Archive for the ‘Hormone Physician’ Category

A visit from a dog can reduce the distress of patients waiting for emergency treatment in hospital, a study by the University of Saskatchewan (USask) shows.

Patients who spent 10 minutes with a visiting therapy dog--a four-year-old springer spaniel named Murphy--reported they felt more comfortable, happier and less distressed while waiting for emergency care in hospital.

The study, published in thePatient Experience Journal, found a significant increase in comfort levels and positive feelings after spending time petting, cuddling or interacting with the experienced canine.

The study was carried out at the Royal University Hospital (RUH) in Saskatoon, Saskatchewan--the first emergency department in Canada to introduce therapy dogs to improve the experience of waiting patients.

There is growing evidence that therapy or comfort dogs can be beneficial to human health and can reduce anxiety, heart rate and blood pressure. Interaction with a dog increases production of dopamine, a neurotransmitter, which reduces the stress hormone cortisol.

Professor Colleen Dell, Research Chair in One Health & Wellness at USask's College of Arts and Science, co-led the study with emergency physician Dr. James Stempien, MD, Provincial Department Head, Emergency Medicine in Saskatchewan. The research was supported by the Saskatchewan Centre for Patient-Oriented Research.

"Emergency departments are hectic and confusing places. Most people waiting for treatment feel nervous, and waiting can increase their pain. It is well-known that interacting with animals can help humans feel calm and relaxed. Our study showed a noticeable improvement in the patient's mood after interacting with a therapy dog," Dell said.

"With waiting times consistently high in emergency departments, it suggests that therapy dogs may have a broader therapeutic role to play comforting patients in distress and pain."

RUH is the first emergency department in Canada to allow therapy dogs to visit, with up to six trained therapy dogs now visiting several days a week.

Patients met the dog for between 10 and 30 minutes and included people with cardiac complaints, fractures, psychiatric issues, and those suffering chronic pain.

The 124 patients were waiting in curtained-off cubicles and found their distress levels decreased, and their perceived comfort levels increased after interacting with the spaniel, a certified St. John Ambulance Therapy Dog and its handler. The distress of patients meeting Murphy decreased regardless of the length of their wait.

Patients filled out questionnaires about their well-being and feelings before and after meeting Murphy. The most common themes were feeling 'happy', 'okay', 'better' and 'calm', and 80 per cent expressed happiness during the visit and said they felt calmer after the visit.

Sixty six per cent of those visited by Murphy patted him, stroked him or cuddled him. One patient gave the dog a massage and some snuggled up to him or let the dog put his head on their chest. In almost a quarter of cases, the dog's 'intuition' when interacting with a patient was noted.

Logan Fele-Slaferek, a co-author of the paper and patient advocate, met Murphy on several occasions while an RUH inpatient for a recurrent health condition. On one occasion, after a six-month-long treatment program had failed and he was feeling 'crushed and hopeless', the spaniel jumped on Logan's lap and fell asleep.

"I was a little skeptical about his helping at first, but that all changed five minutes later. The dog picks up on your mood or temperament better than most people would. He helped my recovery immensely. It's something about being next to an animal that exudes nothing but love and kindness," Fele-Slaferek, an undergraduate at USask, said. "The emergency department can be so hectic, but time slows down when you are with a therapy dog. His presence is soothing."

Jane Smith, Murphy's handler, said it is clear the therapy dog enjoys meeting the patients, and sometimes does not want to leave them.

"When Murphy enters the emergency department, the mood changes quickly. You can see patients, doctors, and staff smiling, even before he actually visits anyone," she said. "During the visits he looks at patients with big, brown eyes, settling in to enjoy the pets and cuddles. Sometimes, Murphy needs extra encouragement to leave a patient. It is actually hard to tell who enjoys the visit more."

This preliminary study has led to Dell and her team being awarded a research grant of $20,000 from the Royal University Hospital Foundation to undertake further research at RUH into the impact of therapy dog visits on adult emergency department patients and their experiences of pain.

Read more here:
Dogs reduce distress of patients waiting for emergency hospital care - Jill Lopez

(Pregnancy Help News) Recently, a Tennessee woman gave birth to healthy twin babies who miraculously survived a chemical abortion attempt at a Knoxville, TN, Planned Parenthood.

The incredible story of these miracle babies, as told by one pro-life physician, underscores just how sorely the abortion giant fails to meet the needs of women, both from a medical standpoint and a human one.

Displaying obvious ineptitude from the start, the nations largest abortion business only informed the woman she was pregnant with twins after the chemical abortion shed been given by Planned Parenthood staff failed.

Furthermore, at her initial visit to the Planned Parenthood facility, the staff misinformed her about the basic biological development happening within her seven-week pregnancy, stating that it was too early for a heartbeat and that it was just cardiac activity they were seeing.

Pro-life physician Brent Boles, who helped the woman following her failed abortion, commented on Facebook earlier this month about the twins birth and Planned Parenthoods handling of the pregnancy.

Abortion isnt about caring for the woman, Boles said. Its about the $$$.

Boles had originally shared the story on the social media platform this past March after the woman contacted him looking for help.

Boles, who is a member of the Abortion Pill Rescue Network, told Pregnancy Help News that his patient originally came to him through the groups 24/7 helpline (877-558-0333). She had found the helpline after returning to Planned Parenthood for a follow-up appointment and discovering that she was still pregnant.

READ:Pro-choice? Media slams miscarriage-halting hormone when used to reverse the abortion pill

Because Planned Parenthood had no help to offer her, she left and scoured the web before landing on AbortionPillReversal.com.

From the doctors October 4 post:

Earlier this year, a patient called the Abortion Pill Rescue hotline and was referred to me. Three weeks before, she had been in a Planned Parenthood facility. She had an ultrasound at seven weeks, and asked during the ultrasound if there was a heartbeat. She was told No, its too early to call it a heartbeat; it is just cardiac activity.

