the baby. No one much cares about your hemorrhoids or lower back pain or stretch marks or infected boobs that are causing a fever to spread throughout your body. You have a six-week follow-up, and they send you on your way. You have a baby, and that is your reward and your curse.

The medical community and our culture tends to talk more about babies than women around the transition to motherhood, says Alexandra Sacks, M.D., a reproductive psychiatrist and the host of the Motherhood Sessions podcast. Weaning is a continued time where discussion about the babys health and wellness dominates the conversation.

I was lucky that I could turn to my friends, but still, none of them brought up weaning until I did. I tried to dig up studies and found very few. Even the mom blogs were relatively mum on the topic. One explanation: Its assumed that weaning is easy or that it just happens, when in fact its quite a complicated process, says Lakshmin. I also think theres so much guilt and shame and pressure around breastfeeding conversations, the decision to stop might be one that women feel badly about it, or they worry theyll be judged.

Its assumed that weaning is easy or that it just happens, when in fact its quite a complicated process.

With little to go on, I pumped a tiny bit when my boobs felt like they might explode and suffered through the uncomfortable fullness the rest of the time. I tried drugs and herbs and vegetable poultices. I squeezed my extra ample bosom between the straps of a hiking carrier so we could march along the coastline with Margot. I offered her pouches of purplish sludge instead of nursing her when she fussed.

We returned home in the middle of a Tuesday. I walked in the door and couldnt decide what to put down first or where. I felt paralyzed and hot and unmoored. My levels of the feel-good hormones oxytocin and prolactin were plunging, bringing back the horrible anxiety Id felt postpartum.

For a long time, I tried to understand why no one told me the truth about birth. (Sacks actually co-wrote a book called What No One Tells You. The mothers emotional experience is under-discussed, she says. Youre not alone in feeling that you wish there had been more open education about the transition.) Were they keeping their experiences to themselves, or were theirs just less traumatic than mine? I wondered the same thing about weaning.

It turns out it isnt just different for different women, its also felt differently on a hormonal level. Theres a subset of women who are much more sensitive to hormone changes than others, whether theyre on their period, pregnant, breastfeeding, or weaning, explains Lakshmin. So theres a huge variation, which is why some women had a horrible time with weaning, and for others it was a nonevent.

Eventually, it did become a nonevent. I gave my pump to one friend and my nursing bras to another. As my milk began to dry up, my boobs swam a little in my old underwire bras. There was enough room in there for shoulder pads or cabbage leaves. Theyd once been bigger than a newborns head and just as round and hard. Now they were floppy and soft, dual Velveteen Rabbits.

We worked our way through all the frozen breast milk and transitioned Margot to cows milk, which we started sending in her lunchbox to Montessori. Her teacher poured it into a little metal condiment cup she still drinks from with two hands, as if its a chalice. For a long time, Margot would cry at drop-off, but she grew to look only a little nervous. She sat herself on a child-size wooden bench to remove her shoes, and when she did this, she looked like a tiny woman awaiting a train she wasnt sure she wanted to take.

On Fridays, Montessori serves banana waffles for second breakfast. One day, when I dropped Margot off, she made a beeline for her teacher, an unflappable woman with dark hair I often turn to for parenting advice. Margot softly touched her teachers knee and turned around to look at me, still in her rain jacket, her hair a wild nest of curls she wont let me put in a ponytail. It was all Id hoped for when she was an infant: walking, solid food, a good head of hair, independence. I stood there in my slightly too-big bra, holding a Neoprene lunch sack with a bottle of milk in it, stunned again to be left behind, in a position I longed for but never could envision actually arriving at, again.

Read more here:
How to Wean When Your Baby Stops Breastfeeding - HarpersBAZAAR.com

The low-carbohydrate, high-fat ketogenic diet has become hugely popular over the last few years. For many people, the keto diet including variations such as keto cycling or the less restrictive lazy keto has become the go-to eating plan for weight loss and fighting disease.

Two years ago, I interviewed cancer specialist Dr. Patrick Hwu of MD Anderson in Houston about his research into what he calls the fat-burning metabolism diet, or fat-burning diet. Hwu, a tumor immunologist, has been following the ketogenic diet himself for six years, long before it was trending on social media.

As a leading cancer doctor, he has many patients asking him for the ideal diet while they go through treatment and he often suggests keto.

Hwu emphasizes that more research is needed to determine the ideal diet for cancer patients, but as he has seen in himself, the keto diet has been shown to improve biomarkers associated with heart health.

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Keto is a diet that was developed decades ago and originally used for patients with severe epilepsy, some of whom were on the diet for life with no evidence of harm. It consists of low carb, high fat and only moderate protein intake, as opposed to the Atkins diet. Keto isnt as meat-heavy as commonly believed. Hwu relies on certain go to foods like full-fat regular cream cheese, sour cream and avocados as staples. He also consumes a lot of green vegetables and cauliflower.

Since starting the keto diet, Hwu has dropped 25 pounds and has maintained the weight loss. His blood pressure, triglycerides and sugar levels have all decreased, which are healthy signs. His biomarkers, including lipid profile and blood pressure have been excellent, he said.

There have been a number of studies that show the connection between obesity and certain cancers. Hwu feels that keto makes sense because his patients are not hungry on it, it manages their weight and blood sugar levels and keeps insulin and IGF-1 levels low two proteins that have been shown to drive some cancers.

I feel that fat intake has been overly emphasized as a negative factor and that a high intake of carbs and the subsequent spikes in insulin and IGF-1 (an insulin-like hormone in the blood) that they cause are more harmful to health overall, Hwu said.

Hwus colleague, Dr. Jennifer McQuade, an assistant professor and physician scientist in Melanoma Medical Oncology at MD Anderson says they are currently conducting both human and animal studies of the effects of diet, including the ketogenic diet, on cancer. In addition, they are testing a plant-based high-fiber diet aimed at the gut microbiome, which has been shown to impact response to immunotherapy, a type of cancer treatment that utilizes the patients own immune system to fight the disease. They expect results from the studies early next year.

Recent work from the laboratory of Lew Cantley at Cornell has shown that the ketogenic diet can improve cancer control in mice treated with a type of targeted therapy that can cause elevated levels of insulin.

The MD Anderson researchers will test the ketogenic diet in cancer survivors to see if it lowers insulin and IGF-1, they will then move on to combining with targeted therapy.

The keto diet research will be prepared in an MD Anderson kitchen and provided to the patients in a controlled setting.

Meanwhile, Hwu would like to see a greater variety of keto-friendly offerings in grocery stores because the key to sticking with keto is having enough substitutes, so you never feel deprived.

You can bake almost anything with almond flour," said Hwu, "and stevia, erythritol and monk fruit are all safe sweeteners.

Kristin Kirkpatrick

Kristin Kirkpatrick is the lead dietitian at Cleveland Clinic Wellness & Preventive Medicine in Cleveland, Ohio. She is a best-selling author and an award winning dietitian.

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Is the keto diet healthy? Cancer researchers study effects of keto - TODAY

Another busy year for clinical research has come and gone. What are the most important findings from 2019? Here is our overview of some of the most noteworthy studies of the year.

"Medicine is of all the Arts the most noble," wrote the Ancient Greek physician Hippocrates whom historians call the "father of medicine" over 2,000 years ago.

Advances in therapeutic practices have been helping people cure and manage illness since before the time of Hippocrates, and, today, researchers continue to look for ways of eradicating diseases and improving our well-being and quality of life.

Each year, specialists in all areas of medical research conduct new studies and clinical trials that bring us a better understanding of what keeps us happy and in good health, and what factors have the opposite effect.

And, while each year, experts manage to overcome many obstacles, challenges old and new keep the medical research field buzzing with initiatives.

Reflecting on how research has evolved over the past decade, the editors of the reputable journal PLOS Medicine in a recent editorial emphasize "ongoing struggles" with infectious diseases, as well as growing tensions between two approaches in medical research. These approaches are the effort of finding treatments that are consistently effective in large populations versus the notion of "precision medicine," which favors therapy that we closely tailor to an individual's very personal needs.

But how has clinical research fared in 2019? In this special feature, we look at some of the most prominent areas of study from this year and give you an overview of the most noteworthy findings.

The medication we take as long as we follow our doctors' advice is meant to help us fight off disease and improve our physical or mental well-being. But can these usually trusty allies sometimes turn into foes?

Most drugs can sometimes cause side effects, but more and more studies are now suggesting a link between common medication and a higher risk of developing different conditions.

In March this year, for instance, experts affiliated with the European Resuscitation Council whose goal is to find the best ways to prevent and respond to cardiac arrest found that a conventional drug doctors use to treat hypertension and angina may actually increase a person's risk of cardiac arrest.

By analyzing the data of more than 60,000 people, the researchers saw that a drug called nifedipine, which doctors often prescribe for cardiovascular problems, appeared to increase the risk of "sudden cardiac arrest."

Project leader Dr. Hanno Tan notes that, so far, healthcare practitioners have considered nifedipine to be perfectly safe. The current findings, however, suggest that doctors may want to consider offering people an alternative.

Another study, appearing in JAMA Internal Medicine in June, found that anticholinergic drugs which work by regulating muscle contraction and relaxation may increase a person's risk of developing dementia.

People may have to take anticholinergics if some of their muscles are not working correctly, usually as part of health issues, such as bladder or gastrointestinal conditions, and Parkinson's disease.

The research that specialists from the University of Nottingham in the United Kingdom led looked at the data of 58,769 people with and 225,574 people without dementia.

It revealed that older individuals at least 55 years old who were frequent users of anticholinergics were almost 50% more likely to develop dementia than peers who had never used anticholinergics.

But, while common drugs that doctors have prescribed for years may come with hidden dangers, they are, at least, subject to trials and drug review initiatives. The same is not true for many other so-called health products that are readily available to consumers.

Such findings says the study's lead researcher, Prof. Carol Coupland, "highlight the importance of carrying out regular medication reviews."

In 2019, we have celebrated 50 years since someone first successfully sent a message using a system that would eventually become the internet. We have come a long way, and now, we have almost everything within reach of a "click and collect" order.

This, unfortunately, includes "therapeutics" that specialists may never have assessed, and which can end up putting people's health and lives in danger.

In August, the Food and Drug Administration (FDA) issued a warning against an allegedly therapeutic product that was available online, and which appeared to be very popular.

The product variously sold under the names Master Mineral Solution, Miracle Mineral Supplement, Chlorine Dioxide Protocol, or Water Purification Solution was supposed to be a kind of panacea, treating almost anything and everything, from cancer and HIV to the flu.

Yet the FDA had never given the product an official assessment, and when the federal agency looked into it, they saw that the "therapeutic" a liquid solution contained no less than 28% sodium chlorite, an industrial bleach.

"[I]ngesting these products is the same as drinking bleach," which can easily be life threatening, warned the FDA's Acting Commissioner Dr. Ned Sharpless, who urged people to avoid them at all costs.

Many studies this year have also been concerned with cardiovascular health, revisiting long held notions and holding them up to further scrutiny.

For instance, a study in the New England Journal of Medicine in July which involved around 1.3 million people suggested that, when it comes to predicting the state of a person's heart health, both blood pressure numbers are equally important.

When a doctor measures blood pressure, they assess two different values. One is systolic blood pressure, which refers to the pressure the contracting heart puts on the arteries when it pumps blood to the rest of the body. The other is diastolic blood pressure, which refers to the pressure between heartbeats.

So far, doctors have primarily taken only elevated systolic blood pressure into account as a risk factor for cardiovascular disease.

However, the new study concluded that elevated systolic and diastolic blood pressure are both indicators of cardiovascular problems.

Its authors emphasize that the large amount of data they had access to painted a "convincing" picture in this respect.

"This research brings a large amount of data to bear on a basic question, and it gives such a clear answer."

Lead researcher Dr. Alexander Flint

At the same time, a slightly earlier study, appearing in the European Heart Journal in March, emphasizes that having high blood pressure may not mean the same thing for everyone, and while doctors may associate it with adverse outcomes in some, this does not hold for all populations.

The study's first author, Dr. Antonio Douros, argues that "[w]e should move away from the blanket approach of applying the recommendations of professional associations to all groups of patients."

Dr. Douros and team analyzed the data of 1,628 participants with a mean age of 81 years. The researchers found that older individuals with lower systolic blood pressures actually faced a 40% higher risk of death than peers with elevated blood pressure values.

"[A]ntihypertensive [blood pressure lowering] treatment should be adjusted based on the needs of the individual," the study's first author advises.

When it comes to protecting heart health, 2019 studies have shown that diet likely plays an important role. Thus, research in the Journal of the American Heart Association in August showed that people who adhered to plant-based diets had a 32% lower risk of death that researchers associate with cardiovascular disease than those who did not.

People who ate plant-based foods also had a 25% lower risk of all-cause mortality, according to this study.

And another study from April in the journal Nutrients warned that people who follow a ketogenic diet, which is high in fats and low in carbohydrates, and who decide to take a "day off" from this commitment every now and again, may experience blood vessel damage.

Ketogenic or keto diets work by triggering ketosis, a process in which the body starts burning fat instead of sugar (glucose) for energy. But "cheat days" mean that, for a brief interval, the body switches back to relying on glucose.

"[W]e found [...] biomarkers in the blood, suggesting that vessel walls were being damaged by the sudden spike in glucose," notes first author Cody Durrer.

In 2019, the topic of how our food choices influence our health has remained popular among researchers and readers alike.

According to Google Trends, some of the top searches in the United States this year included intermittent fasting diets, the Noom diet, and the 1,200 calorie diet.

And this year's studies have certainly reflected the widespread interest in the link between dietary choices and well-being.

One intriguing study in Nature Metabolism in May pointed out that protein shakes, which are popular among individuals who want to build muscle mass, may be a threat to health.

Fitness protein powders, the study authors explain, contain mostly whey proteins, which have high levels of the essential amino acids leucine, valine, and isoleucine.

The research in mice suggested that a high intake of these amino acids led to overly low levels of serotonin in the brain. This is a key hormone that plays a central role in mood regulation, but which science also implicates in various metabolic processes.

In mice, the heightened levels of leucine, valine, and isoleucine, which caused excessively low serotonin, led to obesity and a shorter life span.

So, if too much of certain types of protein can have such detrimental effects on health, what about fiber? Dietary fiber present in fruit, vegetables, and legumes is important in helping the body take up sugars little by little.

But how much fiber should we consume? This is the question that a study commissioned by the World Health Organization (WHO) and appearing in The Lancet in January sought to lay to rest.

The research took into account the findings of 185 observational studies and 58 clinical trials, covering almost 40 years.

It concluded that to lower their death risk, as well as the incidence of coronary heart disease, stroke, type 2 diabetes, and colon cancer, a person should ideally consume 2529 grams of fiber per day.

"Fiber-rich whole foods that require chewing and retain much of their structure in the gut increase satiety and help weight control and can favorably influence lipid and glucose levels," explains one of the authors, Prof. Jim Mann.

On the other hand, several studies from this year draw attention to just how detrimental foods that are not 100% natural can be. A small trial, whose results came out in Cell Metabolism in May, showed that processed food leads to abrupt weight gain but not for the reasons we may think.

The study authors said they were surprised that when they asked participants to eat either an ultraprocessed food diet or a nonprocessed food diet whose caloric contents the researchers matched perfectly the people who ate processed foods rapidly gained more weight than the ones who ate the nonprocessed foods.

The researchers blame this on the speed with which individuals end up eating processed foods, in particular. "There may be something about the textural or sensory properties of the food that made [participants] eat more quickly," says study author Kevin Hall, Ph.D.

"If you're eating very quickly, perhaps you're not giving your gastrointestinal tract enough time to signal to your brain that you're full. When this happens, you might easily overeat," he hypothesizes.

And more research in mice from Scientific Reports in January found that emulsifiers, which are a common additive present in many products from mayonnaise to butter, could affect gut bacteria, leading to systemic inflammation.

What is more, the impact on the gut could even influence processes that occur in the brain, increasing anxiety levels. "[W]e [now] know that inflammation triggers local immune cells to produce signaling molecules that can affect tissues in other places, including the brain," explains co-lead researcher Prof. Geert de Vries.

While some of the studies that made the headlines in 2019 were conclusive, many encourage further research to confirm their findings or further investigate the underlying mechanisms.

Stepping into the next decade, this much is clear: The wheels of medical research will keep on turning for better health across the globe.

Originally posted here:
2019 in medical research: What were the top findings? - Medical News Today

Shares of Horizon Therapeutics (NASDAQ:HZNP) closedmore than 4% higher on Monday after an U.S. Food and Drug Administration advisory committee votedin support of the company's treatment for thyroid eye disease, and the stock extended gains by more than 2% over the next two trading sessions.The FDA's Dermatologic and Ophthalmic Drugs Advisory Committee concluded that potential benefits of teprotumumab outweighed possible treatment risks.

IMAGE SOURCE: GETTY IMAGES.

But a long-term rally may be limited, at least for now. The FDA has until March 8 to issue its decision on the treatment, leaving investors plenty of time to speculate, wonder, and buy or sell shares. Of course, the committee's vote for teprotumumab is a strong positive indicator, and the FDA does take such a recommendation into consideration. That said, the vote doesn't guarantee the drug's approval.

At the moment, there are more reasons to be positive about Horizon than negative. Any sign of possible approval is good news, and what's particularly interesting here is the fact that if the FDA gives the green light, teprotumumab will become the firstFDA-approved treatment for thyroid eye disease.

In its latest earnings call, the company said it estimated15,000 to 20,000 patients per year are eligible for its treatment and said initial physician feedback supports those figures. As for how that translates into sales, Horizon forecastspeak annual net sales of more than $750 million. Analysts predict peak sales could reach $500 million to $1.5 billion.

Thyroid eye disease is an autoimmune disease resulting in eye bulging, double vision, and even blindness, and often affects those who suffer from Graves' disease.In Graves' disease, the body's immune system attacks the thyroid, causing it to make more thyroid hormone than needed, while in thyroid eye disease, the body's immune system attacks tissue surrounding the eye. Teprotumumab acts by inhibiting a key receptor involved in the development of thyroid eye disease. The global Graves' disease market totaled $306.3 million last year, according to a Research and Markets report, and about 25% of people suffering from that disease can also develop thyroid eye disease, datafrom Persistence Market Research showed.

Even without teprotumumab on the market, Horizon's general financial picture is bright, with the company postingpositive earnings surprises for the past four quarters. Third-quartersales rose 3%, and Horizon increased its full-year 2019 adjusted EBITDA guidance to the range of $465 million to $475 million from the earlier forecast range of $460 million to $475 million. The company also took steps to improve its capital structure, issuing senior notes and, through proceeds and cash on hand, repaying $625 million of outstanding debt.

Now the question is: What's in store for the stock in the next few weeks? Let's have a look at the stock's performance this year. Horizon has climbedabout 61% since the start of 2019, and now, trading at close to $35, its shares are approaching the average analyst price target of $38.10. By that measure, investors can expect an upside of more than 8%. The stock clearly has further to go if indeed the FDA approves teprotumumab, but considering the stock's gains so far this year and the fact that the FDA hasn't yet issued a decision, volatility may be ahead.

That doesn't mean it's too late for investorsto bet on the Horizon story. In fact, any volatility that drives the shares down may make for the perfect buying opportunity. The FDA's March deadline to issue a decision on teprotumumab will be the next catalyst for the stock and should determine clear direction one way or the other.

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Horizon Therapeutics Rally May Be Short-Lived As Investors Wait For Key Date In March - Motley Fool

Quality of Life Maintained With Abemaciclib Plus Trastuzumab With or Without Fulvestrant in Patients with HR-Positive, HER2-Negative Breast Cancer

The results were published as a poster session during the San Antonio Breast Cancer Symposium in San Antonio, TX. In the randomized, 3-arm, phase 2 study monarcHER study for HR-positive, HER2-positive ABC, abemaciclib in combination with trastuzumab and fulvestrant significantly improved investigator-assessed progression-free survival versus trastuzumab plus chemotherapy.

In the study, 237 postmenopausal (surgical, natural, or chemical ovarian suppression) women with ABC prior to HER2-positive directed therapies in the advanced setting were randomized 1:1:1 to 150 mg abemaciclib + trastuzumab (intravenous infusion every 21 days) with 500 mg fulvestrant or without fulvestrant vs trastuzumab plus physicians choice of chemotherapy. Patient-reported outcomes were measured at baseline and at every cycle using the modified Brief Pain inventory-short form and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30.

Abemacilib is an oral selective inhibitor of cyclin-dependent kinases 4 and 6 approved for HR-positive, HER2-negative metastatic breast cancer.

Patient-reported outcome compliance rates were 90% through cycle 15. The range for median duration of each treatment component of each group was 7.5-10.0 cycles. No statistically significantly differences or clinically meaningful changes from baseline differences were observed between treatment groups for global health score, function scales, or for symptoms of fatigue, dyspnea, appetite loss, or financial difficulties. Worsening adverse events (AEs), including nausea/vomiting and diarrhea, showed statistically significant improvements with the fulvestrant plus trastuzumab group versus chemotherapy.

Overall, quality of life was maintained for patient-reported pain, global health, functioning, and most symptoms when abemaciclib was added to fulvestrant plus trastuzumab compared with physicians choice of chemotherapy in patients with HR-positive, HER2-positive ABC. Furthermore, gastrointestinal-related adverse events were transient and consistent with the manageable, reversible AE profile.

REFERENCEHealth-related quality of life (HRQoL) in monarcHER: Abemaciclib plus trastuzumab with or without fulvestrant versus trastuzumab plus standard-of-care chemotherapy in HR+, HER2+ advanced breast cancer. Accessed December 2, 2019. https://plan.core-apps.com/sabcs2019/abstract/a25f48e96f590da9de0d7c903eddc944.

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Quality of Life Maintained With Abemaciclib Plus Trastuzumab With or Without Fulvestrant in Patients with HR-Positive, HER2-Negative Breast Cancer -...

Winter's official arrival this weekend is not welcomed by those of us who experience cold more severely than others.

I'm unfortunate to be one of the so-called cold-natured who feel chilled when everyone is getting along just fine; we are often ridiculed and heartily despised by warmer brethren for our tiresome complaints.

This isn't limited to winter. I'm cold for most of the summer because of aggressive air-conditioning, which requires me to schlep around sweaters and fleeces to restaurants, movie theaters, shopping venues, early morning outings with my dogs, and my newspaper office, where I persuaded our kindly and accommodating building manager to disconnect the fan that was blowing chilled air on me (I was long ago banned from messing with the thermostat outside my door, which also controls the temperature in a nearby conference room usually filled with warm-natured colleagues).

Wearing summery sleeveless dresses to work is out of the question. Soft flannel throws are easily found draped on furniture around my house year-round.

Right now, in December, the temperature in the newsroom is set on 70 degrees. I'm wearing a V-neck sweater over which is draped a thick gray mohair cardigan (the sort of ugly pilling garment that no one would ever wear when out in public). I'm clutching a HotHands single use air-activated heat pack, which keeps my fingers warm but makes it difficult to type. (It's also hard to type when one's index finger is numb.)

This is apparently all my fault.

According to the The Conversation, an online community of more than 93,200 academics and researchers from 3,044 institutions, most of us who are healthy but claim to feel excessively cold "have only ourselves to blame. We have habituated ourselves to feeling comfortably warm. In the developed world we rarely expose ourselves to cold, letting expensive clothing protect us from outdoor cold and letting power companies warm our living and working spaces." (My raggy office sweater, purchased at a recycled clothing store, was definitely not expensive, but I get the point.)

Noting that we allow power companies to do the work that our metabolism is supposed to do, "We'd probably all be much better off if we spent more time being cold," concludes The Conversation.

Easy for the website to say; I grew up in northern Ohio, where the type of depression known as seasonal affective disorder is alive and well. Winter is deeper, colder, darker, longer and snowier on the edge of Lake Erie than it is in central Arkansas, so presumably I would have arrived here physically and psychologically able to cope with far less frosty conditions.

While I was delighted my first year here by the ability to sit poolside in a bikini at the end of March (we didn't fear skin cancer then like we do now), I didn't find such adaptations to exist, let alone do me any good.

WebMD comes to the defense of cold-natured sufferers in an online submission titled Why Am I Cold? Possible causes include anemia (not enough red blood cells to carry oxygen throughout he body), hypothyroidism (the body doesn't make enough thyroid hormone, which controls metabolism; a sluggish metabolism can result in feeling chilled), blood vessel problems such as Raynaud's disease (spasms of narrowing arteries to the fingers and toes), diabetes (can cause kidney damage resulting in diabetic nephropathy, a symptom of which is feeling cold all the time), and anorexia.

Like most medical sites, WebMD recommends you check with your doctor. I like my family physician just fine, but figure I'm better off by investing in a puffy down jacket (reversible from navy blue to screaming yellow), quilted pull-on fleece-lined boots (on sale for $18--probably because they're purple--that are supposed to be waterproof, but they're not), furry ear muffs, and my most successful investment: ultra-thick fleece-lined mittens.

Such clothing--jackets from Carhartt, Lands' End and North Face, tights and sweats from Under Armour, dense woolen socks from Bass Pro, flannel-lined jeans from L.L. Bean, snow boots from REI--takes up a lot of closet space. But since I have no need for wispy summer dresses and loosely woven cropped-sleeved shirts, there's always room for something warm.

Karen Martin is senior editor of Perspective.

kmartin@arkansasonline.com

Editorial on 12/22/2019

Print Headline: Take pity on those who suffer from the cold

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Take pity on those who suffer from the cold - NWAOnline

It was a decade that began with the electrifying results of a clinical trial for a revolutionary new cancer therapy and ended with a Nobel Prize in Medicine for very different cancer-related research. In between those dramatic bookends, the 2010s were packed with progress, with discoveries leading to the FDAs 2017 approval of the first CAR T-cell therapy. Additional approvals would follow.

The 2010s started with clinical trial results centered on the use of checkpoint inhibitors, drugs that unleash a powerful immune system attack on cancer cells. The results founded on decades of research by scientists like Dana-Farbers Gordon Freeman, PhD helped usher in a new era of cancer immunotherapy.

Checkpoint blockersare transformational, Laurie H. Glimcher, MD, president and CEO of Dana-Farber and a prominent immunologist, said back in 2017, but they are only the tip of a proverbial immunotherapy iceberg.

On the other side of the last 10 years in cancer research was the Nobel Prize in Medicine, shared by Dana-Farbers William G. Kaelin, Jr., MD, for discoveries into the mechanism that enables cells to sense and adapt to changes in oxygen abundance research that has already led to exciting new treatments for cardiovascular disease and cancer.

As cancer research pioneer and Dana-Farber founder Sidney Farber, MD, said back in 1965, I have never accepted the incurability of cancer. And I have remained hopeful, not because of wishful thinking thats not progress but because of the factual evidence of progress. There is no such thing as a hopeless case.

Aside from these prominent discoveries, what were the most significant advances in cancer research and treatment? Heres what scientists and clinicians from around Dana-Farber said.

William Hahn, MD, PhD, Chief Research Strategy Officer

The sequencing of human cancer genomes over the past decade has demystified the genetics of cancer. We now have a blueprint of cancer genes in every type of cancer and information about the frequency and type of mutations that occur. This has revealed new genes and pathways important for cancer development and in some cases has already led to new approved cancer therapies.

In addition, geneticallysequencing tumor tissue samples guides the therapeutic agents selected for asubset of cancer patients. This tailored approach, termed precision medicine,selects patients most likely to respond and spares those that are unlikely torespond from untoward side effects. Recent discoveries that its possible tosequence DNA in the blood to detect cancers provide hope that this approach canbe used to identify cancers earlier and follow the response to therapy.

Through the study of rare cancers, we have identified mutations in genes that regulate the epigenome, the cells machinery for activating and deactivating genes. These studies have revealed that these same pathways are dysregulated in many common cancers and play key roles in cancer pathogenesis and resistance to therapy.

Sapna Syngal, MD, MPH, Director of Research, Center for Cancer Genetics and Prevention

The realization that upto 10% of many solid tumors have an inherited genetic basis provides us with agreat opportunity for precision prevention and early interception.

Scott Armstrong, MD, PhD, President, Dana-Farber/Boston Childrens Cancer and Blood Disorders Center

Were now able to identify several premalignant states that significantly increase peoples risk of developing certain hematologic cancers. Individuals with clonal hematopoiesis of indeterminate potential (CHIP), for example, have certain genetic mutations in their blood-forming stem cells that are associated with leukemia.

People with CHIP dont have symptoms of disease, but their risk of developing a blood cancer such as leukemia is 10 times higher than average and their risk of cardiovascular disease is elevated as well. Being able to identify high-risk individuals means we can begin to think about early-intervention strategies to prevent these cancers from developing an active area of research.

Ursula Matulonis, MD, Chief, Division of Gynecologic Oncology

The introduction of drugs known as PARP inhibitors has had a major impact on the treatment of ovarian cancer, and now they are showing effectiveness against other cancers including breast and pancreatic. PARP inhibitors work by blocking one of the key routes by which cells repair damaged DNA and are especially effective in cancers with existing DNA-repair deficiencies such as those harboring BRCA mutations.

Also, better understanding of the genomics of gynecologic cancers the set of genetic mutations within the cancer cells is transforming the way we approach treatment and prevention. Its now widely recognized that women with ovarian cancer, regardless of age, histology type, or the stage at which their cancer is diagnosed, should undergo genetic testing. A percentage of them will have a predisposing mutation in one of the BRCA genes. Women with newly diagnosed endometrial cancer should have their cancer tested for mismatch repair deficiencies, which interfere with the proper copying of DNA during cell division.

The presence of these genetic features not only influences the treatment patients receive, but, because they can be inherited, often enable us to identify family members who are also at risk and can benefit from more intensive monitoring or preventive treatment.

Richard Stone, MD, Program Director in Adult Leukemia

Morethan 10 drugs have been approved for acute leukemia in the past three years,whereas there had been very few new agents in the previous 25 years.

DNA sequencing of patients leukemia cells to identify mutations is being used to help guide treatment decisions.

Eric Winer, MD, Senior Vice President for Medical Affairs and Faculty Development; Chief, Division of Breast Oncology

In the treatment of breast cancer, we now know for a certainty that one size does not fit all. This allows us to personalize therapy to a much greater extent than ever before. In some patients, this means we can treat them with less-intensive therapy and still obtain excellent results. Others may require more extensive therapy or benefit from a different therapeutic approach. For all patients, this means better, more effective care, fewer side effects, and, for many, a longer life.

Kimberly Stegmaier, MD, Vice Chair of Pediatric Oncology Research

There have been multiple approvals of new targeted drugs in adult acute myeloid leukemia (AML) in the past two years, as well as TRK inhibitor approval for adult and pediatric patients with TRK fusion-positive cancers.

Bruce Johnson, MD, Chief Clinical Research Officer

Addingthe kinase inhibitor midostaurin to standard chemotherapy significantlyprolonged overall and event-free survival in patients with acute myeloidleukemia whose cancer cells have a FLT3 mutation.

Enzalutamide,an androgen receptor inhibitor, was associated with significantly longer progression-freeand overall survival than standard care in men with metastatic,hormone-sensitive prostate cancer receiving testosterone suppression.

Dana-Farberscientists reported on the feasibility, safety, and immunogenicity of apersonalized cancer vaccine that caused immune T cells to recognizecancer-related neoantigens on tumor cells. These results have promptedfurther development of a neoantigen vaccine approach.

Nadine Jackson McCleary, MD, MPH, Gastrointestinal Oncologist

Weve made strides in ensuring that evidence from cancer research studies actually makes its way into clinical practice. For too long, research findings often seemed to remain in academia without being translated to clinical medicine.

Professional and patient advocacy organizations have undertaken a variety of steps to not only implement these advances in the clinical setting but also to make sure theyre sustainable. For example, organizations such as the American Society of Clinical Oncology (ASCO) and cooperative research groups regularly inform the broader public about research results and work at the state and federal level on behalf of patients. The development of implementation science is having a sizable impact on clinical practice.

Were also making progress in improving equity in cancer care delivery. Where equity issues have traditionally involved issues such as race, gender, and socioeconomic status, were broadening the focus to include considerations of gender identity, patient location (where patients receive treatment may affect their outcome), and treatment of the very youngest and oldest patients. These efforts will help ensure that advances in cancer medicine reach all populations.

Toni Choueiri, MD, Director of the Lank Center for Genitourinary Oncology

An important ongoing approach is liquid biopsies obtaining tumor-related DNA in the blood as a means of early cancer detection. Liquid biopsies also have the potential to detect minimal residual disease in the body following surgery to predict the risk of relapse.

Rameen Beroukhim, MD, PhD, Physician-Scientist in Neuro-Oncology

This decade is the first in which targeting collateral vulnerabilities in cancer cells has become an important strategy. Most efforts at treating cancer focus treatment on the genetic changes within cells that cause them to become cancer. But along the way, many genes that have nothing to do with cancer are also affected, and scientists have found that targeting these genes on which the cancer cells depend can be an effective way of attacking cancer. Immunotherapy, for example, detects cancer cells based on this collateral damage.

I predict that targeting collateral vulnerabilities will become increasingly important in future decades. Another recent strategy is based on the emerging technology of protein degradation, which removes cancer-related proteins from cells rather than simply binding to these proteins to inhibit their activity.

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The Most Significant Cancer Research Advances of the 2010s - Dana-Farber Cancer Institute

December 17, 2019 Cover

Let the Laughlin resorts serve your family a special meal this Christmas.

How anyone can confuse The Vogues, a white male singing group from the 1960s, with En Vogue, the R&B girl group of the 1990s makes you wonder what people are thinking or drinking.But that happened to Troy Elich, (son of the late Stan Elich, an early member of the Vogues), who has been a member and manager of the group since the passing of his father.

What if the nostalgia of holiday television specials and films were blended with vintage Vegas Rat Pack-type shows to create a whole new kind of musical magic?A swinging show filled with these elements like classic hits and Christmas favorites might just set the tone for creating a new holiday tradition the whole family can enjoy together.

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December 20, 2019 (LifeSiteNews) The Teacher was right: What has been will be again, what has been done will be done again; there is nothing new under the sun. This observation by King Solomon rings true -- and loudly in 2019 America. Arguably the most intense and divisive year in the abortion wars, 2019 reminds us all of the dangers of forgetting our history, which one political party seems committed to repeat.

Kicking off 2019 with New Yorks Reproductive Health Act, New York Democrats renewed their resolve to repeat the judicial tyranny of their partys history by treating some human beings as an inferior class of non-persons. This 2019 Act is disturbingly reminiscent of the 1857 Dred Scott vs. Sandford ruling, which denied personhood to African American Dred Scott. Seven Democrats on the Supreme Court ruled that Dred Scott, while temporarily residing in American territory that declared African American men free persons, was not truly a person after returning to Missouri with his slave-owner, a Captain John Emerson. The court declared that Scott was the property of Emersons wife (Emerson having already passed), and as a non-citizen with no rights of personhood, Scott could be treated as any other form of property owned by Emersons wife, Eliza Sandford. Summarizing the case, Chief Justice Roger [racist] Taney, wrote: "A black man has no rights a white man is bound to respect."

What has been will be again.

In January of 2019, New Yorks Reproductive Health Act, declared that while unborn human beings may have certain personhood rights in other territories of America, New Yorks unborn children have no rights of personhood and can be treated as property through the moment of birth. Denying the personhood of the unborn in the most extreme way, New York legislators even declared that murderers of pregnant women will only be charged with one count of homicide. Channeling the historical discrimination of his party, New York Governor, Andrew Cuomo sent the same message as Taney did so long ago: An unborn human has no rights a born human is bound to respect. Since then, Illinois, Rhode Island, and Vermont have passed similar, radical legislation.