As he did in his Facebook post this past March, Boles lambasted the abortion industry cardiac activity lie in his new post about the twins:

Problem #1: those types of statements are just deceptive word games. Calling the fetal heartbeat embryonic pulsing or cardiac activity and saying that it is not yet a heartbeat is a lie. The leading textbooks of embryology say that the heart begins to beat at five weeks and they call that a heartbeat. No medical or scientific text affirms their erroneous concept that pulsatile activity is not yet a heartbeat. In fact, those texts say that the cardiac/circulatory system is the first organ system to perform its adult purpose in utero. They lied to her in order to have her emotionally commit to handing over her cash and having the abortion.

That wasnt the only problem with Planned Parenthoods so-called medical evaluation of his patient:

Problem #2: at seven weeks the vast majority of competent sonographers will never miss twins at that point. But women who find out they are having twins are far less likely to abort twins, as the thought of aborting only one baby does t seem quite as bad as aborting two. So either an incompetent sonographer missed the fact that she had twins or didnt want to tell her and have her thousand dollars walk out the door with her.

She did the course of the abortion pill and nothing happened. She went back two weeks later and had another ultrasound at approximately nine weeks and they said oh well, it didnt work, and you are having twins. She asked what could be done and they said nothing. She left, found the number to call on google, and that led her to my office.

Abortion Pill Reversal, which has saved more than 900 babies to date, works by giving pregnant women additional progesterone, a natural hormone that sustains a healthy pregnancy. In the case of a twin pregnancy, a womans body produces more progesterone to nurture both babies.

In evaluating his patient and the twins, Boles determined that in this case, extra progesterone via Abortion Pill Reversal wouldnt be necessary. But for Boles, that still didnt excuse Planned Parenthoods glaring incompetence when it came to administering a practice he strongly opposes:

Problem #3: they (Planned Parenthood) dont even know how to use the medication properly, assuming they did know it was twins. I am prolife and I know that a higher dose of mifeprex is required to work successfully to abort a multiple gestation, because a twin pregnancy produces higher levels of progesterone.

For Christa Brown, director of Medical Impact at Heartbeat International, the twins survival, as well as other survivals achieved through the Abortion Pill Rescue Network, marks a notable victory for life.

Its incredible to think that the abortion industry has already counted those babies as abortion statistics, but instead they are alive and well, she said. We are so thankful for Dr. Boles and all of the providers in the Abortion Pill Rescue Network who are saving lives every single day worldwide. To date, the abortion industry has lost nearly 1,000 of their statistics and our world has gained nearly 1,000 precious babies who are growing and thriving thanks to the APR Network.

Not only did Planned Parenthood fail this woman in every medical aspect, but the abortion business also failed to meet her basic human needs as a pregnant woman now expecting twins. Boless final critique of the abortion giant?

Problem #4: they refused to offer any advice or counsel.

For several years now, abortion advocates have fired off endless lies about the help provided by pro-life pregnancy help organizations. But who is really taking care of women in unexpected pregnancies?

More than 2,750 pregnancy help centers all across the U.S. are providing counsel and resources to women in need every day. From diapers to housing to parenting classes to free obstetrical ultrasound scans, they are serving families from a place of utmost compassion and care.

READ:Abortion pill reversal saved her baby after she regretted taking the first dose

In 2017, they served nearly 2 million clients, saving communities, an estimated $161 million.

When the abortion industry fails to meet womens needs, pregnancy centers are there. When a woman is kicked out of her home and has nowhere to go, maternity homes are there. When the abortion industry leaves a woman grieving and regretting her choice, abortion recovery ministries are there.

When a woman desperately wants to save her unborn child from an in-process chemical abortion, Dr. Boles and hundreds of other pro-life physicians in the Abortion Pill Rescue Network are there, offering her child one last chance at life.

Despite Planned Parenthoods utter failure to meet this patients needs, today two healthy babies are alive and doing well in the state of Tennessee.

These twins have now delivered at term, uncomplicated by any other issues, Boles wrote in his social media post, and are at home with their parents, who are exceedingly pleased that a decision made under pressure and while in fear did not work out as planned.

PHN Editors note: The AbortionPillReversal.com program, the Abortion Pill Rescue Network (APRN) and Pregnancy Help News are managed by Heartbeat International.

Editors Note: This article was printed at Pregnancy Help News and is reprinted here with permission.

Like Live Action News on Facebookfor more pro-life news and commentary!

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Planned Parenthood didn't tell her she was pregnant with twins. Then, they survived the abortion pill. - Live Action News

A solid eight hours can be hard to come by in our non-stop, tech-saturated world. But the modern science of sleep shows that shut-eye is just as critical as diet and exercise in shaping both mental and physical health.

Host Rao is joined by Mary Ellen Wells, the director of the neurodiagnostics and sleep science program at the University of North Carolina School of Medicine; Jade Wu, a licensed clinical psychologist at Duke University specializing in behavioral sleep medicine; Roger Ekirch, a university distinguished professor in the department of history at Virginia Tech; and Sheena Faherty, a science communicator who conducted doctoral research into hibernation in lemurs at the Duke Lemur Center to talk about sleep on this edition of 'Embodied.'

On this episode of The State of Things series Embodied: Sex, Relationships and Your Health, host Anita Rao speaks with experts in psychology, neurology, history and even lemur biology to better understand what is actually happening when we sleep and how we can learn to sleep better.

If I had no social obligations, no work and I lived in a cave, I would just want to go to bed later and later each day and wake up later and later each day. -Jade Wu

Rao is joined byMary Ellen Wells, the director of the neurodiagnostics and sleep science program at the University of North Carolina School of Medicine;Jade Wu, a licensed clinical psychologist at Duke University specializing in behavioral sleep medicine and the host of the Savvy Psychologist podcast;Roger Ekirch, a university distinguished professor in the department of history at Virginia Tech and the researcher who brought to light an ancient pattern of segmented sleep; andSheena Faherty, a science communicator who conducted doctoral research into hibernation in lemurs at the Duke Lemur Center.