Shortly after the New York Reproductive Health Act passed, Virginia Governor Ralph Northam went on WTOP radio to publicly defend Virginia DelegateKathy Tran's bill that would legalize abortion to point of birth. Likely realizing that there is no meaningful difference between a full-term baby about to be born and that same baby just after birth, Northam went a step further by saying that mothers and physicians should be able to have conversations about whether born babies should be left to die or not. In response to Northams clinically cool demeanor describing infanticide, Nebraska Senator Ben Sasse brought the Born-Alive Abortion Survivors Protection Act (BAASPA) for a vote in the Senate. The bill would have done three simple things:

Each of these requirements is very important, because while the 2002Born-Alive Infants Protection Act (which gained unanimous consent from Republican and Democrat senators) specifies that babies who survive abortions and are born are to be recognized as human beings with human rights, the bill did not define what types of care, if any, are to be rendered. Nor did it specify what punishments would be levied against physicians who failed to act to save the life of an abortion-survivor.

Tragically and predictably, Senate Democrats took their cue from racist Democrats in the early 20th century who routinely filibustered every Republican effort to enact an antilynching law. Ideological consistency can be a dangerous thing. According to the reasoning of Democrats of that day, if blacks were truly not persons, then lynching them theyd claim would be no more morally problematic than killing an animal, as many racists described African Americans.

Today we see the same ideology leading to the dehumanization and slaughter of the unborn. Both African Americans and unborn human persons have died on the altar of an evil ideology.

And so, what has been done will be done again. In February of 2019, the United States Senate voted in majority favor (53-44) of the BAASPA. However, the bill didnt gain the 60 votes necessary to overcome the filibuster initiated by Democrat senators. Additionally, only 3 Democrat Senators crossed the aisle to vote for protecting newborns from abortionists. And all of the Democratic Senators running for President voted against the BAASPA!

It seems filibustering bills that would prevent discrimination and violence against actual innocent human persons (while simultaneously denying that theyre persons) is a Democratic party trademark. As of December 2019, Senate Democrats have blocked a vote on the BAASPA over 80 times. By refusing to pass the BAASPA, Senate Democrats are enabling abortionists to kill born-alive infants that they failed to kill in the womb. But this pales in comparison to Senate Democrats support of abortion-on-demand, which takes the lives of nearly one-million babies every year in America.

When abortion is treated as sacrosanct, politics becomes liturgy: a spiritual practice engaged in for the purpose of praising and protecting that which is sacred. Therefore, anyone who questions the Lefts political liturgy is an apostate and must be purged and exchanged for those sufficiently woke to the escalating political threat posed by those pro-lifers.

In order to protect their liturgical purity, Planned Parenthood fired their new president, Dr. Leana Wen in July 2019. Buzzfeed News, who broke the story, reported that there were internal concerns over her [Wens] management style and a perceived shift away from the groups political work (emphasis own).

A source familiar with the matter said that her removal was accelerated by the intensifying battle over abortion rights, saying that she was not the right leader in this climate. Wen herself confirmed all this in her Twitter statement saying, I believe that the best way to protect abortion care is to be clear that it is not a political issue but a health care one (emphasis own).

Denying abortions political centrality to the leftist liturgy is tantamount to a Catholic priest denying the centrality of the eucharist to Catholic liturgy. Such an action would oust you from the Catholic Church. And Wen was quickly ousted. A movement based on the belief that human value is found in your wanted-ness, its unsurprising that Planned Parenthood, the political war hawk of the pro-choice movement, will quickly abort its own, whose apostasy renders them unwanted. Wen was quickly replaced by Alexis McGill Johnson, a lifelong political activist, and more of the Cecile Richards mold than Wen ever was.

This is noteworthy because Planned Parenthood is publicly dropping its healthcare organizational faade and fully embracing its identity as a political machine. Ironically, removing this healthcare mask will likely further damage their reputation and cause more Americans to distance themselves from the organization. Americans are not interested in supporting a political hackery of a machine focused on enshrining abortion rights through the day of birth. According to a 2019 Gallup Poll, only 25% of Americans believe abortion should be legal under any circumstances (the de facto position of Planned Parenthood). In fact, a 2007 Gallup Poll found that 72% of Americans think late-term abortions should be illegal, a procedure euphemistically described by the abortion juggernaut as reproductive health care.

Not to be outdone by East Coast radicals in New York, California Governor, Gavin Newsom moved to establish himself in the abortion hall of fame books by signing SB24, a move that makes pro-abortion, former Governor, Jerry Brown look pro-life. In fact, Brown vetoed the bill in 2018. Introduced under the guise of combatting abortion access problems, this bill will force California 4-year state universities (Cal State and UC) to provide the RU-486 abortion pill to students through university health centers.

According to the bills sponsor, Connie Leyva, Students shouldnt have to travel off campus or miss class or work responsibilities in order to receive care that can easily be provided at a student health center. Ignoring for the moment that slaughtering unborn children is not care, Leyva blatantly ignores the fact that former Governor Jerry Brown rightly pointed out that the average distance to abortion providers in campus communities varies from five to seven miles, not an unreasonable distance.Despite easily accessible resources such as this Youtube video, many pro-choice advocates dont know or care how the abortion pill kills a baby. An RU-486 chemical abortion is offered through 10 weeks gestation. A pregnant woman first takes Mifepristone, which blocks the hormone progesterone, without which the lining of the uterus breaks down, cutting off blood and nourishment to the baby, who is starved to death. One or two days later, she takes misoprostol, forcing her uterus to have contractions, in order to dispel her dead baby in the toilet. Not only does the abortion pill kill a human being, but it also poses threats to the health and life of the women taking it. While the combatting abortion access problem is clearly a guise for Newsom and the bills defenders, it is a guise they must maintain, because the reality is too ghoulish for even the most ardent pro-choice advocates.

According to the FDA, risk & effects include: Abdominal pain, nausea, vomiting, diarrhea, headache, heavy bleeding, even maternal death. They further report that 24 women have died taking RU-486, average bleeding lasts 9-16 days and 8% of women will endure bleeding more than 30 days. It gets worse. According to a 2000 Oxford University Press study, the average failure rate of a medication abortion is eight percent. Live Action News points out that an eight percent failure rate means that about one in every 12 chemical abortion attempts will be unsuccessful, which means women will need to be subjected to a surgical abortion, which, of course, alsohas its own risks. Left undiagnosed and untreated, the eight percent of women whose babies were not properly dispelled will be walking around with a dead baby in their uterus, thus susceptible to sepsis and death. As such, the FDA has requirements for prescribers of the abortion pill, including that providers must also be able to provide any necessary surgical intervention and must be able to ensure that women have access to medical facilities for emergency care. Because university health centers are not equipped with surgical abortion instruments or staff qualified or licensed to perform surgical abortions, Newsom will endanger the health and lives of young women who show up to their health centers bleeding and in immense pain, only to be turned away or pointed toward Planned Parenthood. All this under the mantle of healthcare.

Naturally, neither Newsom, Leyva or any of the other bills supporters, addressed these concerns. Ignoring reality and its consequences in favor of ideology is nothing new for the abortion juggernaut. In fact, in June of 2018, Cecile Richards, then President of Planned Parenthood, wrote an LA Times opinion editorial in which she claimed that non-invasive medication abortion is safe by all measures safer than Tylenol and Viagra, even. Heres a perfect example of the linguistic gymnastics that are required by abortion advocates who call a medication safe when its success is gauged on whether its target was murdered.

The first legislation of its kind, SB24 will turn 4-year California state universities into abortion clinics, a far cry from the purpose for which the academy was designed. In a failed sleight of hand, the abortion industry and their cronies have shown their hand and it clearly has nothing to do with real choice. Failing to provide any type of funding for nurseries or daycares on college campuses and fully willing to endanger the actual health and lives of college-aged women in their pursuit of expanding abortion, it is clear that the only choice Newsom is interested in pushing is abortion. Most concerning of all, however, is Californias reputation as a political bellwether in the abortion wars. The moral decay that starts in the Golden State rarely stays in state.

An unprecedented and tragic year for unborn babies and human equality, 2019 serves as a lesson that there can be no bi-partisan or national unity when one political party publicly commits itself to the slaughter of unborn children through the day of birth, even refusing to condemn infanticide and ensure better protections for infants who survive abortions. However, this is not the first time our two-party system has been divided over who is a person.

There is nothing new under the sun.

Woefully ignorant to reality, todays Democratic Party seems to have forgotten that the last time they fought against human equality it led to a war that they lost. This is because, invited or not, reality has an annoying tendency of reasserting itself in our lives. It was self-evidently true that African-Americans were human persons with the same human dignity as everyone else. It is similarly self-evidently true that unborn human beings conceived by human parents are little persons who also share the same dignity. We can either respond to that self-evident reality by aligning our beliefs, lives, and policies correctly, or we can stick our head in the ground and insist that 2 + 2 = 5. But in the end, reality will win out.

Either historically describing the Democratic party during slavery, or prophesying the nature of that same party today, George Orwell, speaking through his character Winston said:

In the end the Party would announce that two and two made five, and you would have to believe it. It was inevitable that they should make that claim sooner or later: the logic of their position demanded it. Not merely the validity of experience, but the very existence of external reality, was tacitly denied by their philosophy. The heresy of heresies was common sense.

In other words, when you base your entire ideology on fantasy, your ideas, foolish though they may be, will merely be a reflection of your ideology. When your worldview leads you to label common sense observations, such as blacks and babies are persons, as heresy, you know youre on the wrong road. And as C.S. Lewis aptly pointed out, the true progressive is the one who, realizing he is on the wrong road, makes an about-turn and walks back to the right road.

Will the abortion juggernaut and its strategic arm, the Democratic party, learn from the mistakes of history and prove their progressiveness by walking back to the right road? I desperately hope and pray so. But Im not holding my breath.

Trump: Boon to pro-life movement

And the pro-life movement hasnt been holding its breath. While 2019 saw a significant rise in pro-abortion radicalism and legislation, this rise correlates directly to the threat posed by what has become the most pro-life administration in American history. After eight years of the most pro-abortion president our country has ever seen, the Trump administration gave a weary pro-life movement the political encouragement necessary to catapult them back onto the offensive.

In his first year alone, President Trump proved to be more pro-life than either Reagan or Bush, appointing pro-life judges, permitting states to defund Planned Parenthood of Title X funds, stopping the overseas funding of abortion, cutting Planned Parenthoods tax funding by $60 million, and creating a new office of conscience protections at HHS, among many more. Encouraged to know that this administration was on their side, pro-life legislators across the country, all began implementing pro-life laws, with the intent of presenting a credible challenge to Roe v. Wade.

It was this rising threat that led New York Governor Cuomo to pass the Reproductive Health Act. Clearly on the defensive, Cuomo rationalized his support of the bill, saying Kavanaugh is going to reverse Roe v. Wade. I have no doubt. Gorsuch is going to reverse Roe v. Wade. I have no doubt. The abortion industry and their political pawns are scared. This should greatly encourage the pro-life movement. And it has.

Americans United for Life released their Fall 2019 State Legislative Sessions Report. They report that so far in 2019, 58 life-affirming laws passed and were signed into law across 22 states, representing a more than 25% increase from 2018. Laws ranging from informed consent, parental involvement, heartbeat, abortion-survivor protections, and down-syndrome protections; these laws are saving lives.

Dr. Michael New of the Charlotte Lozier Institute has researched the effect of state anti-abortion laws and found a direct correlation between the number of pro-life laws and a decrease in the number of abortions. This spike in pro-life legislation has led Planned Parenthood to stick their head further in the ground, launching a campaign titled Bans Off My Body, repeating the decades old trope that the unique human life you pay a physician to intentionally dismember is actually just part of your body.

The pro-life movement heads into election year with massive victories and substantial momentum. Contrastively, the abortion juggernaut is limping into 2020 and their political cronies will soon face an electorate that is growing increasingly uncomfortable with the idea of abortion through point of birth. One of the abortion juggernauts political backers will become the nominee and face the President in debate, who in 2016 correctly defined abortion as rip[ping] the baby out of the womb. That moral clarity on abortion will destroy any euphemistic attempts by the Democratic nominee to appeal to the voters with a reproductive health care pitch.

163 years after the Dred Scott decision, the Democratic party is still the enemy of human equality. They are still dehumanizing a certain class of human beings by defining personhood according to randomly and arbitrarily selected criteria. As Scott Klusendorf rightly points out, We used to discriminate on the basis of skin color and gender (and still do at times), but now with elective abortion, we discriminate on the basis of size, level of development, location, and degree of dependency. Weve simply swapped one form of bigotry for another.

The consequences of that bigotry are the 62 million babies who have been slaughtered in the last 47 years. And now, as in 1857, the Republican party is the only political party staying the madness and attempting to enshrine rights of personhood to every human being. Until the Democratic party and the pro-choice movement choose to bring something new under the sun, what has been will be again: The Democratic party will again be remembered as the party of discrimination and have to account for instituting and protecting the greatest genocide in human history.

Seth Gruber is the West Coast Director for Life Training Institute. He is also the host of "UnAborted with Seth Gruber. Visit his website here.

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Abortion is the greatest genocide in human history, and Democrats are its greatest champion - Lifesite

Annet Negesa had just finished training in Kampala, Uganda, in June 2012 when she received a call from a doctor from track and fields world governing body. He told her that she would no longer be competing in the London Olympics because her testosterone levels were too high for competition.

I went back into the house and started crying, she recalled.

Negesa was 20 at the time and one of the top athletes in her country, a promising middle-distance runner who had set a national record for 800 meters earlier in the year at a meet in Hengelo, the Netherlands. She was a three-time national champion and took home a gold medal at the 2011 All-Africa Games. The Uganda Athletics Federation named her athlete of the year.

World Athletics, formerly the International Association of Athletics Federations, or I.A.A.F., track and fields world governing body, did not catch Negesa using performance-enhancing drugs. Rather, she is an intersex athlete.

She identifies as female and was born with external female genitalia but also with internal male genitalia that produce levels of testosterone that men do. According to sports officials, that gave her an unfair advantage over most women in some events.

What makes Negesa different from so many other intersex athletes is that she tried to alter her body with surgery so she could continue to compete. Negesa claims that a doctor for World Athletics recommended the surgery. The federation denies this.

For seven years, Negesa, 27, refused to speak about what happened. But time did little to assuage her grievances.

Now I see my body as different, very, very different, she said. I dont know how to talk about it.

The years since the surgery have been a struggle. Negesa has battled persistent headaches and achy joints. Her postoperative care, she said, has not included the kind of hormone treatment that might have helped her body adjust to the change.

What happened to Annet is dangerous, and happened because she wanted to compete, said Payoshni Mitra, a researcher and activist on gender and sports who has lectured on the topic of intersex athletes.

For the past decade, Mitra has stood alongside numerous athletes with naturally high testosterone levels, including Caster Semenya, the South African middle-distance champion, and Dutee Chand, the Indian sprinter. Negesas case, however, was one of the most difficult ones for Mitra to reconcile because Negesa opted to have surgery.

For years, World Athletics has struggled to create rules that maintain a level playing field for the overwhelming majority of women with only female genitalia without impinging on the human rights of intersex people, who account for roughly one in every 2,000 births. A study this year found that female athletes with male testosterone levels are overrepresented in womens middle-distance races.

World Athletics, in a decade of research, found that nearly seven in every 1,000 elite female athletes are intersex athletes with levels of testosterone within the male range. Some endocrinologists have concluded it remains unclear whether high testosterone gives athletes a competitive edge, but many scientists believe it does.

After years of litigation, the Court of Arbitration for Sport in May upheld World Athletics testosterone restrictions for female athletes in races with distances from 400 meters to the mile. The court ruled by a 2-to-1 vote that the restrictions were indeed discriminatory but also a necessary, reasonable and proportionate means of achieving the World Athletics goal of preserving a level playing field in womens track events.

Most women, including elite female athletes, have natural testosterone levels of 0.12 to 1.79 nanomoles per liter, World Athletics said, while the typical male range after puberty is much higher, at 7.7 to 29.4 nanomoles per liter.

Intersex athletes who want to participate in middle-distance womens track events must take hormone-suppressing drugs and reduce testosterone levels below five nanomoles per liter for six months before competing, then maintain those lowered levels.

But Negesa, the eldest of nine siblings raised in a village in Jinja, Uganda, southeast of the Nile, had a much more invasive intervention after she learned in 2012 that she could not compete.

She said a World Athletics physician, Dr. Stphane Bermon, told her she needed to undergo medical treatment and was given surgery as her first option: a gonadectomy to remove her internal testes.

I love my sport so much, thats why I decided to go for the surgery, she said in a recent video interview from Germany, where she now lives.

After Negesa appeared in a documentary on German televisions ARD network in October, World Athletics issued a statement denying that it participated in or recommended a specific treatment to Negesa.

Dr. Bermon has never met the athlete in question and was not at either the consultation in Nice nor the surgery she speaks of in Uganda, the statement said. Through a World Athletics spokesman, Dr. Bermon declined to comment.

Negesa said she traveled alone to Nice for medical tests soon after learning she could not compete. She recalled having her body measurements taken by two doctors who spoke in French. Negesa speaks Swahili and English.

It was so weird, she recalled. I was shy.

She returned to Kampala for treatment, and paid $900 for the procedure.

On the morning of her surgery in Kampala, she had little knowledge of what she was about to undergo. Doctors had told her that it was a simple surgery and that she would return to competition in a few weeks.

I woke up in the morning feeling cuts on my body, she said. I felt so scared. I didnt know that I was going to be cut open.

She hasnt returned to the sport and has suffered from depression and joint pain since the operation.

Negesas medical records from the Womens Hospital International & Fertility Centre in Kampala were reviewed by The New York Times and confirm that World Athletics, then known as the I.A.A.F., recommended a thorough medical examination, citing the high levels of testosterone in her body. The report states that after her testing in Nice she had a gonadectomy in Kampala. The document states that her surgeon in Kampala, Dr. Edward Tamale Sali, did not start her on hormone therapy because he was awaiting further discussion with Dr. Bermon.

Dr. Tamale Sali declined to comment.

In 2013, Dr. Bermon, now director of the World Athletics health and science department, published a report citing four unidentified athletes from developing countries who were referred to hospitals in France for naturally high testosterone levels.

I think I was the first one, Negesa said of the four athletes cited in the study. She said Dr. Bermon was the World Athletics official who first called her in 2012.

After Negesas appearance in the German documentary in September, 25 French athletes wrote to World Athletics, the International Olympic Committee and the minister of sports and health calling for an investigation.

The French minister of sports and minister of health opened a joint investigation in October.

In its statement, World Athletics said it does not advise athletes on preferred treatments and did not do so in this case. The global federation has never forced any athlete affected by its regulations to undergo surgery, nor paid for any of their treatment.

In March, the United Nations Human Rights Council condemned World Athletics attempt to regulate female athletes testosterone levels. And in May the World Medical Association advised physicians around the world to abstain from implementing the new regulations.

They are assigned female at birth and have grown up to have a female gender identity, so theres no question that they belong in that category, said Katrina Karkazis, a fellow at Yale Universitys Global Health Justice Partnership.

Negesa said that returning home, where L.G.B.T. individuals are openly condemned, would lead to imprisonment or death.

She filed for asylum in Berlin in September, and was granted it this month.

She runs every day, with the hope of one day returning to international competition. Her next step, though, is litigation. I need to take them to court, she said of World Athletics, for violating my human rights.

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This Intersex Runner Had Surgery to Compete. It Has Not Gone Well. - The New York Times

Case Presentation

A 56-year-old white woman with a history of fibromyalgia and anxiety presentsto her primary care physician (PCP) for follow-up to review abnormal laboratoryfindings. During her visit she mentions worsening digestive problems includingbloating and frequent diarrhea. The patient denies abdominal pain, nausea, andvomiting. Her digestive symptoms began approximately 3 years ago and have waxedand waned in severity. She believes certain foods intensify her symptoms but cannotpinpoint exactly which foods are the triggers.

The patient is not on any long-term prescription medications but occasionally takes an antacid. She recently finished courses of trimethoprim and sulfamethoxazole for a urinary tract infection.

Upon physical examination, the patients abdomen is extremelydistended with hyperactive bowel sounds and hyper-resonance with percussion inall 4 quadrants. The abdomen is non-tender to palpation and the spleen andkidneys are non-palpable. Neitherpulsatile mass nor ascites are present.

Laboratory tests are ordered: white blood cell count is 4.3 K/L andlymphocytes are 1.2 K/L. The patients calcium level is 10.3 mg/dL, but wasreduced to 9.7 mg/dL following correction of albumin of 4.8 g/dL. Vitamin D25-hydroxy is 20.9 ng/mL. Additional tests were within normal limits.

Differential diagnoses include antibiotic-induced Clostridium difficile colitis, food intolerance, irritable bowel syndrome (IBS), diverticulitis, and inflammatory bowel disease.

Additional tests are ordered, including thyroid-stimulating hormone, antinuclearantibody, erythrocyte sedimentation rate, and C-reactive protein, which are allwithin normal range. Stool guaiac and culture are also negative, ruling out C difficile infection.

The patient is referred to gastroenterology for further testing.Gallbladder ultrasound was normal with no stones or sludge identified in thegallbladder lumen. Endoscopy and colonoscopy images and biopsies wereunremarkable.

The patient is then referred to an allergist. Food allergy testing wasnegative. The patient was instructed to try a dairy-free diet for 1 month andsubsequently a gluten-free diet for 1 month. The patient did not experiencerelief from either elimination phase diets.

The patient returned to her PCP and was told she likely suffered fromdiarrhea-predominant irritable bowel syndrome (IBS-D); her demographics as a womanwith fibromyalgia and anxiety and recent antibiotic use made the diagnosis evenmore likely. However, no specific test was performed to confirm the diagnosis.

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Battle of the Bloat: What is the Right Rx for IBS? - Clinical Advisor

Doctors issue open letter to the Australian government: Julian Assange at risk of death in prison 17 December 2019

The following open letter has been issued to the Australian government by Doctors4Assange on behalf of more than 100 signatories. The letter and accompanying addendum has been published on Medium and medical doctors can add their name to the current list of signatories by contacting Doctors4Assange@gmail.com

To: Australian Minister for Foreign Affairs, the Hon Marise Payne

CC: Shadow Minister for Foreign Affairs, the Hon Penny Wong

Prime Minister of Australia, the Hon Scott Morrison

Leader of the Opposition, the Hon Anthony Albanese

16 December 2019

Dear Minister,

RE: MEDICAL EMERGENCYMR JULIAN ASSANGE

We, the undersigned medical doctors, wrote to the UK Home Secretary on 22 November 2019, and to the Lord Chancellor and Secretary of State for Justice on 4 December 2019, expressing our serious and unanimous concerns that an Australian citizen, Mr Julian Assange, is at risk of death due to the conditions of his detention in a UK prison.

Our open letter received worldwide media coverage and we received letters of support from doctors and others around the world. Now, having received no response from the UK Government, we call upon you to intervene as a matter of urgency. As Australian Minister for Foreign Affairs, you have an undeniable legal obligation to protect your citizen against the abuse of his fundamental human rights, stemming from US efforts to extradite Mr Assange for journalism and publishing that exposed US war crimes.

The medical imperative to protect Australian citizen Julian Assange cannot be overstated. Our letters to the UK Government have warned of serious consequences if Mr Assange is not transferred immediately from Belmarsh Prison to an appropriate hospital setting, where he can be assessed and treated by a suitably constituted specialist medical team. Mr Assange requires assessment and treatment in an environment that, unlike Belmarsh prison, does not further destabilise his complex and precarious physical and mental state of health.

On 22 November 2019, we warned the UK Home Secretary that if such a transfer were not to take place immediately, there was a real possibility that Mr Assange would die in a UK prison. That assessment of risk was based on publicly available information dating from 2015, provided by medical experts and leading authorities in human rights and international law.

You will recall that the United Nations Working Group on Arbitrary Detention concluded in December 2015 that Mr Assange was being arbitrarily detained by the governments of the UK and Sweden. Crucially, it was made clear at the time that any continued arbitrary detention of Mr Assange would constitute torture. Medical experts have repeatedly advised the UK Government of potentially catastrophic consequences should it fail to facilitate adequate medical care for Mr Assange. As our letters of 22 November 2019 and 4 December 2019 outline, such consequences, including death, would be eminently foreseeable and attributable to the actions and inactions of the UK Government.

On 9 May 2019, UN Special Rapporteur on Torture Professor Nils Melzer interviewed Mr Assange at Belmarsh Prison, accompanied by a medical team. On 31 May 2019, Mr Melzer published his report and condemned the collective persecution of Mr Assange by the UK, Swedish, Ecuadorian and US governments. Mr Assanges health has been seriously affected by the extremely hostile and arbitrary environment he has been exposed to for many years, the expert warned. Most importantly, in addition to physical ailments, Mr Assange showed all symptoms typical for prolonged exposure to psychological torture, including extreme stress, chronic anxiety and intense psychological trauma.

The evidence is overwhelming and clear, the UN Special Rapporteur stated. Mr Assange has been deliberately exposed, for a period of several years, to progressively severe forms of cruel, inhuman or degrading treatment or punishment, the cumulative effects of which can only be described as psychological torture.

On 1 November 2019, Professor Melzer was forced to intervene once more: What we have seen from the UK Government is outright contempt for Mr Assanges rights and integrity Despite the medical urgency of my appeal, and the seriousness of the alleged violations, the UK has not undertaken any measures of investigation, prevention and redress required under international law. He concluded: Unless the UK urgently changes course and alleviates his inhumane situation, Mr Assanges continued exposure to arbitrariness and abuse may soon end up costing his life.

These are extraordinary and unprecedented statements by the worlds foremost authority on torture. The Australian government has shamefully been complicit by its refusal to act, over many years. Should Mr Assange die in a British prison, people will want to know what you, Minister, did to prevent his death.

Lest there be any misapprehension about the reality of the medical risks facing Mr Assange, important underlying medical facts are outlined in the Addendum to this letter. These facts render Mr Assanges continued detention in Belmarsh Prison medically reckless at best and deliberately harmful at worst.

We therefore urge you to insist upon the immediate transfer of Mr Assange from Belmarsh Prison to an Australian university teaching hospital, on urgent medical grounds, so that he can receive the assessment and treatment that he requires. We are aware of statements by Australian Prime Minister Scott Morrison that Mr Assange is not going to be given any special treatment and that Australia is unable to intervene in Mr Assanges legal proceedings. However, the most fundamental human rights of an Australian citizen are being denied by the British government.

We demand that you exercise your diplomatic and legal powers to defend the rights of Mr Assange, as you have done previously for other Australian citizens detained abroad, including Melinda Taylor, James Ricketson, David Hicks and Peter Greste.

Further, Mr Assange must not face extradition proceedings for which he may well be medically unfit. At the case management hearing on 21 October 2019, Mr Assange struggled to answer basic questions regarding his name and date of birth, a potentially ominous sign with respect to his cognitive functioning and his state of health.

That we, as doctors, feel ethically compelled to hold governments to account on medical grounds speaks volumes about the gravity of the medical, ethical and human rights travesties that are taking place. It is an extremely serious matter for an Australian citizens survival to be endangered by a foreign government obstructing his human right to health. It is an even more serious matter for that citizens own government to refuse to intervene, against historical precedent and numerous converging lines of medical advice.

We are reliably advised that it is a well-established principle of international lawand of Australian law recognised by its own courtsthat if a countrys citizens face improper treatment, persecution, and human rights violations, they may be the subject of diplomatic action, at that sovereign powers discretion, to protect its citizens abroad. The Australian government must exercise that discretion and request from Britain the safe passage of Mr Assange to Australia, to protect Mr Assange and the rights of all Australian citizens.

We hope that this letter has helped to clarify the reality and urgency of the medical crisis facing your citizen, Mr Assange. We urge you to negotiate Julian Assanges safe passage from Belmarsh Prison to an appropriate hospital setting in Australia before it is too late.

As the present matter is of inherent public interest, copies of this open letter will be distributed to media outlets worldwide.

Yours faithfully,

Dr Mariagiulia Agnoletto MD Specialist in Psychiatry ASST Monza San Gerardo Hospital, Monza (Italy)

Dr Vittorio Agnoletto MD Universit degli Studi di Milano Statale, Milano (Italy)

Dr Sonia Allam MBChB FRCA Consultant in Anaesthesia and Pre-operative Assessment, Forth Valley Royal Hospital, Scotland (UK)

Dr Norbert Andersch MD MRCPsych Consultant Neurologist and Psychiatrist, South London and Maudsley NHS Foundation Trust (retired); Lecturer in Psychopathology at Sigmund Freud Private University, Vienna-Berlin-Paris (Germany and UK)

Dr Marianne Beaucamp MD Fachrztin (Specialist) in Neurology & Psychiatry Psychoanalyst and Psychotherapist (retired), Munich (Germany)

Dr Thed Beaucamp MD Fachrztin (Specialist) in Neurology, Psychiatry & Psychosomatic Medicine Psychoanalyst and Psychotherapist (retired), Munich (Germany)

Dr Margaret Beavis MBBS FRACGP MPH General Medical Practitioner (Australia)

Dr David Bell Consultant Psychiatrist and Psychoanalyst, London (UK)

Mr Patrick John Ramsay Boyd (signed John Boyd) MRCS LRCP MBBS FRCS FEBU Consultant Urologist (retired) (UK)

Dr Hannah Caller MBBS DCH Paediatrician, Homerton University Hospital, London (UK)

Dr Franco Camandona MD Specialist in Obstetrics & Gynaecology E.O. Ospedali Galliera, Genova (Italy)

Dr Sylvia Chandler MBChB MRCGP BA MA General Medical Practitioner (retired) (UK)

Dr Marco Chiesa MD FRCPsych Consultant Psychiatrist and Visiting Professor, University College London (UK)

Dr Carla Eleonora Ciccone MD Specialist in Obstetrics & Gynaecology AORN MOSCATI, Avellino (Italy)

Dr Owen Dempsey MBBS BSc MSc PhD General Medical Practitioner (retired) (UK)

Dr H R Dhammika MBBS Medical Officer, Dehiattakandiya Base Hospital, Dehiattakandiya (Sri Lanka)

Dr Tim Dowson MBChB MRCGP MSc MPhil Specialised General Medical Practitioner in Substance Misuse, Leeds (UK)

Miss Kamilia El-Farra MBChB FRCOG MPhil (Medical Law and Ethics) Consultant Gynaecologist, Essex (UK)

Dr Beata Farmanbar MD General Medical Practitioner (Sweden)

Dr Tomasz Fortuna MD RCPsych (affiliated) Forensic Child and Adolescent Psychiatrist, Adult Psychotherapist and Psychoanalyst, British Psychoanalytical Society and Tavistock and Portman NHS Foundation Trust, London (UK)

Dr C Stephen Frost BSc MBChB Specialist in Diagnostic Radiology (Stockholm, Sweden) (UK and Sweden)

Dr Peter Garrett MA MD FRCP Independent writer and humanitarian physician; Visiting Lecturer in Nephrology at the University of Ulster (UK)

Dr Rachel Gibbons MBBS BSc MRCPsych. M.Inst.Psychoanal. Mem.Inst.G.A Consultant Psychiatrist (UK)

Dr Bob Gill MBChB MRCGP General Medical Practitioner (UK)

Elizabeth Gordon MS FRCS Consultant Surgeon (retired); Co-founder of Freedom from Torture (UK)

Professor Derek A. Gould MBChB MRCP DMRD FRCR Consultant Interventional Radiologist (retired): BSIR Gold Medal, 2010; over 110 peer-reviewed publications in journals and chapters (UK)

Dr Jenny Grounds MD General Medical Practitioner, Riddells Creek, Victoria; Treasurer, Medical Association for Prevention of War, Australia (Australia)

Dr Paul Hobday MBBS FRCGP DRCOG DFSRH DPM General Medical Practitioner (retired) (UK)

Mr David Jameson-Evans MBBS FRCS Consultant Orthopaedic and Trauma Surgeon (retired) (UK)

Dr Bob Johnson MRCPsych MRCGP Diploma in Psychotherapy Neurology & Psychiatry (Psychiatric Institute New York) MA (Psychol) PhD (Med Computing) MBCS DPM MRCS Consultant Psychiatrist (retired); Formerly Head of Therapy, Ashworth Maximum Security Hospital, Liverpool; Formally Consultant Psychiatrist, Special Unit, C-Wing, Parkhurst Prison, Isle of Wight (UK)

Dr Lissa Johnson BA BSc(Hons, Psych) MPsych(Clin) PhD Clinical Psychologist (Australia)

Dr Anna Kacperek MRCPsych Consultant Child and Adolescent Psychiatrist, London (UK)

Dr Jessica Kirker MBChB DipPsychiat MRCPsych FRANZCP MemberBPAS Psychoanalyst and Consultant Medical Psychotherapist (retired) (UK)

Dr Willi Mast MD Facharzt fr Allgemeinmedizin, Gelsenkirchen (Germany)

Dr Janet Menage MA MBChB General Medical Practitioner (retired); qualified Psychological Counsellor; author of published research into Post-Traumatic Stress Disorder (UK)

Professor Alan Meyers MD MPH Emeritus Professor of Paediatrics, Boston University School of Medicine, Boston, Massachusetts (United States)

Dr Salique Miah BSc MBChB FRCEM DTM&H ARCS Consultant in Emergency Medicine, Manchester (UK)

Dr David Morgan DClinPsych MSc Fellow of British Psychoanalytic Society Psychoanalyst, Consultant Clinical Psychologist and Consultant Psychotherapist (UK)

Dr Helen Murrell MBChB MRCGP General Medical Practitioner, Gateshead (UK)

Dr Alison Anne Noonan MBBS (Sydney) MD (Rome) MA (Sydney) ANZSJA IAAP AAGP IAP Psychiatrist, Psychoanalyst, Specialist Outreach Northern Territory, Executive Medical Association for Prevention of War (NSW) (Australia)

Dr Alison Payne BSc MBChB DRCOG MRCGP prev FRNZGP General Medical Practitioner, Coventry; special interest in mental health/trauma and refugee health (UK)

Dr Peter Pech MD Specialist in Diagnostic Radiology (sub-specialty Paediatric Radiology), Akademiska Sjukhuset (Uppsala University Hospital), Uppsala (Sweden)

Dr Tomasz Pierscionek MRes MBBS MRCPsych PGDip (UK)

Professor Allyson M Pollock MBChB MSc FFPH FRCGP FRCP (Ed) Professor of Public Health, Newcastle University (UK)

Dr Abdulsatar Ravalia FRCA Consultant Anaesthetist (UK)

Dr. med. Ullrich Raupp MD Specialist in Psychotherapy, Child Psychiatry and Child Neurology; Psychodynamic Supervisor (DGSv) Wesel, Germany (Germany)

Professor Andrew Samuels Professor of Analytical Psychology, University of Essex (recently retired); Honorary/Visiting Professor at Goldsmiths and Roehampton (both London), New York and Macau City Universities; Former Chair, UK Council for Psychotherapy (20092012); Founder Board Member of the International Association for Relational Psychoanalysis and Psychotherapy; Founder of Psychotherapists and Counsellors for Social Responsibility (UK)