The sleep experts break down the latest research into the science of sleep, how our ancestors used to sleep in two shifts with a period of wakefulness in between, and why lemurs may hold the key to human hibernation and deep space travel.

Interview Highlights

Jade Wu on whats happening to our brains and bodies during deep sleep:

Human growth hormone peaks in how much it's being released in the body during deep sleep. So that's why kids need a lot of sleep, need a lot of deep sleep because they're growing. Sex hormones are also being released during this stage. That's why teenagers also need a lot of sleep, because they're going through puberty. And we're also consolidating memories The brain is also doing some janitorial work very important janitorial work. We're clearing out debris from the cerebrospinal fluid, just basically junk in the brain that we don't need. And with this clearing out, we're sort of resetting and we're maintaining brain health.

Wu on how we are programmed to have different circadian rhythms:

We are all biologically wired to be either a morning lark, a night owl or somewhere in the middle. And this is largely driven by genetics, so we can't help it. And there's actually differences in the length of our cycles depending on what we have. So for example, I'm a night owl. So I probably don't have a 24 hour cycle I probably have something more like a 24.3 hour cycle. Meaning if I had no social obligations, no work and I lived in a cave, I would just want to go to bed later and later each day and wake up later and later each day. Whereas people who are morning people tend to have closer to a 24 hour cycle. Though the average I believe, is about 24.1 hours.

Mary Ellen Wells on the science behind sleepwalking:

So sleepwalking, it can be surprisingly common about one to 15% of the population can suffer from sleepwalking at any point. And it's more common in children. And it's one of what we call a parasomnia, [those] are essentially acting out or movements, odd things that are happening during the night ... And there are certain parasomnia that happen during REM sleep and certain parasomnia that happen during non-REM sleep. Sleepwalking is one of those that happen during non-REM sleep. REM sleep is essentially your dreaming state. And sleepwalking it's not entirely understood exactly why this happens to people. But there are many things that can spark it to happen, such as sleep deprivation Sleepwalking is very, very dangerous. The person [is] not aware that this is happening. So there's a misperception out there that you should never wake a sleepwalker.

It was a prime time for petty crime. -Roger Ekirch

Roger Ekirch on what people did in the break between segmented sleep:

There were special prayers to be said after your first sleep. They meditated, many reflected upon dreams from whence they had just awakened. Others of course, used chamber pots. But then, still others left their beds, they performed chores. There's a wonderful passage in Virgil's Aeneid describing this. [They] performed chores that required very little light and virtually no skill in the dead of night. Some left their homes, visited neighbors or I think even more commonly pilfered apples from a neighbor's orchard. It was a prime time for petty crime. It was also, in the view of physicians writing in the 16th, 17th and 18th centuries, a prime opportunity in which to conceive children, after the first sleep when a couple would be more rested. In the words of Laurent Joubert, a French physician in the 16th century: It is after the first sleep when couples and I'm quoting him verbatim do it better and enjoy it more.

Sheena Faherty on the question of whether humans could possibly hibernate one day:

NASA is really interested in it because of things like space travel. And these types of things have applications to emergency medicine and organ transplantation....What we find is that the same metabolic pathways, and genes that are involved in these metabolic pathways that are regulating these changes in metabolism [during lemur hibernation], are the same genetic pathways and genes that humans have already. And so in theory, humans have the capability to enter a torpor-like state based on this finding.

Original post:
Embodied: The Elusive Science Of Sleep - WUNC

When the Below Deck crew from Valor went out on the town, bosun Ashton Pienaar observed that it seems easy to get into a lot of trouble in Thailand. Thailand is a lot of fun, he says in a confessional. But you can get into a lot of trouble. I think they put something different in their vodka?

The next day after sleeping on the deck, Pienaar exclaims, I feel rough. Meanwhile, chief stew Kate Chastain, who didnt appear to be overly intoxicated the night before searches for medicine to help with her hangover. She is filmed in the fetal position on a couch. I think the vodka in Thailand is different, she says in a confessional. This is like 18-year-old Kate partying and hungover. Its not a good look.

Later one of the guests on the next charter gets extremely drunk before she even boards the yacht. Previews for an upcoming episode catch her being so drunk in another instance, she needs medical attention. What is it about Thailand that has the crew and guests getting so drunk?

While yachties may be used to tropical conditions, Below Deck cast members often remark about the intense heat in Thailand. The problem with drinking in extreme heat is that booze becomes a diuretic, which drains the body of fluids. People think of alcohol as a thirst-quencher because it comes in a refreshing, cold liquid. But in hot weather, youre already losing fluids through sweat and through exercise, Dr. Josef Thundiyil, an emergency physician with Orlando Regional Medical Center told The Epoch Times.

What ends up happening is people urinate more often in the hot weather and get dehydrated faster. You end up peeing out more than you take in, he said. Once you start drinking alcohol, you shut that hormone off, so its not as simple as making up for it by drinking more water. Youre going to continue to urinate more than you normally would if you hadnt been drinking alcohol.

Combine heat with booze and it could be a recipe for trouble. Thundiyil says that alcohol depresses the hypothalamus, which is the gland thatregulates body temperature. As a result, drinking in the heat means youll feel hotter (and perhaps drink more). Impaired judgment is a big issue because a lot of times people dont know exactly how unclear their decisions actually are, he said. Even if people may not achieve the legal driving limit, .08 in most states, you can still have ill effects. You can lose judgment and coordination, and that can give way to things like more significant inebriation.

The heat sounds pretty brutal just from the comments coming from the crew. Thailand is an especially hot destination but extremely hot during the months when Below Deck was filming.

The weather doesnt cool off much at night, although higher elevations in some areas make it more bearable than in the rest of the country, according to Trip Savvy. During the hot season, visitors can expect highs to reach above 90 degrees Fahrenheit (32 degrees Celsius), with some sweltering days even hotter.

Like many places in the world, Thailand experienced an increase in temperatures over the last several years. Temperatures have reached such significant heights in the past, animals at the Dusit Zoo in Bangkok were at risk of overheating.

More here:
'Below Deck': Why Is Drinking Alcohol in Thailand Getting the Crew and Guests so Drunk? - Showbiz Cheat Sheet

Breast cancer is the most commonly diagnosed cancer among American women. And surgery is the most common form of treatment.

In the Silver Cross Breast Center, patients can see a highly skilled surgeon for diagnosis and treatment of breast cancer and other abnormalities.

Surgeons on staff at the Silver Cross Breast Center have specialized training and expertise to quickly diagnose disease, explain the range of treatment options available, and help you decide on a plan tailored to your needs and goals.

This may include breast-conserving surgery, mastectomy and breast reconstruction.

These highly skilled surgeons evaluate and manage patients with breast pain, benign lumps and cysts and abnormal mammograms, in addition to breast cancer.

They look at the stage of cancer, its characteristics, and what is the best individual treatment for the patient.

Oftentimes cases are reviewed by multiple specialists at Silver Cross Hospitals weekly multi-disciplinary breast conference to expedite diagnosis and treatment.

Convenient, comprehensive care

If it is determined that surgery is the best option, procedures are performed in Silver Cross state-of-the-art operating suites followed by a short stay in a spacious, private patient room; although some patients may go home the same day.

If chemotherapy, hormone therapy, or radiation therapy is recommended, the UChicago Medicine Comprehensive Cancer Center at Silver Cross is just steps away from the Breast Center.

It offers the latest clinical trials, genetic testing and counseling and advanced techniques including prone breast radiation therapy.

After surgery, sometimes patients experience lymphedema. Therapists with the world-renowned Shirley Ryan Ability Lab (formerly Rehabilitation Institute of Chicago) are available at Silver Cross to help patients find relief.

And through Siona Boutique, patients have access to a variety of specialized products to help improve their quality of life.

Certified breast care nurse

Neda Zelehovitishas a duel certification as anOncology Certified Nurse and Certified Breast Care nurse. She serves as a liaison between the patient, doctors, and family in the Silver Cross Breast Center.

With over 22 years of oncologyexperience, she provides each patient with personal and compassionate assistance in navigating through the health care system, ensuring that patients make informed decisions.

As a certified breast care nurse, Zelehovitis is responsible for assisting women who come to the Center for Womens Health with their care including:

Providing pre and post procedural nursing care for patients having biopsies

Explaining what will happen during the procedure and why the physician may have ordered the test

Obtaining physician orders for follow up testing, if recommended by the radiologist

Serving as a liaison between the patients primary physician and the radiologist to obtain information about the patients course of care and to help guide the patient in making decisions about the next steps in her care process

Providing nursing assistance to the technologists during procedures

Serving as a resource to the patient who may require additional assistance, including co-facilitation of the monthly Breast Cancer Support Group

Zelehovitis provides patients with education about breast health screenings, treatments, and recovery; coordinates follow-up care and consistently maintains this support through the continuum of cancer care all the way to healing.

The patient's well-being and health are a priority to Zelehovitis, and she is committed to providing patients with peace of mind as they seek medical care.

Get started at the Silver Cross Breast Center

Whether diagnosed at Silver Cross or elsewhere, call (815) 300-6350.

A certified breast health nurse will schedule the initial appointment and assist in coordinating the next steps in care.

This includes any additional diagnostic testing including breast ultrasound, breast MRI, or stereotactic breast biopsy to determine whether a lump is benign or cancerous.

For more information, visit http://www.silvercross.org

Continued here:
Breast cancer care close to home - The Herald-News

Yom Kippur or Day of Atonement, the most sacred day on the Jewish calendar, sees hundreds of people admitted into the emergency room and many others who "suffer" through fasting.

Whether fasting is healthy for them or not, many believers cling to the custom even despite medical recommendations, until their condition worsens.

Consult you attending physician before fasting (Photo: Shutterstock)

So, we take a look at who shouldn't fast under any circumstance, how to take medication correctly, which medical services will be avialable in Israel during the holiday, what women going through fertility treatments should do and whether you should take birth control pills as usual.

Prolonged fasting like on Yom Kippur might put patients with chronic diseases could cause a slew of medical problems, such as high blood pressure, heart failure, diabetes, ischemic heart disease, renal and liver failure and malignant diseases.

Patients suffering from these conditions are not recommended to fast on Yom Kippur at all and since fasting could cause a wide range of life threatening conditions such as sharp drops in blood pressure, fluctuations in the body's salt-water levels, acute drops in blood-sugar levels, cardiac arrhythmias and even strokes.

Patients taking fixed medication due to chronic diseases, especially when it comes to different medication, are not recommended to stop the permanent treatment without consulting a physician first.

In any case, if it is decided to pause the treatment for the 25-hour fast, consult your physician to set your medication times and mealtimes before and after the fast accordingly.

The treatment shouldn't be stopped under no circumstance if given for life threatening conditions.

In milder conditions such as strep throat and urinary tract infection, consult a doctor and ask them for their approval to take the medicine at the last meal before Yom Kippur and then again at the end of Yom Kippur.

Women taking birth control pills face no problem at all as they can take the pill at the last meal before fasting and then again at the end of the fast the next day.

Psychiatric patients not advised not to stop their treatment due to real life-threatening concerns.

If you still wish to halt a psychiatric treatment, consult your attending physician first.

For patients with Inflammatory bowel diseases, it is advisable to keep yourself hydrated and avoid fully fasting for the entirety of Yom Kippur.

Additionally, it is important to note that some medicines require food or drink, therefore, it is advisable not to decide this on your own, but to consult your doctor about each specific pill - whether you can swallow it with or without liquids.