Mr John H Scurr BSc MBBS FRCS Consultant General and Vascular Surgeon, University College Hospital, London (UK)

Dr Peter Shannon MBBS (UWA) DPM (Melb) FRANZCP Adult Psychiatrist (retired) (Australia)

Dr Gustaw Sikora MD PhD F Inst Psychoanalysis Fellow of British Psychoanalytic Society Specialist Psychiatrist (diploids obtained in Poland and registered in the UK); Psychoanalyst; currently in private practice (UK and Poland)

Dr Wilhelm Skogstad MRCPsych BPAS IPA Psychiatrist & Psychoanalyst, London, United Kingdom (UK and Germany)

Dr John Stace MBBS (UNSW) FRACGP FACRRM FRACMA MHA (UNSW) Country Doctor (retired), Perth (Australia)

Dr Derek Summerfield BSc (Hons) MBBS MRCPsych Honorary Senior Clinical Lecturer, Institute of Psychiatry, Psychology & Neuroscience, Kings College London (UK)

Dr Rob Tandy MBBS MRCPsych Consultant Psychiatrist in Psychotherapy & Psychoanalyst; Unit Head, Psychoanalytic Treatment Unit, Tavistock and Portman, London; City & Hackney Primary Care Psychotherapy Consultation Service, St Leonards Hospital, London (UK)

Dr Noel Thomas MA MBChB DCH DobsRCOG DTM&H MFHom General Medical Practitioner; homeopath; has assisted on health/education projects in six developing countries Maesteg, Wales (UK)

Dr Philip Thomas MBChB DPM MPhil MD Formerly Professor of Philosophy Diversity & Mental Health, University of Central Lancashire; Formally Consultant Psychiatrist (UK)

Dr Gianni Tognoni MD Istituto Mario Negri, Milano (Italy)

Dr Sebastio Viola Lic Med MRCPsych Consultant Psychiatrist, Cardiff (UK)

Dr Peter Walger MD Consultant, Infectious Disease Specialist, Bonn-Duesseldorf-Berlin (Germany)

Dr Sue Wareham OAM MBBS General Medical Practitioner (retired) (Australia)

Dr Elizabeth Waterston MD General Medical Practitioner (retired), Newcastle upon Tyne (UK)

Dr Eric Windgassen MRCPsych PGDipMBA Consultant Psychiatrist (retired) (UK)

Dr Pam Wortley MBBS MRCGP General Medical Practitioner (retired), Sunderland (UK)

Dr Matthew Yakimoff BOralH (DSc) GDipDent General Dental Practitioner (Australia)

Dr Rosemary Yuille BSc (Hons Anatomy) MBBS (Hons) General Medical Practitioner (retired), Canberra (Australia)

Dr Felicity de Zulueta Emeritus Consultant Psychiatrist in Psychotherapy, South London and Maudsley NHS Foundation Trust; Honorary Senior Clinical Lecturer in Traumatic Studies, Kings College London (UK)

Dr Paquita de Zulueta MBBChir MA (Cantab) MA (Medical Law & Ethics) MRCP FRCGP PGDipCBT CBT Therapist and Coach; Senior Tutor Medical Ethics; Honorary Senior Clinical Lecturer, Dept of Primary Care & Population Health, Imperial College London (UK)

New signatories added:

Dr Victoria Abdelnur MD Specialist in Integrative Trauma Therapy (Germany and Argentina)

Dr Talal Alrubaie Psychiatrist and Psychotherapist MBChB MSc MD (Austria)

Dr Ernst Berger MD Univ. Prof., Specialist for psychiatry and neurology, Specialist for child psychiatry, Psychotherapist, Former head of Human Right Commission of Austrian Ombudsman Board MUW Klinik f. Kinder- u. Jugendpsychiatrie (Austria)

Dr Brenda Bonnici, B Pharm (Hons), M Pharm (Regulatory Affairs), PhD (Neuropharmacology); Consultant Patient Information (Switzerland)

Dr Stephen Caswell Clinical Psychologist BSc (Hons) MSc PGDip DClinPsych (UK)

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Doctors issue open letter to the Australian government: Julian Assange at risk of death in prison - World Socialist Web Site

At the annual San Antonio Breast Cancer Symposium, MSK investigators presented the latest research on detection and screening methods for people at high risk;immunotherapy for breast cancer;and the underlying causes of resistance to targeted therapies, among other topics.

Here are some of the noteworthy studies that featured contributions from MSK investigators.

Mammography screening has been shown to reduce breast cancer mortality by about 30% in the general population. But in women at an increased risk for the disease, additional imaging is recommended. This group includes people who carry a BRCA or other genetic mutation. Other risk factors include a family or personal history of breast cancer, certain high-risk lesions, or having undergone chest radiation at a young age.

At SABCS, diagnostic radiologist Maxine Jochelson discussed newer imaging technologies and the advantages they have over mammograms alone for detecting cancer in high-risk women. People in the high-risk group may need supplemental imaging to improve early detection, Dr. Jochelson says.

She explains that this approach would incorporate vascular imaging techniques. These methods can highlight areas of increased blood flow, a hallmark of tumor growth. This technology includes MRI and contrast-enhanced mammography. It can find tumors that mammograms may miss. Although vascular imaging costs more and generally takes longer to perform, its use is justified in high-risk women because ofthe increased chance of finding cancer, she says.

Mammograms & Other Types of Breast Exams

Learn about the different types of breast exams that can help detect breast cancer at its earliest stages, before symptoms develop.

Its undisputed that vascular imaging is better at detecting cancers than purely anatomical imaging, Dr. Jochelson adds. She emphasizes the need to fine-tune imaging strategies based on each persons specific risk factors.

Some of the imaging approaches she discussed during her presentation include:

We need to continue improving ways of assessing an individuals risk so we can stratify them and determine which type of imaging will most benefit each patient, Dr. Jochelson says. The true test will be studies to demonstrate that these newer technologies actually save lives.

Immunotherapy that uses genetically engineered cells, such as chimeric antigen receptor (CAR) T cells, has proven effective in treating some forms of blood cancer. So far, efforts to create immune cells that can effectively target solid tumors, including breast cancer, have been disappointing. At SABCS, MSK physician-scientist Christopher Klebanoff presented research from his lab on a novel tactic for enabling the immune system to better target and kill breast cancer cells while sparing healthy tissue.

We believe a major limiting challenge in successfully developing immunotherapy for breast cancer has been the identification of antigens. These are targets that the immune system can recognize, Dr. Klebanoff explains. Weve become very interested in the possibility that common mutations in breast cancer may produce antigens that can be recognized as foreign by the immune system.

The Klebanoff labs current research focuses on a gene called PIK3CA, which is mutated in about 40 to 45% of hormone receptor-positive breast cancers. It is also mutated in some HER2-positive and triple-negative breast cancers. Mutations inPIK3CA cause cancer cells to grow in an uncontrolled manner. In May 2019, the US Food and Drug Administration approved a pill called alpelisib (Piqray), which targets mutations in this gene. However, the drug has the potential for significant side effects, and tumors ultimately develop resistance to this medicine. Dr. Klebanoff and his colleague Smita Chandran, a senior research scientist in his lab and the scientific lead on this study, decided to look for a way to target antigens created by this mutation using immune cells designed to recognize them.

We believe a major limiting challenge in successfully developing immunotherapy for breast cancer has been the identification of antigens.

A challenging aspect of this approach was that mutated PIK3CA is found on the inside of cancer cells, allowing it to hide from many components of the immune system, such as antibodies. Physiological processes present in all cells, including cancer cells, allow mutated PIK3CA to be broken down into shorter fragments and loaded onto a molecular basket, called HLA, which is shuttled to the surface of the cell, Dr. Klebanoff says. This process allows immune cells to functionally look inside of other cells.

The researchers identified a specialized molecule, known as a T cell receptor, that has the ability to recognize this mutated PIK3CA-HLA complex. Immune cells specific for this complex recognize the target cell as being cancerous and destroy it. Healthy cells without the mutation remain untouched. The T cell receptors are matched to a patients unique complement of HLA molecules. As with a stem cell transplant, HLA must be matched for this immunotherapy to be effective.

Right now we are focused on the most common HLA types that are seen in a large proportion of our patients. The big-picture goal is to build a library of T cell receptors that can work in people with different HLA molecules and can target other common cancer mutations, Dr. Chandran explains. This work is still early and so far has only been done in the laboratory and not in humans. We are nonetheless excited about the prospect of working toward developing a more effective and less toxic immunotherapy customized to the genetic attributes of a patients tumor.

CDK4/6 inhibitors are an important class of drugs to treat estrogen receptor-positive breast cancer. These drugs stop the growth of breast cancer cells by targeting enzymes that are important in cell division. They are given in addition to hormone therapy. But about 10 to 15% of people who get these drugs dont respond to CDK4/6 inhibitors, and others later develop resistance.

MSK physician-scientist Sarat Chandarlapaty has been studying why this is the case. Understanding this resistance could contribute to the development of new targeted drugs. In December 2018, he published a study that reported on two genes that play a critical role in promoting this resistance. At SABCS, he presented his latest research on this area.

Weve been delving deeper into the role of these genes, as well as others, to try to understand some of the principles that could guide the next generation of therapies, Dr. Chandarlapaty says. By working out these detailed mechanisms, we will have the tools needed to design more potent and selective inhibitors for these refractory breast cancers.

Dr. Chandarlapaty explains that because tumors outsmart CDK4/6 inhibitors in different ways, he doesnt expect to find a one-size-fits-all approach for new drugs. There are some key principles for why these drugs fail, he says. For some tumors, making a more potent drug of the same general class will work. Other tumors bypass the pathway in a way that renders many of the old therapies weve used ineffective. For them, a completely different approach is needed.

Researchers Identify Why Women May Develop Resistance to a New Class of Breast Cancer Drugs

Clues emerge about why promising new breast cancer drugs sometimes dont work and what might be done about it.

Read more:
Updates from SABCS 2019: Detection and Screening, Immunotherapy Advances, and Therapy Resistance - On Cancer - Memorial Sloan Kettering

When Brooke Brumfield wasnt battling morning sickness, she craved nachos. Like many first-time expectant mothers, she was nervous and excited about her pregnancy. She had just bought a house with her husband, a wildland firefighter who had enrolled in paramedic school to transition to firefighting closer to home. Everything was going according to plan until 20 weeks into Brumfields pregnancy, when she lost her job at a financial technology startup and, with it, her salary and three months paid maternity leave. After building a new business to support her family, she had clients, but childcare was limited, and her husbands schedule was always shifting. By the time her baby arrived, everything was beyond overwhelming, Brumfield says. I pretty much felt like a truck hit me.

Brumfield had heard stories from friends and family about a way to minimize the stress and emotional fallout of the postpartum period: consuming her placenta, the vascular organ that nourishes and protects the fetus during pregnancy and is expelled from the body after birth. The women swore by the results. They said their milk supply improved and their energy spiked. The lows caused by plummeting hormone levels didnt feel as crushing, they explained.

Brumfield enlisted her doula who, for a fee, would steam, dehydrate, and pulverize her placenta, pouring the fine powder into small capsules. She swallowed her placenta pills for about six weeks after delivering her daughter. She said they helped her feel more even, less angry and emotional. When her milk supply dipped, she says, I re-upped my intake and [the problem] was solved.

Social scientists and medical researchers call the practice of consuming ones own placenta placentophagy. Once confined to obscure corners of alternative medicine and the countercultures crunchier communities, it has been picked up by celebrities (Kourtney and Kim Kardashian, January Jones, Mayim Bialik, Alicia Silverstone, Chrissy Teigen) and adopted by the wider public.

Although there are no official estimates of how many women ingest their placenta after delivery, the internet is increasingly crowded with placenta service providers preparers of pills, smoothies, and salves to support new mothers in the slog to recovery. But the purported benefits are disputed. Depending on whom you ask, placenta-eating is either medicine or a potentially dangerous practice based on myth. How did this practice go mainstream, despite a lack of reported scientific or clinical benefits? The answer may say much more about the world new mothers live in than it does about the placenta.

* * *

In any doctors office or primary care setting, a provider treating a patient will often mention new research that supports a recommended treatment. A pregnant woman diagnosed with preeclampsia, for example, might learn from her health care provider that low-dose aspirin has been shown in recent studies to reduce serious maternal or fetal complications. But the basis for placentophagy, a practice that lies beyond the boundaries of biomedicine, is a 16th-century text.

Li Shizhens Compendium of Materia Medica, or Bencao gangmu, first published in 1596, is a Chinese pharmacopoeia and the most celebrated book in the Chinese tradition of pharmacognosy, or the study of medicinal plants. It appears on the websites of placenta service providers and in the pages of the standard references for practitioners of traditional Chinese medicine (TCM), a millennia-old medical system with a growing global reach.

A physician and herbalist, Li drew on his empirical experiences treating patients but also on anecdotes, poetry, and oral histories. His encyclopedia of the natural world is a textual cabinet of natural curiosities, according to historian Carla Nappis The Monkey and the Inkpot, a study of Lis life and work. Containing nearly 1,900 substances, from ginseng and peppercorn to dragons bone and turtle sperm, Lis book describes dried human placenta as a drug that invigorated people, and was used to treat impotence and infertility, among other conditions. For advocates of placentophagy, this book serves as ethnomedical proof of the long-standing history of the practice and by extension, its efficacy and safety.

But like many claims to age-old provenance, the origins of placentophagy as a postpartum treatment are disputed. Sabine Wilms, an author and translator of more than a dozen books on Chinese medicine, scrutinized classical Chinese texts on gynecology and childbirth and told me theres no written evidence at all of a woman consuming her own placenta after birth as a mainstream traditional practice in China, even if formulas containing dried human placenta were prescribed for other conditions, as described in Lis book.

Beyond Lis 400-year-old encyclopedia, evidence of postpartum placenta-eating is nearly impossible to find in the historical record. Womens voices are notoriously difficult to unearth from the archives, and even in the 19th century, the details of childbirth and what happened to the placenta went largely unreported. But when two University of Nevada, Las Vegas anthropologists pored over ethnographic data from 179 societies, they discovered a conspicuous absence of cultural traditions associated with maternal placentophagy.

The earliest modern recorded evidence of placentophagy appears in a June 1972 issue of Rolling Stone. I pushed the placenta into a pot, wrote an anonymous author, responding to the magazines call asking readers to share stories from their personal lives. It was magnificent purple and red and turquoise. Describing her steamed placenta as wonderfully replenishing and delicious, she recounted eating and sharing it with friends after delivering her son.

Raven Lang, who is credited with reviving the oldest known and most commonly used recipe for postpartum placenta preparation, witnessed placentophagy while helping women as a homebirth midwife and TCM practitioner in California in the early 1970s. These women lived off the land, she explained, and might have drawn inspiration from livestock and other animals in their midst.

It wasnt long before placentophagy made its way beyond Californias hippie enclaves. In 1984, Mary Field, a certified midwife and registered nurse in the U.K., recounted eating her placenta, an unmentionable experience, to ward off postpartum depression after the birth of her second child. I remain secretive, Field wrote, for the practice verges on that other taboo cannibalism as it is human flesh and a part of your own body. She recalled choking down her own placenta. I could not bear to chew or taste it.

* * *

The rise of encapsulation technology, developed for the food industry and picked up by placenta service providers in the early aughts, put an end to visceral experiences like Fields. No longer must women process their own placenta or subject themselves to its purported offal-like flavor. Tidy, pre-portioned placenta pills resembling vitamins can be prepared by anyone with access to a dehydrator, basic supplies, and online training videos.

The boom in placentophagy highlights a longstanding puzzle for researchers. Almost every non-human mammal consumes its placenta after delivery, for reasons that remain unclear to scientists. Why did humans become the exception to this nearly universal mammalian rule? For Daniel Benyshek, an anthropologist and co-author of the UNLV study that found no evidence of placentophagy being practiced anywhere in the world, the human exception raises a red flag: It suggests the reasons that humans have eschewed placentophagy arent just cultural or symbolic, but adaptive that theres something dangerous about it, or at least there has been in our evolutionary history.

Scientific data on the potential benefits and risks of placentophagy is scarce, but a few small studies suggest that any nutrients contained in cooked or encapsulated placental tissue are unlikely to be absorbed into the bloodstream at concentrations large enough to produce significant health effects. Whether and in what quantity reproductive hormones such as estrogen survive placental processing has been little studied, but ingesting them after birth could have negative effects on milk production and may also increase the risk of blood clots.

Yet placental encapsulation services which remain unregulated in the U.S. have found a receptive audience of American consumers. (The food safety agency of the European Union declared the placenta a novel food in 2015, effectively shuttering the encapsulation business on the continent.) Mostly small and women-owned, placenta service businesses position themselves as an alternative to a highly medicalized, bureaucratized birthing process that has often neglected the needs of women. Postpartum checkups focus narrowly on pelvic examinations and contraceptive education. One survey of U.S. mothers found that one in three respondents who received a postpartum checkup felt that their health concerns were not addressed. In contrast, placenta service providers speak the language of empowerment.

That language can resonate with new mothers like Brumfield, who face overwhelming pressures to care for a newborn, nurse on demand, manage a household, and return to work amid anxieties about postpartum depression, dwindling energy, and inadequate milk supply.

In some ways, placenta consumption is motivated by a desire to perform good mothering, wrote scholars from Denmark and the United States in a paper on the emergence of the placenta economy. It reflects the idea of maternity as a neoliberal project, in which new mothers are responsible for their own individual well-being as well as that of their babies, they added.

Meanwhile, rates of postpartum depression keep climbing, maternity leave policies are stingy, and child care costs are often prohibitive. Its easy to see why many women would be eager to seek help, real or perceived, wherever they can find it.

* * *

Daniela Blei is a historian, writer, and book editor based in San Francisco.

This article was originally published on Undark. Read the original article.