In the past, people with diabetes were strictly prohibited from fasting, but since there are two types of diabetes and treatments are quite diverse, each patient should consult their attending physician to pick the right treatment and determine if fasting is permitted and under which circumstances.

Fasting could indeed cause headaches, mainly due to dehydration causing blood vessels to expand, very similarly to a migraine.

Apart from taking medicines such as Paracetamol, Ibuprofen and Dipyrone, you can consult your doctor about using Arcoxia.

Arcoxia, used to treat arthritis, was also found to be helpful in preventing headaches during fasting.

It should be noted that some medication must be taken on a full stomach in order to reduce damage to the stomach lining.

Additionally, some medications have alternatives in the form of rectal candles, which solve the eating issue.

Women in high-risk pregnancies are prohibited from fasting. Healthy women can usually fast during pregnancy, if they do not suffer from anemia, weakness, dehydration and only after consulting a gynecologist.

Women in high-risk pregnancies are prohibited from fasting (Photo: Shutterstock)

In any case a pregnant woman feels dizzy or nauseous, she should drink a quarter-cup of a sweetened drink every few minutes until the weakness goes away.

In general, pregnant women are advised not to go to the synagogue but to stay at home in an air-conditioned room.

Fastng is not advised for women breastfeeding full time without any baby formulas.

Breastfeeding women should alternately drink water throughout Yom Kippur to prevent a decrease in breast milk production.

If the woman combines breastfeeding with formulas, there is no prohibition on fasting, however, it is advisable to stay in an air-conditioned place and avoid unnecessary efforts.

In any case, pregnant women must consult the attending physician about fasting.

Women going through fertility treatments, requiring a series of hormone injections and must receive them at predetermined dates and times, will be able to call emergency services - if necessary - in order to set up an appointment at the nearest first-aid station.

When arriving at the station for an injection, bring the medication to be injected as well as your attending physician's referral with the date and time of injection, dosage, location and manner of injection (intramuscular or subcutaneous).

Paramedics will inject the medication only to patients who have already received at least one injection of the same drug before.

Fasting might dehydrate the body this condition increases the risk of damaging various body systems and can lead to the formation of kidney stones.

Dehydration is a medical emergency that is expressed by weakness, sleepiness, headaches, blurred vision, failure to urinate for more than10 hours, nausea, loss of consciousness and convulsions.

Infants and small children, who don't fast anyway, are at a higher risk, alongside pregnant women and seniors.

To avoid dehydration, those fasting must stay in shady and air-conditioned places as much as possible.

Call emergency services in any condition suspected as dehydration.

In case of emergency, call emergency services. In any other case, you can turn to the main urgent care centers, which keep operating on a limited scale that day.

Chronic patients need to make sure that they have enough medication for the day of fasting.

It is advisable to make sure that there are also basic non-prescription drugs available, such as antipyretics and analgesics.

If necessary, there are emergency pharmacies available, which can be found on your municipality's website or hotline.

Continue reading here:
Who should and who shouldn't fast on Yom Kippur? - Ynetnews

TULSA, Okla. The door frame that Cathy Carter leans against is all that separates her from the fate suffered by her great aunt in the 1930's.

Carter has been diagnosed with anxiety and agoraphobia, and she believes her ancestor suffered similarly or worse. For her great aunt, that meant being hauled away to a California insane asylum, as they were called at the time a trip that did nothing to ease her condition or help her life.

Carter, still leaning in her doorway, pauses in telling the family story. For her, the outcome has been different.

More than 600 miles southeast of Colorado Springs, in the boom-or-bust oil town of Tulsa, exists an effort to tackle mental illness not just with therapists or pharmaceuticals, but with four walls and a roof.

Spearheaded by the Tulsa-centered Mental Health Association of Oklahoma and backed by tens of millions of dollars from wealthy, oil-made philanthropists, the initiative provides hundreds of housing units to people battling mental health and substance abuse problems often both. Hundreds more units have been set aside by the nonprofit for affordable housing as a preventative measure to keep people from descending into homelessness and in need of even more acute mental health care.

For Carter, that means an apartment. Her apartment. No psychiatric hospital visits needed.

Here, were accepted, she says.

The Tulsa program is earning a growing reputation for addressing mental health's many tendrils even among some nonprofit leaders in Colorado Springs. And it centers on a hard truth for any community seeking to finally tackle mental illness: Making meaningful headway is impossible without addressing the societal factors that play into a persons well-being.

So often, housing ranks at the top of that list.

Its the deal maker or the deal breaker, said Mike Brose, the nonprofits CEO, over dinner at a downtown diner. Its all the difference in the world. If you dont have a place to live, you cant get anywhere.

And its not like Broses nonprofit is starting from a place of privilege.

The Sooner state has one of the worst mental health care systems in the nation, ranking 41st in Mental Health Americas most recent report.

Chief among those concerns for social service providers is the fact that Oklahoma has yet to expand Medicaid benefits to impoverished and low-income adults without children. It was a key benefit of the Affordable Care Act that the states Republican leaders eschewed in a show of defiance against President Barack Obamas signature health law.

Tulsa and Oklahoma City also routinely rank disproportionately high in evictions, meaning more people are at risk of homelessness, and in turn, at higher risk for new or exacerbated mental illnesses brought on by living on the streets.

In the face of those obstacles, mental health advocates in Tulsa got creative.

Unable to woo more clinicians to the area or single-handedly shift the states prevailing political winds, they focused on the fundamentals the social determinants of health. Issues like crime, employment and access to healthy foods can play an outsized role in a persons overall well-being, according to the federal Substance Abuse and Mental Health Services Administration.

And housing ranks among the most important of those factors.

Its a fact that Carter, 67, knows all too well.

She leans away from her doorway, shuffling unsteadily back to her wheelchair, and invites visitors in for a tour. The linoleum flooring looks like paneled wood, the kitchen is quaint, there are two bedrooms in the back. Two cats one white behemoth named Snowball and a nimble tabby named Jack lay on cushions in her living room. Her old service dog rests nearby.

At the moment, her walls are white and empty shes only lived in this apartment for a week, because her last unit flooded in a storm. But shes been a tenant of the Mental Health Association of Oklahoma for six years.

She still struggles with agoraphobia a condition that can cause her to feel overwhelmed when shes overstimulated, such as when she leaves her house. And she still grapples with anxiety a particular problem, given that she also suffers from a rare neurological disorder that becomes exacerbated when her stress spins out of control.

But backward as it may sound, having a place to live has helped keep her from becoming isolated from the rest of the world.

There are other people around who maybe have the same disorder," says Carter, her voice soft and calm. If I have panic or problemswith agoraphobia, I know Im not the only one.

Theyre not going to freak out if I'm freaking out, with panic or the agoraphobia. Thats not going to bother them."

The Mobile Medical team of physician assistant Whitney Phillips, center, and licensed practical nurse Jacki Sauter examine a homeless woman on the streets of Tulsa

. The medical team is one of the many services the Mental Health Association of Oklahoma provides to the homeless population in Tulsa. The

team also decreases trips to the emergency room by the homeless, lowering overall medical costs.

The nonprofit owns and manages about two dozen apartment complexes all across Tulsa, a sprawling city bisected by the Arkansas River. Those buildings contain 1,435 units about three times the number possessed by Colorado Springs largest nonprofit provider of affordable housing. That's despite Tulsas population being slightly smaller.

There are streets lined by Art Deco architecture. Downtown is brimming with reinvestment, including a Woody Guthrie museum, new restaurants and a minor league baseball stadium. A downtown arena hosts national concert tours, and a nearby theater recently captured dates from a touring production of "Hamilton." A Bob Dylan museum is on the drawing board.

Just a short walk from all of it is the Altamont Apartments a 1930s-era brick building purchased by the nonprofit to use as affordable housing, complete with a quiet gazebo in back and an interior that recently underwent millions of dollars in renovations.

And there is the newly constructed Yale Apartments, tucked beside Interstate 244 east of downtown, home todozens of formerly homeless people.

Each of the units comes with a caseworker who to seeks to connect tenants to whatever health care is needed and available, as well as job and food assistance.

The reason is simple, says Greg Shinn, the nonprofits chief housing officer.

The bottom line is that when people are on the street, or in a homeless shelter, they could not stabilize and go into recovery mode to be successful," he said. "Theyre in survival mode."

Shinn himself became a believer in the early 2000s. After spending years running a homeless shelter in downtown New York City, he heard aboutthe Tulsa nonprofit's plan to provide housing.

Immediately, he thought: Well, thats the solution.

Lets give them choice of where to live, if you can do that, Shinn said. And then that empowers them to choose where they wantto live to get out of their homeless situation. And then to offer them flexible services they feel they need to recover. And then thatll give them a head start on recovery in the housing where they could be successful.

Most importantly, he says, once people are housed, they don't often return to the streets.

Through the end of August, 82 percent of the people with mental illnesses who have received apartments from the nonprofit remain there. It's a retention rate that has remained relatively steady for years, and one the nonprofit proudly boasts as proof of its success.

A resident waits outside Yale Apartments

on Aug. 27 in Tulsa

. Yale is one of the 28 apartment buildings owned and managed by the Mental Health Association of Oklahoma. It provides 1,435 units of affordable housing, three times the number of Colorado Springs largest provider, despite Tulsas population being slightly smaller.

Housing as key to recovery

The concept stems from the Housing First ethos. And it is rooted in a growing pile of research on the social determinants of health.

For decades, researchers have grown increasingly confident that a persons health both physical and behavioral is swayed by far more than doctors or therapists. Myriad triggers can push a persons well-being for better or worse including crime, racial discrimination and poverty, according to the federal Substance Abuse and Mental Health Services Administration.

The connection is simple, says Vickie M. Mays, a professor of psychology and health policy and management at the University of California, Los Angeles. Those issues all cause toxic stress otherwise known as the hormone cortisol to build up inside a person, deteriorating their health and causing a cascade of mental health problems.

Often, housing ranks at or near the top of those social determinants, Mays said. Without it, how can anyone kick an addiction? And how can anyone maintain their hygiene well enough to find or keep a job?

"So if you want to know how to enhance people's well being, to motivate them, you need to think about housing as a very significant social determinant, Mays said. "And to think about building our houses in ways in which while theyre affordable at the same time, they really allow some communities to be able to thrive.

In Colorado, the situation is no different.

A recent report by the Colorado Health Institute warned of a connection between the states rising housing costs and the negative health outcomes that may result.

Housing costs across the state increased by 77% over the last decade as newcomers have flocked to the state, causing the Front Range two swell with new houses and prices in scenic mountain towns to skyrocket. Meanwhile, wages have inched up a mere 4.5% in that same time, the report found.

More than a quarter of the states households are now cost burdened, meaning more than a third of their income goes to housing costs. Its a problem thats even worse for minorities.

"One of the big connections between housing instability and mental health is around chronic stress, said Sarah Barnes, manager of special policy initiatives for the Colorado Childrens Campaign, which is helping lead a group that's using the report to help spur policy solutions.

Shinn, the Tulsa nonprofits housing leader, says he sees the benefits of housing day in, and day out.

More affordable housing means fewer people living paycheck to paycheck and strapped for cash, reducing the generational cycles of poverty that often cause traumas that lead to poor mental health, he said.

And fewer evictions mean children can change schools less, meaning a better education and eventually better jobs, lower incarceration rates and fewer tax dollars spent on emergency room visits and lockups.

This leads to sustainable neighborhoods and higher quality of life for everybody else, Shinn said. The housing needs being met in the community has a direct impact on the overall mental health of the community. You can connect the dots all day long. Some of them are direct, some of them are indirect. But every community in the country needs more affordable housing.