Read more here:
Medicine or myth? The dubious benefits of placenta-eating - Salon

Few sports are as fast and furious as roller derby. The hour-long game unfolds in frenetic two-minute bursts as two teams race anti-clockwise around an oval track.Each team has a jammer aiming to pass four opposing blockers, and they score points for each opponent they lap.Blockers can obstruct the path with their torso or push opponents off course with a swift nudge of their upper legs or upper arms. Jammers juke a sideways dummy move and whip where a team member grabs their hand and swing them forwards ahead of the pack.

Fans are addicted to the ferocious drama of the competition, but, as you would expect for any contact sport, injuries are commonplace.Jessica had just moved to the USA from France when she attended her first roller derby match. From that first game I really fell in love with it, she says. She started competing, eventually leading Team France in the 2011 World Cup, and she even met her wife through the game.

In the summer of 2016, Jessica was playing blocker for a team in the Bay Area, California. She was in front of the oppositions jammer, and just as she turned to check her position, an opposing blocker collided with her at high speed.As the blockers shoulder hit the right side of her chin, Jessica felt an extraordinary pain on the opposite side of her skull and fell to the floor. The sudden jerking movement of her head, she now knows, caused her brain to ricochet within the skull leading to the sharp pain and severe concussion.

Sharing the full story, not just the headlines

She didnt seek immediate medical care. When she had suffered concussion previously, her doctors advice was to take it easy for a few weeks before returning to play. And it had seemed to work fine.This time, however, she had continued headaches and sense of mental constriction a feeling of pressure, like a vice on the brain, she says no matter how much she rested. Concentration for any length of time was often extremely difficult, and she was sensitive to the bright light of computer and phone screens, meaning that she had to wear sunglasses at work.

She also experienced inexplicable dips in her mood; at work, she would sometimes have to go and cry in her car. There was nothing that would have prompted it, she says. And I was not somebody who cried very easily, so it was exceedingly alarming for me to suddenly have these bursts of tears happen from nowhere.

It is now three years since her injury, but Jessica still hasnt recovered fully from these symptoms. I havent given up hope, but at this point, its not like theres a clear path to being better, or a clear timeline of when that would be.

Could Jessica have been at a higher risk of concussion simply because of her sex? Compelling new research suggests this is a distinct possibility, with a growing recognition that male and female brains may respond to injuries very differently.This follows a wider growing concern about concussion, triggered, in part, by high-profile injuries in sports like soccer, American football, rugby and boxing.

***

Concussion is changed neurological function as the result of a bump, blow or jolt to the head. The violent movement of the head causes a momentary release of various neurotransmitters that throws the brains signalling out of balance. It can also cause the neural tissue to swell and reduce the flow of blood to the brain and along with it, the glucose and oxygen starving our nerve cells of their fuel.

Immediate symptoms include seeing stars, feeling dizzy and confused, or losing consciousness entirely. Many people also suffer from post-concussion syndrome long after the event, with a constellation of lingering symptoms, including nausea, headaches, dizziness and mental confusion. These can last for weeks, months or even years. Some studies suggest that a concussion may also be accompanied by an increased risk of suicidal thinking, and there are concerns that repeated injuries could lead to long-term damage and brain degeneration.

The potential long-term impact of concussion is now well-known and has led many sports associations to change their rules and procedures to reduce the danger of injury. But there is low awareness of the potentially higher risks to female players and the possible need for differing diagnosis and treatment, including among healthcare professionals. At no point at any time when I was talking to physicians did they ever mention any potential difference [arising] from being a woman, says Jessica.

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Recent research, however, suggests that female athletes are not only more likely to sustain a concussion in any given sport; they also tend to have more severe symptoms, and to take longer to recover.Katherine Snedaker, founder of the non-profit campaign group Pink Concussions, believes that many like Jessica are invisible patients with an invisible injury and that means that they may struggle to get the support they need.

By shining a light on these differences, and understanding their causes, scientists and campaigners like Snedaker hope to improve the plight of all women struggling with the lingering and sometimes debilitating consequences that can arise from a single blow to the head.Given that millions of people a year sustain concussion around the world, and many more women are now taking up contact sports like rugby and soccer that might put them at greater risk of injury, this new understanding cannot come soon enough.

Womens brains may respond more severely to injury (Erin Aniker for Mosaic)

Concussion is thought to have first been distinguished from other types of brain injury more than 1,000 years ago, by the Persian physician Rhazes, but sex differences in concussion have only been the subject of serious research within the last two decades or so.

The delay perhaps reflects historic sexism within medicine, which has often neglected to investigate the possibility that female bodies may act differently from male bodies (besides the obvious differences, for example, in reproductive health). In the past, most clinical trials had included many more men than women, for instance though that has now improved. Most animal trials were also conducted on males, and it was only in 2014 that the US National Institutes of Health announced that studies it funded must use female as well as male animals, unless there were clear reasons to focus on one and not the other.

The sex differences in concussion were also obscured by the fact that many of these injuries are the result of accidents in sport, and girls and women were historically less likely to compete in events where concussion has attracted most attention.

Tracey Covassin, who is now based at Michigan State University, has been one of the leading researchers looking at potential sex differences in concussion. Canadian by birth, and inspired by her own love of ice hockey, when she first started out 20 years ago, she found next to no research on the subject.

There was nothing that really looked at females and concussion, because everything was about the NFL or the NHL, and concussions in male athletes or boxers.

To correct that deficit, Covassin turned first to the National Collegiate Athletic Associations injury records, to see how common concussion was among males and females within the same sports. In soccer, basketball and softball, for example, she found that female players are almost twice as likely to suffer a concussion as males.

Covassin and others then began to look at the effects of a concussion. They found that males and females are also likely to report different symptoms in the following days and weeks.

While male concussions are more likely to be followed by amnesia, for instance, female ones are more likely to lead to prolonged headaches, mental fatigue and difficulties with concentration, and mood changes.

Female athletes also seem to require more time for those symptoms to disappear. One study of 266 adolescents including soccer and American football players, wrestlers and skiers found that, on average, females took 76 days to recover, while males took 50 days.

As Esther, a student at Georgetown University in Washington, DC, who had a debilitating concussion while playing soccer when she was in the eighth grade, tells me: I just didnt really realise how serious it was. And then it wasnt really until the following day, when I returned to school as normal, that I couldnt really see the whiteboard. I felt so nauseous and had a horrible, horrible headache.

Some women have come forward stating they wish they had known their higher risk factor (Erin Aniker for Mosaic)

The symptoms lingered. Even at lunchtime, she says, it was a struggle to concentrate on what others were saying in the noise of the room, and watching a documentary in class gave her waves of nausea. Her post-concussion syndrome lasted for two and a half years, but, just as she was beginning to feel back on track, she suffered a new concussion (from falling down a flight of stairs) that led to further prolonged symptoms that shes still learning to cope with today, four years later. I think the symptoms that I still have now are kind of a cumulative effect.

Anna, an 18-year-old from New York City, sustained three concussions while playing basketball during her second and third years of high school. The third concussion was the most debilitating, resulting in her taking four to five months off school to recover.

I had terrible headaches, I wasnt able to properly think or put sentences together in a logical manner, she recalls.

*

Some researchers have argued that many of the reported sex differences are simply the result of societal gender roles.

Maybe girls and women are more cautious about their health, and more likely to disclose symptoms, while boys and men have been conditioned to play through the pain? Evidence to support some kind of baseline difference in the self-reporting of symptoms is mixed, however.

Some studies have also used more objective measures of cognitive function, with one finding females were about 1.7 times as likely as males to show signs of cognitive impairment a few days after experiencing the concussion. This includes a much larger decline in reaction times. Concussed female athletes also tend to show greater deficits in visual memory (though not every study has been able to detect this difference).

Given this evidence, self-reporting cannot be the only reason for the sex differences, says Inga Koerte, a neurobiologist at Harvard Medical School and the Ludwig Maximilian University of Munich.

Following a concussion, female athletes also seem to perform worse than males on a test of the vestibular-ocular reflex which allows our eyes to fix on a target as our body moves.

These tests ask people to focus on a fixed point as they move their head up and down or side to side and then rate symptoms of headache, dizziness, nausea or feelings of fogginess. The close observation makes it hard for someone to hide their condition, says Covassin. So even if theyre trying to lie to you about it, they just dont look very good, she says. That should reduce any self-reporting bias, yet in this test females are still found to have worse symptoms than males.

Perhaps the assumption that boys and men are somehow more ambitious and competitive and therefore more likely to hide their symptoms is itself a reflection of some outdated stereotypes and implicit biases?

Snedaker thinks so. I think that womens pain has been discounted as it has been for other mental or other physical injuries.

She points to some evidence that women, in general, are less likely to be prescribed painkillers in hospital. A 2008 study of American patients undergoing cardiac surgery, for instance, found that women were more likely to be given sedatives than men, who were more likely to be given painkillers perhaps because doctors implicitly assume that womens distress is more emotional than physiological. Another study found that women reporting to the emergency room with abdominal pain were less likely to be prescribed painkillers than men with the same complaint.

Ramesh Raghupathi, a professor in neurobiology and anatomy at Drexel University in Philadelphia, is similarly sceptical of the idea that we can dismiss the sex differences in concussion so easily.

He says that he has come across many female athletes who play through their pain rather than give up on their sporting ambitions despite the risks that this involves. Especially at [high] levels of competition, girls at middle school, high school or college theyre just as likely to hide their injuries, he says.In the weeks before Jessicas concussion, she had sustained some minor impacts, but had chosen to return to play which may then have exacerbated the effects of the later injury. In hindsight, she now wishes she had taken more time out.

***

Understanding exactly why women are more susceptible to concussion will be essential, if we are to reduce those risks. Recent research has focused on three main theories.

Some researchers have proposed that it may be due to the fact that female necks tend to be slimmer and less muscular than male ones.

Remember that the brain is free to move within the skull it is like jelly tightly packed into a Tupperware container and this means that any sharp movement of the head can cause it to shift around, potentially causing damage.For this reason, anything that helps to protect the skull from sharp movements should protect you from concussion and that includes a sturdier neck that is better able to buffer a blow.If you have a thicker neck, you have a stronger base, so the likelihood of head movement is much less, says Raghupathi.

Overall, the girth of a female neck is about 30 per cent smaller than a male, and this increases the potential acceleration of the head by as much as 50 per cent, according to one study.

Certain small anatomical differences can mean greater risks of injury for women (Erin Aniker for Mosaic)

The second idea that researchers have pointed to is some small anatomical differences within the brain itself. Female brains are thought to have slightly faster metabolisms than male ones, with greater blood flow to the head: essentially, they are slightly hungrier. And if a head injury momentarily disrupts that supply of glucose and oxygen, it could cause greater damage.

The third possibility lies in female sex hormones with some striking evidence that the risk of concussion changes with varying hormone levels during the menstrual cycle.Researchers at the University of Rochester School of Medicine and Dentistry, for instance, tracked the progress of 144 concussed women visiting six emergency departments in upstate New York and Pennsylvania.They found that injuries during the follicular phase (after menstruation and before ovulation) were less likely to lead to symptoms a month later, while an injury during the luteal phase (after ovulation and before menstruation) resulted in significantly worse outcomes.Exactly why this may be is still unclear, but it could relate to the rise and fall of progesterone levels during the cycle phases.

Previous research has shown that head injuries can temporarily disrupt the production of various hormones, including progesterone. During the luteal phase, progesterone levels are highest, and the researchers hypothesise that the sudden withdrawal due to head injury throws the brain off balance and contributes to the worse lingering symptoms. In the follicular phase, by contrast, progesterone levels are alreadylower and would not drop so dramatically meaning the resultant symptoms are less severe.

In line with this hypothesis, various studies have found that females taking contraceptive pills are also less likely to suffer severe symptoms following a concussion. Amy Herrold at Northwestern Universitys Feinberg School of Medicine, in Chicago, explains that oral contraceptives work by regulating the levels of sex hormones in the body. So instead of having hormonal surges and dips, over the course of a month, its more consistent, says Herrold, who also works as a research scientist at the Edward HinesJrVA Hospital in Illinois.

Provided that the pill continues to be taken after the concussion, that could prevent the sudden fall in progesterone, which would explain the less severe symptoms.

Complicating matters, the surges in oestrogen and progesterone during the luteal phase might also influence dopamine signalling. Dopamine is implicated in many of the brains functions that are influenced by concussion including motivation, mood, memory and concentration making it a good contender for a potential mechanism.

Raghupathis teams recent work on animals suggests that the surge of hormones during the luteal phase could render dopamine receptors slightly more vulnerable to perturbation. So, if a head injury occurs during this time, it seems to throw the dopamine signalling off balance in the long term, with potentially important ramifications for those many different brain functions. Its the disruption of this connectivity between cells [and] between regions that is a potential basis for the behavioural problems, Raghupathi says.

But, as Tracey Covassin emphasises, we still dont know how much truth these hypotheses hold. I wouldnt say any of them are clearly determined at this point.

The different explanations arent mutually exclusive: further research may find that the differences in musculature, blood flow, and the balance of hormones and neurotransmitters all contribute.Future research will also have to investigate other longer-term consequences of concussion. There are concerns, for example, that head impacts can increase the risk of neurodegenerative diseases like Alzheimers. We dont know if women may be at a greater risk here too.

*

Although the evidence for these sex differences has grown over the last few years, some experts would prefer to see these results replicated with further, carefully controlled studies, before the message is widely shared.

Without that corroboration, they worry that inadequately supported public claims may inadvertently harm womens recoveries. As Melissa McCradden, a neuroscientist and former competitive athlete, argued in a piece for Scientific American in 2017, a patients own expectations can influence their progress. So if we label women in this way, it can have a direct, negative effect on their recovery from concussion, she wrote.

There is also the fear that this information might put males at greater risk, if they wrongly assume that concussion is only a female problem.

If you focus too much on any kind of perceived or possible male-female divide, it might give this false perception that actually males are more able to withstand concussion [than they really are], says Luke Griggs, the deputy CEO of Headway, a charity that offers support for the survivors of brain injury and their carers across the UK. Boys and men might believe they could return to play too early whereas everyone, he emphasises, should be cautious following a concussion rather than trying to ignore their symptoms.

These are reasonable concerns, but many with concussion have been frustrated by the current lack of awareness about their condition.

Esther told me that some of her doctors were aware of the sex differences. But she would have preferred to know herself, before she ever got concussed. I had no idea, she says. And I think that if youre an athlete, playing any sport, you deserve to know the potential risks. If youre a girl playing sports, you deserve to know that maybe you are more at risk than your male counterparts.

Esther and Jessica emphasise that they wouldnt have let the risks prevent them from playing the sports in the first place this should not be taken as another excuse to limit the potential of girls and women. But they hope that female athletes would benefit from having the knowledge to protect themselves from unnecessary injuries and to ensure that they do not feel pressured to return to play too quickly, for instance.

Better awareness of these sex differences could ultimately lead to better care before and after the event.

One strategy might be to build better headgear for women. Unfortunately, its not quite that simple: concussions can arise from the sudden movement of the head as well as from a direct blow to the skull, which means that headgear wont prevent certain causes of concussion (though it can prevent fractures and other head injuries).

Some researchers are taking another approach: designing special exercises which could strengthen female neck muscles, which could reduce the violent movement of the head following an impact. It could decrease the basic chance for [concussive] brain injuries, says Inga Koerte.

And if further research shows that the sudden drop in progesterone increases the risks, then it might be a reason for female athletes to take oral contraceptives (though the evidence is not yet strong enough to make this recommendation).

For Jessica, these measures will be too late. She now lives and works in the UK, and after three years, many of her symptoms have subsided enough for her to mostly live my life without too much trauma, she says, but she still has a constant lingering headache, and she has to be on constant watch-out for a flare-up which can occur whenever she has over-exerted herself. And small difficulties that she once could have easily managed continue to feel overwhelming.

Indeed, on the day we were due to speak, she had been making some sales forecasts for work. She says it was hardly rocket science, yet she soon felt the fog descending.

I was looking at those numbers, and nothing made sense like I couldnt [even] figure out where to start to have them make sense.

She is still unable to play her beloved roller derby, and even running with its repeated jolting movements reverberating through the body is too much to bear, though she has recently taken up climbing, which doesnt lead to flare-ups. Without any answers from conventional medicine, shes sought help from acupuncture and osteopathy.

More than anything, the experience means that Jessica is constantly conscious of her brains physical presence and its vulnerability. I mean, youre normally not aware of your brain. Its just there its like your feet, its like breathing. But for me, Im always aware of it.

This article was first published by Wellcome on Mosaic and is republished here under a Creative Commons licence. Sign up to the newsletter at https://mosaicscience.com/newsletter

The rest is here:
Male and female brains respond to injury differently, research shows - The Independent

Operating final month, I felt a well-known twinge. Seconds later, a ache ripped by my proper calf and I stumbled to a halt, annoyed.

For many years I might dash 200 metres or run six miles a number of occasions per week with barely an aching muscle to indicate for it. However since turning 40 final June, scarcely a month has handed with out me sustaining an harm.

Ive pulled each calf muscle mass a number of occasions; the Achilles tendon in my heel, which precipitated ache for months; and Ive pulled muscle mass in my higher again whereas doing weights.

Antonia Hoyle is a working mom of two young children and has skilled damaged sleep and again ache amongst different niggles since turning 40

However as Ive learnt, torn muscle mass arent the one unwelcome physiological change after 40. My higher again hurts, my sleep is more and more damaged and hangovers really feel brutal. Im typically exhausted, my toes harm and my temper switches from sunny to murderous in seconds.

After many years of taking my well being as a right, I all of the sudden really feel extra fragile.

Im not alone on this realisation, nevertheless. Analysis final month by vitamin firm Healthspan revealed that at round 40, most of us realise our physique now not capabilities in addition to it used to.