Resident Glen Bailey, 64, dust mops the first-floor hallway Tuesday, Aug. 27, 2019, at Yale Apartments in Tulsa, Okla. Bailey, who lived off and on the streets for several years, has lived in housing owned by the Mental Health Association of Oklahoma for 10 years.

Alyssa Orcutt knows that reality all too well.

Black tattoos crisscross Orcutts arms and back etchings of a past she chooses not to forget.

Theres the four-leafed clover with the words But for the grace of God a throwback to the moment she got sober in 2014, on St. Patricks Day.

And theres a picture of lady justice, her scales resting even to represent the vast criminal record she accumulated while homeless and on the streets of Tulsa that she's since overcome.

It takes a lot of courage to live the life I lived, Orcutt said.

Her life is a case study in the mental toll that homelessness can take and the power of housing to heal those invisible scars.

She descended into homelessness when her abusive husband went to prison leaving her with nothing, because the house and car were in his name. A man groped her the first time she visited a homeless shelter, so she never went back. Instead, for two and a half years, she camped at a local park.

I just gave up all hope and I turned to street drugs to help cope with the pain of what you go through on the streets, Orcutt said. Because its very violent; theres a lot of violence that happens when you're living outside.

You cant focus on mental health when youre just trying to survive the day, Orcutt added. I just wanted to make it to midnight to live another day. When I wanted to live."

She racked up a slew of charges, ranging from what she calls survival crimes for stealing food and clothes to violent felonies. But a prison diversion program helped her finally get sober, she said.

Then came years of therapy to unpack the tangled web of mental illness that became exacerbated on the streets.

"I lived 24 years without anxiety and depression and PTSD," she said. "And after two and a half years on the streets, now I have these diagnoses.

She's an example ofthe Mental Health Association's culture of inclusivity. She's now a case manager for the nonprofit's Denver House a day center for some of the most mentally ill people living on the streets of Tulsa.About 60 percent of her fellow employees at the association also have diagnosed mental illnesses. More than one-third of the employees have a history of addiction. And a quarter experienced homelessness.

A key step in Orcutt's journey: An apartment provided to her and her two children.

Some people in Colorado Springs have taken notice.

Three years ago, several local nonprofit leaders visited Tulsa and toured the nonprofits program.

They saw first-hand the Tulsa nonprofit's strategy: Purchase and refurbish declining or dilapidated apartment complexes and motels across the city. Then, rent them at affordable rates often to people suffering from mental illness.

The reason for relying on existing buildings was simple: Keep costs relatively low while maintaining the citys affordable housing stock, said Brose, the nonprofits CEO.

Under the nonprofits auspices, the buildings wont get razed to make way for a new development, or flipped by developers seeking to gentrify an area and raise rents.

At some point, youve got to not only create more affordable housing, but preserve affordable housing, Brose said. A lot of our properties we only have one new construction theyre all existing apartment complexes that we purchased and own.

Theyre not fancy, he said. "But we certainly want them to be safe and affordable and to be decent.

And, Brose adds, theyre often available to people who wouldnt be accepted anywhere else people with histories of evictions, drug use and homelessness.

We refer to ourselves as benevolent landlords, Brose said. Sometimes people fail in our housing. But as a benevolent landlord, we'll give them repeated chances to come back.

A year later, Brose himself visited Colorado Springs and spoke at a conference hosted by the Pikes Peak Continuum of Care, which is focused on addressing homelessness.

The Tulsa nonprofit made an impression.

They understand that homelessness and health are so intricately related, said Shawna Kemppainen, who went on the trip as executive director of The Place, a youth homeless shelter in downtown Colorado Springs formerly known as Urban Peak. Its really interesting that its the largest mental health association there in the state that's actually doing homeless housing, and is very productive with it.

Chris Garvin, deputy executive director for the El Paso County Department of Human Services, agreed.

It was pretty impressive in that they were able to garner community support, Garvin said. And the fact they would buy maybe a defunct apartment building, or an apartment building that was pretty riddled with crime or drugs. And they were able to go in there and I dont want to say gentrify it but they brought it up a notch. And it kind of improved the neighborhood.

Brose's visit to Colorado Springs helped lead Tulsas fire department to adopt a Colorado Springs program called CARES. Its a partnership of the Colorado Springs Fire Department, AspenPointe and other agencies.

Its goal is to create a team to act as a special service to people who are known as super utilizers people who call 9-1-1 at a disproportionate rate, using it more as a medical service than an emergency line and tying up resources while jacking up health-care costs in the region.

Now, some wonder whether Colorado Springs could learn a lesson or two from Tulsa.

For his part, Greg Shinn, the Tulsa nonprofit's chief housing officer,called the organization's model inherently transferrable." And he urged for local leaders also to consider tax increases, arguing such investments could pay off in spades.

Any locality can do it its a nonpartisan issue, Shinn said. Nobody wants to waste money locking up people who are homeless that could be in housing. Nobody wants to waste money with law enforcement emergency runs or emergency hospitalizations that could be avoided if these people were in housing with the services that they need.

Lets stop throwing away money.

A belief in 'doing what's right'

Several Colorado Springs nonprofit leaders who saw the Tulsa program first-hand a few years ago said one factor stands above the rest in limiting Colorado Springs from taking a similar approach: Funding.

The presence of multiple well-heeled philanthropists in Tulsa and those donors penchant for giving substantial sums of money to the social service sector is what separates that city from others.

Most of the Mental Health Association of Oklahoma's units were purchased over the last 10 years, after the nonprofit raised $65.5 million.

Three-quarters of those donations came from private donors. And nearly half $30 million came from a single philanthropic organization: The Anne and Henry Zarrow Foundation.

Henry Zarrow was the son of a Jewish immigrant who fled to the U.S. escaping the Russian pogroms, according to accounts in the Tulsa World. He started his first company at the age of 22 and became a powerful player in the oil and gas industry then gave away much of his wealth at the behest of his wife, Anne Zarrow.