Respondents to its ballot of two,000 adults reported their knees begin to harm after 40, their backs began to go at 44, whereas by their late-40s three-quarters of individuals stated they suffered joint ache each day.

Solely 55 per cent noticed a physician and nor have I, accepting on some stage, maybe, that such modifications are inevitable at 41.

Additionally, as a working mom of two young children, I dont have a lot spare time and dont suppose these well being niggles warrant a go to to the GP.

Specialists arent stunned by this development in well being decline from 40.

From experience, Ive realised that the physique doesnt bounce again as rapidly over 40, says Valentina Roffi, a physiotherapist at Dash Physiotherapy in Kensington, West London.

Niggles set people back and health and fitness levels can decline to get the results we had in our 20s after the age of 40, we need to put in more effort.

So what causes these post-40 well being niggles, and the way greatest can we counter them? I requested the consultants . . .

The issue: I really like working however since turning 40 Ive pulled each calf muscle mass endlessly and my proper Achilles heel, which took three months to fix.

In my experience, as soon as you turn 40 these injuries become more frequent, says Tim Allardyce, a physiotherapist and osteopath at Surrey Physio.

The timing is partly as a result of such accidents are cumulative (after working greater than 700 miles a yr for 25 years, my calves had been maybe destined to protest) and degenerative muscle mass shrink as we age. After 30, except we train, we lose as much as 5 per cent of our muscle per decade, making remaining muscle mass weaker and extra prone to pressure.

Many individuals expertise sore knees by the age of 40, brought on by the carrying down of cartilage

Declining ranges of testosterone which stimulates muscle progress in women and men can exacerbate muscle loss, as can oestrogen depletion in girls. Oestrogen works to strengthen the muscles, which support bones and joints, says Dr Roger Wolman, a marketing consultant in rheumatology and sport & train at Spire Bushey Hospital in Hertfordshire.

Tim Allardyce provides: The nervous system doesnt perform as effectively after 40, with response pace lowering, making us extra susceptible to harm, and our our bodies take longer to heal.

Many individuals expertise sore knees by the age of 40, brought on by the carrying down of cartilage.

The way to repair it: With regards to avoiding accidents, varying workouts [incorporating swimming, cycling and cross-training, for example, into routines] is beneficial to your nervous system because it challenges different muscle groups, as is incorporating balance training with a wobble board or Swiss ball, says Tim.

As I havent been in a position to run for 3 weeks because of my injured calf muscle, Ive been biking on an train bike and lifting weights 3 times per week, which has helped preserve my health and a greater temper. Doing stretches to heat up earlier than a full exercise makes the connective tissue round muscle extra pliable and might cut back harm, provides Tim.

For sore knees, reducing weight can ease pressure on the joints, whereas train will strengthen muscle mass and bones. Keep away from low chairs to minimise knee pressure.

Therapies embody injections of hyaluronic acid into the knee each six months to lubricate it. An alternative choice is platelet-rich plasma remedy, the place your individual blood is re-injected into the knee to stiumulate therapeutic.

The issue: Though a lifelong insomniac, Im sleeping worse than ever. Its typically 2am earlier than I nod off, and I frequently wake, worrying about my ever-expanding to-do record. Natural teas and over-the-counter cures havent helped. Ive been prescribed sleeping drugs earlier than in my 30s however I do know theyre not a long-term resolution.

Sleep professional Dr Neil Stanley says the deep restorative part of our sleep cycle when blood strain drops and blood provide to muscle mass will increase reduces from a number of hours once we are youngsters to as little an hour an evening in our 40s (its unclear why).

This means we can feel exhausted even if were getting the identical quantity of sleep, and were extra simply woken, he provides.

Center-age weight achieve can improve loud night breathing and interrupt sleep, whereas weaker bladders (widespread in over-40s) imply we wake extra to go to the toilet

Within the decade earlier than the menopause (the common age of which is 51), theres a drop within the hormone progesterone which usually will increase the manufacturing of sleep-aiding mind chemical GABA and different hormonal modifications that have an effect on the physiques temperature management. To have a good nights sleep we have to lose one diploma of our physique temperature. If thats elevated (which might occur within the years previous the menopause), youll discover it harder, says Dr Stanley.

Center-age weight achieve can improve loud night breathing and interrupt sleep, whereas weaker bladders (widespread in over-40s) imply we wake extra to go to the toilet.

The way to repair it: If attainable, sleep alone in a cool, quiet room, says Dr Stanley, I have found 36 per cent of sleep disturbance is caused by your partner.

Typically, at 2am, I transfer to our spare room the change of scene and house from my husband who, annoyingly, falls asleep immediately, appears to assist.

Reduce out your afternoon espresso, as our our bodies metabolise caffeine extra slowly with age, and do some train: research present a reasonable cardio exercise might help us sleep higher as a result of it reduces stress, a standard explanation for sleep issues.

Dont use your smartphone within the bed room. It emits blue gentle that suppresses the manufacturing of melatonin, the sleep hormone. Use a separate alarm clock as a substitute.

The issue: Most days, caught at my pc, I really feel an ache in my higher again.

Ache on this space is related to poor posture, muscle fatigue and stress, says Tim Allardyce and its significantly extra widespread for the over-40s.

Theres proof that the ache could also be associated to hormones launched once were confused. For instance, adrenaline causes muscle across the backbone to tense and spasm.

Posture deteriorates with age. This impact is each degenerative and cumulative, says Tim Allardyce.

Ache on this space is related to poor posture, muscle fatigue and stress says Tim Allardyce

Whereas age can put on down the discs in your backbone, which might trigger again ache, sitting hunched over a pc all day causes muscle weak point.

The way to repair it: Tim Allardyces favorite train for higher again ache is the dart.

He says: Lie on your front with your arms by your side. Lift your head, arch your back and lift your arms up behind you. Build up to holding for a minute, once a day. This strengthens muscles along the spine and between the shoulder blades.

Cardiovascular train similar to working or swimming improves circulation, which can assist flush out inflammatory by-products, provides Valentina Roffi: Strength exercises [such as lifting weights] build up the muscles, including those that act as scaffolding to the spine. Stretching exercises will improve the flexibility of the soft tissue surrounding the joints and the skeleton. Massage can also relieve symptoms.

Excessive heels was once a staple a part of my outfits, says Antonia Hoyle

The issue: Excessive heels was once a staple a part of my outfits however now theyre uncomfortable and my toes have developed calluses. If I do courageous heels on an evening out, Ive usually turned into my emergency flat sandals inside an hour.

Podiatrist Matt Fitzpatrick believes adopting a extra lively life-style in our 40s to halt middle-age unfold contributes to growing foot issues. This, mixed with carrying tight sneakers for work all day, and ageing, imply a deterioration of the gentle tissue, bones and joints in our toes, he provides.

Onerous pores and skin within the type of corns and calluses builds as much as shield them. You may as well get bunions.

The way to repair it: Keep away from heels for prolonged intervals of time, advises Matt Fitzpatrick and free flats, similar to ballet pumps: You have to curl your toes to keep them on, which can cause rubbing.

Take tight sneakers off all through the day to alleviate the strain, says George Hill, a podiatrist at Fleet Avenue Clinic in London, who additionally advises choosing trainers with cushioning and shock absorbance.

Ask your pharmacist for a foot cream with urea or lactic acid, which break down arduous pores and skin.

The issue: My moods are more and more erratic. One minute my husband and I are chatting amicably, the following he places the satsumas within the fruit bowl with out taking them out of their internet bag and I snap. Dr Louise Newson, a GP and menopause specialist, says it could possibly be a symptom of hormonal modifications that lead as much as menopause.

As well as a fall in oestrogen levels, progesterone levels fall, which can cause anxiety and a short temper, she says.

My moods are more and more erratic. One minute my husband and I are chatting amicably, the following he places the satsumas within the fruit bowl with out taking them out of their internet bag and I snap, says Antonia Hoyle

The way to repair it: An apparent resolution is hormone substitute remedy (HRT) that incorporates oestrogen and progesterone, although some girls and some consultants have blended emotions about it.

In addition to HRT, different consultants suggest testosterone lotions [levels of this hormone, usually linked with males, can fall in menopause, too] however these usually are not licensed for girls within the UK.

There is good evidence testosterone can be very beneficial for women, says Dr Newson. Theres additionally some proof weight loss plan low in sugar and processed meals might help enhance menopausal signs. Train, too, might help regulate temper.

Definitely, I discover my moods way more steady on days after Ive cycled, and I dont really feel prepared for HRT.

Alcohol is damaged down by enzymes within the physique and absorbed by way of the liver

The issue: A decade in the past Id share a bottle of wine (or two) with mates and really feel wonderful at work the next morning. Now, three glasses give me a crippling hangover.

Dr Mo Shariff, a liver specialist at Spire Bushey Hospital, says: Alcohol is damaged down by enzymes within the physique and absorbed by way of the liver. The extra you drink, the extra enzymes are produced to interrupt down this alcohol.

If youre youthful youre prone to be consuming frequently, so are extra tolerant to alcohol. After 40, alcohol consumption is much less frequent, so there may be much less of the enzyme to interrupt it down. Additionally, as we age and lose mind cells, it takes much less alcohol to saturate the cells and trigger hangover results.

The way to repair it: Select properly. Vodka is least prone to trigger hangovers because it has nearly no congeners substances produced throughout fermentation linked with hangovers (wine and whisky are excessive in congeners).

A latest lab research discovered consuming a mix of 65 per cent pear juice, 25 per cent candy lime and 10 per cent coconut water might cut back hangover results, the journal Present Analysis in Meals Science reported.

The issue: Im smug about my good eyesight however I havent seen an optician for years.

However Dr Susan Blakeney, of the School of Optometrists, says almost everyone wants glasses of their 40s: As we age, the lens inside the eye becomes stiffer, so doesnt focus as simply, and the gap as much as which youll see clearly will get additional away.

Dr Susan Blakeney, of the School of Optometrists, says almost everyone wants glasses of their 40s

Many people dont discover due to using electrical units. On these devices the contrast is good, which makes it easier to read, and you can make the font size bigger, says Dr Blakeney.

The way to repair it: Get your eyes examined a minimum of each two years over the age of 40. Not carrying glasses when wanted can pressure your eyes and result in complications and double imaginative and prescient. Ive added this to my to-do record.

To ease eye pressure, cease gazing your pc each 20 minutes and take a look at one thing 20ft away for 20 seconds. This rule was developed by Jeffrey Anshel, a U.S. optometrist, to encourage folks to blink extra typically (15 occasions a minute in comparison with half that once were gazing screens), so avoiding drained, irritated, dry eyes.

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ANTONIA HOYLE reveals everything DOES go wrong at 40 but heres how you can fight back - Herald Publicist

MedicalResearch.com Interview with:

Dr. Julia Blanter, MD MSIcahn School of Medicine at Mount SinaiFirst author of the study

MedicalResearch.com: What is the background for this study?

Response: The Oncotype DX Breast Cancer Assay was developed to genetically profile patients with early stage, hormone positive breast cancer and predict their 10-year risk of distant recurrence. A high-risk recurrence score is associated with a benefit from adjuvant chemotherapy whereas a low risk recurrence score is associated with little to no benefit.

BRCA mutated tumors have been associated with higher risk recurrence scores as compared to BRCA negative breast cancer patients. However, there have been minimal studies relating discordance to BRCA mutations. Discordance refers to a poorly differentiated or high-grade tumor with a low risk recurrence score. Prior studies demonstrated 7-19% discordance, or difference between recurrence score and tumor grade in breast cancer patients regardless of BRCA mutation status.

It has been concluded that patients who exhibit discordance may benefit from additional therapy in conjunction with endocrine therapy.

MedicalResearch.com: What are the main findings?

Response: We developed a large Oncotype database of 723 patients treated at Mount Sinai Hospital from 2006-2018 to determine if BRCA status is associated with higher rates of discordance when compared to the mutation negative breast cancer population.

We found an association between higher recurrence score and BRCA positivity within our database. We also found that the association between discordance and breast cancer patients was similar between BRCA mutated and non-mutated patients.

MedicalResearch.com: What should readers take away from your report?

Response: Given our findings, we were able to conclude that discordance, tumor grade and tumor size should be considered in treatment plans of breast cancer patients regardless of BRCA mutation status.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Both BRCA mutated and non-mutated patients exhibit some discordance. These patients may benefit from receiving chemotherapy even with a low risk Recurrence Score. Future studies may involve looking at BRCA mutated patients with and without chemotherapy to assess rates of recurrence. Many studies have looked at decreasing risk for BRCA mutated patients with adjuvant chemotherapy following surgical treatment. Therefore, a future research project may involve looking at BRCA mutated patients with bilateral salpingo-oophorectomy and/or bilateral mastectomy and how that affects this risk.

MedicalResearch.com: Is there anything else you would like to add?

Response: We hope to continue using our database to look for further associations that may guide treatment. Within our database, we have look at many different factors some of which include: mutation status, demographics, cholesterol levels, BMI, recurrence rates.

Subjects have given their written informed consent and the study protocol was approved by the institutes committee on human research.

Disclosure Statement

Amy Tiersten, final author of the study has had the following financial relationships in consulting: AstraZeneca, F. Hoffman-La Roche Ltd. Novartis.

Industry-Sponsored Lectures: MSSM faculty occasionally give lectures at events sponsored by industry, but only if the events are free of any marketing purpose.

Amy Tiersten has served on the following Scientific Advisory Boards: Eisai Inc., Immunomedics, Novartis

Citation:

BRCA mutations and association with discordance in a large oncotype database

Julia Blanter, Brittney Zimmerman, Serena Tharakan, Krystal Cascetta, Meng Ru and Amy Tiersten. Icahn School of Medicine at Mount Sinai, New York, NY

https://www.abstractsonline.com/pp8/#!/7946/presentation/959

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Last Modified: Dec 15, 2019 @ 8:08 pm

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Oncotype DX Breast Cancer Assay: BRCA Mutations and Association with Discordance in a Large Oncotype Database - MedicalResearch.com

Diabetes Mellitus is a disease that involves impaired glucose metabolism. Sudden adverse changes in blood glucose (high or low) can lead to altered mental status, to seizures, and even death. Long-term complications include damage to end organs, such as eyes, kidneys, heart, and the neurological system.

Further, this is a condition that would renderan existing medical certificate invalid from the moment the pilot knew of the diagnosis, regardless of any theoretical period of validity that might appear to remain for that certificate.

Are all pilots with diabetes grounded indefinitely? Is there any hope for a pilot with diabetes to fly again? What about commercially?

The answers are reassuring. Private pilots with well-controlled diabeteshave been flying for many years. And a recently implemented program with the support of the Federal Air Surgeon will now enable even more diabetics to return to commercial flying.

Without going into an elaborate explanation of itsphysiology, lets break diabetes down into two categories: non-insulin-dependent and insulin-dependent.

Insulin is a hormone that is released by the pancreas in response to blood glucose levels. All body tissues use glucose for energy. When blood glucose rises, the pancreas secretes insulin, permitting the bodily tissues to store and use glucose for various metabolic functions.

In certain cases of diabetes, the production of insulin is significantly decreased or completely absent. Common names include juvenile, type 1, or insulin-dependent diabetes (IDDM). Dont let the term juvenile confuse the situation, as there are times when insulin dependence might not occur until well into adulthood.

The relevant premise here is that the body has stopped producing sufficient insulin to regulate blood glucose, regardless of the persons age. You might also see the term insulin-treated diabetes (ITDM) in various publications, and for the purposes of FAA medical certification, IDDM and ITDM can be used synonymously.

In other cases, the bodily tissues have become resistant to the insulin that the pancreas is dutifully producing (obesity is a common cause of insulin resistance). Terms familiar to most people include adult-onset, type 2, or non-insulin-dependent diabetes.

Google mellitus for the amusing reference of how that word became part of the lore of diabetes centuries ago. I will provide more pathophysiologic information when I discuss the individual types of diabetes and the respective FAA certification programs more specifically in future submissions.

Therefore, I wont go into the formalities and minutia of how to diagnose, treat, and monitor diabetes in this discussion. Suffice it to say that poorly-controlled diabetes poses a significant threat to aviation safety, not to mention long-term health.

Diabetes that can be controlled with diet, exercise, and weight loss is the proverbial no-brainer in FAA medical certification. Anything a pilot can do without medical intervention is always preferable for long-term health maintenance.

All classes of medical certificates can be easily obtained in this setting and usually a special issuance is not required (at times this is followed through a slightly amended protocol for pre-diabetes that Ill discuss at a future date).

The necessity for oral and some of the injectable non-insulin medications that lower blood glucose to control diabetes also does not preclude FAA medical certification. In this case, while the pilot will be followed under a special issuance authorization, all classes of medical certificates are again included in this protocol. I have had many pilots flying commercially on first- and second-class medical certificates for many years who are taking oral diabetic medications.

If a pilot requires insulin, however, things change. Before 1996, any insulin-dependent pilot was unable to fly (all classes of medical certificates were excluded). Beginning in 1996, pilots could obtain a third-class FAA medical certificate if they are taking insulin and their diabetes is well controlled.

Fortunately, the program for third-class IDDM pilots has been a great success. The very rare adverse in-flight incidents over the years with diabetic pilots usually have occurred in pilots with poorly controlled diabetes who likely would not havebeen granted a special issuance authorization in the first place.

A pilot who requires insulin for treatment has been excluded for classes of FAA medical certificates higher than third-class until just recently. I have been a vocal advocate to the FAA and its various Federal Air Surgeons over the years that well-controlled IDDM pilots should be considered for first- and second-class certification.

With the current precise continuous glucose monitoring (CGM) electronics and advancements available, an insulin-dependent diabetic is now able to maintain tightly-controlled blood glucose levels.

In 2002, Canada began permitting IDDM pilots to fly commercially in a multi-pilot crew environment. The UK began doing so in 2012, and now the U.S. joined that group last month (on November 7).

Notably, there is no restriction in the FAA protocol that an IDDM pilot must be in a crew environment. Thus, an FAA-licensed pilot with a special issuance for IDDM can fly single-pilot so long as all provisions are met. The FARs dont permit the FAA to put restrictions such as must be part of a multi-pilot crew on first-class medical certificates.

There are also several other countries that permit private flying in pilots with various forms of diabetes.

As you can imagine, the FAA was very cautious and reviewed the advances in diabetic management technologies methodically over many years before authorizing this new program. No different than any other special issuance program, the FAA did not want aviation accidents resulting from a poorly conceived program.

This would, of course, be a tragedy for anyone involved in the accident and could jeopardize the entire program itself. Out of respect for caution, the FAA spent many years working on this program. And now, its finally here!

However, the requirements are probably the most extensive of any special issuance program that we have. There will be ongoing evaluations of numerous organ systems. In addition to using the latest technology to monitor and treat a pilot's diabetes, evaluations will be ongoing for eyes, heart, kidneys, and neurological systems.

The data presentation to the FAA is also extensive and thorough. As with some of the other special issuance conditions, the FAA has developed comprehensive checklistsfor pilots, their AMEs, and the treating physiciansand flow sheets to assist in the detailed data presentation to the FAA. Ongoing CGM data will also be required.

As exhaustive as this program is, it has finally opened the world of commercial flying to IDDM pilots who require a first- or second-class FAA medical certificate. I am hopeful that the program will be as successful as the earlier program for third-class pilots has been.

Those with IDDM are often some of the most motivated pilots there are, and the new gadgetry involved has demonstrated to the FAA that precise control of diabetes can indeed be achieved and, therefore, such pilots do not pose a threat to aviation safety. Thus, it is predicted that IDDM pilots will be able to fly safely in commercial operationson first- and second-class special issuance authorizationsin the U.S.

For a pilot to obtain a special issuance authorization under this new IDDM protocol, they will need an organized and motivated team of support. The pilot, first and foremost, must adequately control their diabetes using modern electronics, including CGM devices, as that also will improve the likelihood of maintaining long-term health.

Next, the treating physician must be willing to complete thorough FAA flow sheets and, at select times, consulting physicians will have to provide evaluation data of the other organ systems mentioned above. Finally, the AME must be willing to choreograph all of the data into a packet that will be acceptable to the FAA.

See the article here:
AINsight: Diabetes and Flying | Business Aviation - Aviation International News

When Brooke Brumfield wasnt battling morning sickness, she craved nachos. Like many first-time expectant mothers, she was nervous and excited about her pregnancy. She had just bought a house with her husband, a wildland firefighter who had enrolled in paramedic school to transition to firefighting closer to home. Everything was going according to plan until 20 weeks into Brumfields pregnancy, when she lost her job at a financial technology startup and, with it, her salary and three months paid maternity leave. After building a new business to support her family, she had clients, but childcare was limited, and her husbands schedule was always shifting. By the time her baby arrived, everything was beyond overwhelming, Brumfield says. I pretty much felt like a truck hit me.

Brumfield had heard stories from friends and family about a way to minimize the stress and emotional fallout of the postpartum period: consuming her placenta, the vascular organ that nourishes and protects the fetus during pregnancy and is expelled from the body after birth. The women swore by the results. They said their milk supply improved and their energy spiked. The lows caused by plummeting hormone levels didnt feel as crushing, they explained.

Brumfield enlisted her doula who, for a fee, would steam, dehydrate, and pulverize her placenta, pouring the fine powder into small capsules. She swallowed her placenta pills for about six weeks after delivering her daughter. She said they helped her feel more even, less angry and emotional. When her milk supply dipped, she says, I re-upped my intake and [the problem] was solved.

Social scientists and medical researchers call the practice of consuming ones own placenta placentophagy. Once confined to obscure corners of alternative medicine and the countercultures crunchier communities, it has been picked up by celebrities (Kourtney and Kim Kardashian, January Jones, Mayim Bialik, Alicia Silverstone, Chrissy Teigen) and adopted by the wider public.

Although there are no official estimates of how many women ingest their placenta after delivery, the internet is increasingly crowded with placenta service providers preparers of pills, smoothies, and salves to support new mothers in the slog to recovery. But the purported benefits are disputed. Depending on whom you ask, placenta-eating is either medicine or a potentially dangerous practice based on myth. How did this practice go mainstream, despite a lack of reported scientific or clinical benefits? The answer may say much more about the world new mothers live in than it does about the placenta.

In any doctors office or primary care setting, a provider treating a patient will often mention new research that supports a recommended treatment. A pregnant woman diagnosed with preeclampsia, for example, might learn from her health care provider that low-dose aspirin has been shown in recent studies to reduce serious maternal or fetal complications. But the basis for placentophagy, a practice that lies beyond the boundaries of biomedicine, is a 16th-century text.

Li Shizhens Compendium of Materia Medica, or Bencao gangmu, first published in 1596, is a Chinese pharmacopoeia and the most celebrated book in the Chinese tradition of pharmacognosy, or the study of medicinal plants. It appears on the websites of placenta service providers and in the pages of the standard references for practitioners of traditional Chinese medicine (TCM), a millennia-old medical system with a growing global reach.

The basis for placentophagy, a practice that lies beyond the boundaries of biomedicine, is a 16th-century text.

A physician and herbalist, Li drew on his empirical experiences treating patients but also on anecdotes, poetry, and oral histories. His encyclopedia of the natural world is a textual cabinet of natural curiosities, according to historian Carla Nappis The Monkey and the Inkpot, a study of Lis life and work. Containing nearly 1,900 substances, from ginseng and peppercorn to dragons bone and turtle sperm, Lis book describes dried human placenta as a drug that invigorated people, and was used to treat impotence and infertility, among other conditions. For advocates of placentophagy, this book serves as ethnomedical proof of the long-standing history of the practice and by extension, its efficacy and safety.

But like many claims to age-old provenance, the origins of placentophagy as a postpartum treatment are disputed. Sabine Wilms, an author and translator of more than a dozen books on Chinese medicine, scrutinized classical Chinese texts on gynecology and childbirth and told me theres no written evidence at all of a woman consuming her own placenta after birth as a mainstream traditional practice in China, even if formulas containing dried human placenta were prescribed for other conditions, as described in Lis book.

Beyond Lis 400-year-old encyclopedia, evidence of postpartum placenta-eating is nearly impossible to find in the historical record. Womens voices are notoriously difficult to unearth from the archives, and even in the 19th century, the details of childbirth and what happened to the placenta went largely unreported. But when two University of Nevada, Las Vegas anthropologists pored over ethnographic data from 179 societies, they discovered a conspicuous absence of cultural traditions associated with maternal placentophagy.

The earliest modern recorded evidence of placentophagy appears in a June 1972 issue of Rolling Stone. I pushed the placenta into a pot, wrote an anonymous author, responding to the magazines call asking readers to share stories from their personal lives. It was magnificent purple and red and turquoise. Describing her steamed placenta as wonderfully replenishing and delicious, she recounted eating and sharing it with friends after delivering her son.

Evidence of postpartum placenta-eating is nearly impossible to find in the historical record.

Raven Lang, who is credited with reviving the oldest known and most commonly used recipe for postpartum placenta preparation, witnessed placentophagy while helping women as a homebirth midwife and TCM practitioner in California in the early 1970s. These women lived off the land, she explained, and might have drawn inspiration from livestock and other animals in their midst.

It wasnt long before placentophagy made its way beyond Californias hippie enclaves. In 1984, Mary Field, a certified midwife and registered nurse in the U.K., recounted eating her placenta, an unmentionable experience, to ward off postpartum depression after the birth of her second child. I remain secretive, Field wrote, for the practice verges on that other taboo cannibalism as it is human flesh and a part of your own body. She recalled choking down her own placenta. I could not bear to chew or taste it.

The rise of encapsulation technology, developed for the food industry and picked up by placenta service providers in the early aughts, put an end to visceral experiences like Fields. No longer must women process their own placenta or subject themselves to its purported offal-like flavor. Tidy, pre-portioned placenta pills resembling vitamins can be prepared by anyone with access to a dehydrator, basic supplies, and online training videos.

The boom in placentophagy highlights a longstanding puzzle for researchers. Almost every non-human mammal consumes its placenta after delivery, for reasons that remain unclear to scientists. Why did humans become the exception to this nearly universal mammalian rule? For Daniel Benyshek, an anthropologist and co-author of the UNLV study that found no evidence of placentophagy being practiced anywhere in the world, the human exception raises a red flag: It suggests the reasons that humans have eschewed placentophagy arent just cultural or symbolic, but adaptive that theres something dangerous about it, or at least there has been in our evolutionary history.

Scientific data on the potential benefits and risks of placentophagy is scarce, but a few small studies suggest that any nutrients contained in cooked or encapsulated placental tissue are unlikely to be absorbed into the bloodstream at concentrations large enough to produce significant health effects. Whether and in what quantity reproductive hormones such as estrogen survive placental processing has been little studied, but ingesting them after birth could have negative effects on milk production and may also increase the risk of blood clots.

Almost every non-human mammal consumes its placenta after delivery, for reasons that remain unclear to scientists.

Yet placental encapsulation services which remain unregulated in the U.S. have found a receptive audience of American consumers. (The food safety agency of the European Union declared the placenta a novel food in 2015, effectively shuttering the encapsulation business on the continent.) Mostly small and women-owned, placenta service businesses position themselves as an alternative to a highly medicalized, bureaucratized birthing process that has often neglected the needs of women. Postpartum checkups focus narrowly on pelvic examinations and contraceptive education. One survey of U.S. mothers found that one in three respondents who received a postpartum checkup felt that their health concerns were not addressed. In contrast, placenta service providers speak the language of empowerment.

That language can resonate with new mothers like Brumfield, who face overwhelming pressures to care for a newborn, nurse on demand, manage a household, and return to work amid anxieties about postpartum depression, dwindling energy, and inadequate milk supply.

In some ways, placenta consumption is motivated by a desire to perform good mothering, wrote scholars from Denmark and the United States in a paper on the emergence of the placenta economy. It reflects the idea of maternity as a neoliberal project, in which new mothers are responsible for their own individual well-being as well as that of their babies, they added.

Meanwhile, rates of postpartum depression keep climbing, maternity leave policies are stingy, and child care costs are often prohibitive. Its easy to see why many women would be eager to seek help, real or perceived, wherever they can find it.

Daniela Blei is a historian, writer, and book editor based in San Francisco.

Continued here:
Medicine or Myth? The Dubious Benefits of Placenta-Eating - Undark Magazine

I lay on my side, cradling my iPhone, looking up bleeding after sex and dabbing a piece of toilet paper between my legs. I thought about whether or not I should wake my new boyfriend up.

The Healthy Woman website stated, Its common for women of all ages to have bleeding after sex at one time or another.In fact, up to 9 percent of all women experience post coital bleeding (outside of first sex) at some point in their lives.Most of the time its nothing major and goes away on its own.But bleeding after sex can also be a sign of something more serious. SIGN OF SOMETHING SERIOUS?

Great. I had already had acute myeloid leukemiamultiple times, and now, when things were looking up, WebMD saidthis new symptom could mean I have pelvic organ prolapse (when pelvic organs, like the bladder or uterus, jut beyond the vaginal walls).

I found a site where someone asked, Could my uterus fall out? No, it couldnt. At least I had that.

The most important thing to pay attention to is the rate and volume of bleeding, the article read. Most bleeding after sex is fairly light. Heavy bleeding where youre soaking through a pad every hour or passing clots larger than the size of a quarter warrants a visit to the emergency room.

I didnt have a quarter, but I did have a clock that showed it had been two hours. The doctor on call for my internists office, around 2 or 3 a.m., sounded annoyed.

You should have called your gynecologist, he said. But he called ahead to the ER. I shook my boyfriend awake, and off we went into the spring night that had held so much promise. Intellectually I knew it wasnt my fault, but I was more embarrassed than if I had been wearing white shorts and gotten my period in gym class.

On the TLC series, Sex Sent Me to the ER, worse things happen, such as objects stuck where they shouldnt be. My issue was more mundane, but I found out also very common: lack of information after my cancer treatment.

Nobody told me that chemotherapy, which Id undergone after my diagnosis in 2003 and again after relapses in 2007 and 2008, could cause a sudden loss of estrogen production in my ovaries, and that this could lead to symptoms of menopause such as a thinning vagina and vaginal dryness. (Actually, the first round put me into early menopause at 48.) Nobody told me that vaginal dryness can cause pain and bleeding during intercourse.

Yet data shows that the incidence of sexual dysfunction among female cancer survivors is somewhat common.Common sexual side effects are difficulty reaching climax, less energy for sexual activity, loss of desire, reduced size of the vagina, and pain during penetration.

For my part, it had been a 10-year dry spell. You shouldnt need a reason for not having sex, but I had good ones: treatment in 2009 for relapsed leukemia, life-threatening infections after a rare fourth stem cell transplant, a coma, a four-month hospitalization and a year just to get back on my feet.

My 13-year marriage, long over, had consisted of 10 good years and three downhill all the way along a road full of land mines. Afterward, a four-year relationship with an English professor ended in fitting dramatic form when he rediscovered his childhood sweetheart while I was mourning the death of my father. Pulling his hands through his long gray hair, he declared, Were like Heathcliff and Cathy. I love her more than I love you! I had to brush up on my Wuthering Heights to get it. Heathcliff and Catherine were soulmates.

My soulmate was nowhere to be found. He was not the guy who walked into a restaurant looking pale and pasty and nothing like the photo of the fit guy on his online profile, making me think of climbing out the bathroom window. He was not the guy I met at a Matzo Ball, where Jewish singles go on Christmas Eve to comport themselves like eighth graders at a school dance; we lasted for about six months until he complained that he was lower on the totem pole than my three children. I thought he might be the tennis player who strung my rackets and said he was falling in love with me, but he disappeared, in a feat I later learned had a name: hanging you out to dry.

I decided to follow the advice of friends who were tired of hearing me talk about heartbreak and disappointment: Live your best single life. I stopped paying for dating websites but left a profile on a free one.

Stop trying to find something, and then if youre lucky, you will find it, or it will find you. A nice guy wrote that he liked my profile (ugh, I hated writing those things). He thought we had a lot in common (running, kids, reading, similar politics) and would love to have a conversation. Is it corny to say that as we walked toward each other in front of the restaurant where we were to meet, we were being pulled together? Maybe it was just relief that he seemed normal and resembled his profile photo.

We sat at a high table in the bar. Our fingertips brushed together when we held up our phones to show each other photos; his, of places he had traveled, and mine, of kids and dogs. The next day, we went for a walk, and he passed a big test: meeting my chocolate Labrador retriever. She got a crush on him. I think its the soft voice. It works on me, too.

I had been using a vaginal estrogen cream, Estrace (generic name estradiol), twice a week, to reduce symptoms of menopause such as vaginal dryness, burning, and itching. Though I was concerned about side effects, my doctor said the small amount was not absorbed outside the vagina, unlike hormone replacement therapy, which goes into the bloodstream. She said it was also OK to use Estrace once a week and Replens, a nonhormonal moisturizer, the rest of the time if I wanted to.

I remembered hearing that I would need to up the dosage if I wanted to have sex again. I made an appointment with my gynecologist to see if I should do anything else to prepare for physical intimacy.

The physicians assistant who saw me said, Go to the toy store. I was confused. My children were grown. Why did I need a toy store? I learned that she meant the sex toy store tucked behind a doorway next to a pizza place.

I got a set of six pink dilators. They started pinky-sized and increased by gradations up to a dauntingly large one. They didnt come with instructions regarding how long to leave them in. The small one went in OK. I kept it in for a few minutes and then put in the next larger one, increasing in size until I had had enough. Theres not much you can do when youre lying around with a fake pink penis in your vagina.

When it finally came time for real sex, I liked it. It hurt after a while, so we stopped, but I thought that was normal. Next I felt something sticky on my legs. It was blood. Blood on the sheets, blood on our legs. We got in the shower, changed the sheets, and got back into bed. It couldnt have been less romantic.

The emergency room was even worse grungy and poorly lit. He sat with me, holding my hand and looking as upset as I was, until a nurse called me in and he went to sleep in the car.

Please tell me youve seen worse than this, I said to the nurse as I lay on the exam table feeling raw, emotionally and physically. She said she had. The doctor did an internal examination and said the blood had likely come from chafing. It was dawn when we finally got out of there. We went out to breakfast. Ordering my traditional blueberry pancake with an egg over hard brought a sense of normalcy to the misadventure.

The next week, I returned to the doctors office and this time saw the gynecologist herself.

Lets start from scratch, she said. I was to leave a dilator in for between 15 and 30 minutes, while doing diaphragmatic breathing. She sent me to pelvic floor therapy to learn relaxation exercises. I used the Estrace for two weeks straight. By the time we had sex again, it didnt hurt, but I nervously checked the sheets for a long time afterward. I figured if we could get through a post-coital visit to the ER, we could get through most anything.

I may not have known much about sex after cancer, but its a topic thats starting to be talked about more. I learned that after years of dismissing womens sexual function as just one of those things that cancer takes away, many see womens sexual health as a survivorship issue. Anexpert who I interviewed for a story onsex after cancereven called the dearth of information for female cancer survivors a health equity issue.

Many cancer centers are beginning to open sexual health programs. My own cancer center was among them. You missed us by about a year, the director told me.

Luckily, Im no worse for the wear and am still with the nice guy. I use Estrace (and sometimes Replens) twice a week and a lubricant when having sex. Doctors say that one of the best ways to treat vaginal dryness is to have more sex, because increased blood flow stimulates lubrication.

Now that memory of the ER visit is almost three years in the past, that seems like a fine idea to me.

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I Didnt Have Sex For 10 Years. When I Finally Did, It Sent Me To The ER. - HuffPost