Homelessness and mental health have been top priorities for them, as well as for Henrys brother, Jack Zarrow.

Only Jack Zarrow's widow, Maxine, remains alive. But the Zarrows' philanthropy lives on in the foundations established in their names.Both families are really social justice-minded, said Nancy Curry, program officer for the Zarrow Family Foundations. And really kind of believe in doing whats right.

Excerpt from:
Fighting mental illness with affordable housing: What can Colorado Springs learn from this Tulsa nonprofit? - Colorado Springs Gazette

GE Healthcare and Theragnostics have struck up a global commercial partnership around the development and sale of the prostate-specific membrane antigen (PSMA) PET/CT imaging agent, GalliProst.

The scan indicates whether the disease is within the prostate gland, spread to the local lymph nodes or spread with more distant metastasis. Theragnostics will head development of the radiopharmaceutical, while GE will oversee all pre-approval commercial preparations, as well as all subsequent commercial and distribution tasks following the tracers approval.

"We believe GE is one of a few companies that provide a global reach into every market in the world. They also have the ability to access both generator-produced Ga-68 as well as cyclotron produced Ga-68," Greg Mullen, CEO of Theragnostics, told HCB News. "Ga-68 is the radioisotope in GalliProst that allows it to be visualized on the PET scanner."

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Derived from Gallium-68, the new tracer provides clinicians with "heatmap-style" images that show the precise location and intensity of PSMA, which is expressed on the surface of prostate cancer cells. A phase II clinical study that met its primary and secondary endpoints showed that clinicians who used GalliProst ended up modifying treatment plans for one third of newly diagnosed prostate cancer patients and over 50 percent with biochemically recurrent disease. This change in patient management rose to 75 percent in a post-radical radiotherapy environment.

"The scan provides the physician with an indication as to whether the disease is within the prostate gland, spread to the local lymph nodes or has spread with more distant metastasis," said Mullen. "Conventional imaging (CT or bone scan) has difficulty in detecting small volume disease outside of the prostate. Therefore, GalliProst can help determine whether curative therapy (surgery or targeted radiotherapy) or systemic treatment (hormone/chemotherapy) is the most appropriate treatment."

The agreement follows another orchestrated last month in which AstraZeneca granted Theragnostics a license to operate globally in the diagnostic field of certain selected radionuclide-labelled PARPi (Poly (ADP-Ribose) Polymerase inhibitors), with an option to an exclusive license for freedom to operate globally in the therapeutic field of certain selected radionuclide-labelled PARPi.

Both GE Healthcare and Theragnostics will be on hand to discuss their findings from October 12-16 at the European Association of Nuclear Medicine 2019 Congress (EANM) in Barcelona.

Link:
GE Healthcare and Theragnostics partner on PSMA PET/CT tracer - DOTmed HealthCare Business News

As with fertility testing, the type of infertility treatment you receive will depend on your unique health and medical history. If youre a woman with a blocked fallopian tube, for instance, you may need surgery to remove the blockage or to repair damage before trying other fertility treatments. If youre a man who isnt producing sperm, its possible you have a blockage as well, and your doctor might recommend a procedure that retrieves viable sperm directly from the testes, or a surgery that removes the blockage.

If youre a woman under 35, treatment will likely start conservatively, said Dr. Choi. For example, your doctor may prescribe oral drugs such as clomid or letrozole, which increase the odds of pregnancy by boosting the number of eggs you release during ovulation. This approach is also common for women with certain hormonal conditions such as polycystic ovary syndrome, in which ovulation doesnt occur regularly.

Your doctor might instruct you to combine oral drugs with sex at home; or to time taking them with ovulation or with an in-office procedure called an intrauterine insemination (IUI), in which a clinician prepares a sperm sample then inserts it directly into the uterus to increase the odds of conception.

[More on intrauterine insemination.]

Women who are over 35 may also start conservatively with oral drugs or IUI, but if those measures dont work after a couple of tries, or if its clear from your medical history that they arent likely to work, Dr. Choi typically recommends moving more quickly to more aggressive treatments, such as in vitro fertilization (I.V.F.). Here, the idea is to fertilize the egg outside of the body and then put the resulting embryo back in. (To read more about I.V.F., see our guide on it here.)

Fertility treatments will also vary for people who are single, in same-sex relationships or transgender. If youre a woman whos single or in a same-sex relationship, for example, you may try IUI or I.V.F. with sperm from a donor, depending on your age and your fertility status. Women in same-sex partnerships will also need to decide which partner should carry the baby, which will depend on preference, age and health. (It is also possible for one partner to harvest eggs and the other to carry the embryo, a process sometimes called reciprocal I.V.F., shared maternity or co-maternity.)

Men who are single or in same-sex partnerships will need a surrogate to carry the embryo, whether she uses IUI, I.V.F. or some other means of conception. Men in these circumstances may also need an egg donor.

If youre transgender, your fertility treatment will depend on your individual history regarding sex reassignment surgeries, hormone treatments and so on. For example, if youve already had sex reassignment surgery, you may need donor sperm or eggs, unless you froze your own beforehand. If you only had hormone treatments, you may be able to reverse this process temporarily through new hormone treatments (under the guidance of a physician), in order to produce viable sperm or eggs.

Continue reading here:
Your Guide to Fertility and Getting Pregnant - NYT Parenting

When did you first hear about the hunger disease study that was conducted in the Warsaw Ghetto?

I visited Poland as part of a delegation from Ichilov Hospital [in Tel Aviv]. Given the composition of the group, our guide, Yaki Gantz, included medical information in his tours. One day, when we were near the Warsaw Childrens Hospital, he told us about the hunger that had existed in the ghetto during World War II. And then he mentioned, in passing, that because the hunger was so acute, a group of Jewish physicians there decided to carry out a study of its effects.

The situation in the Warsaw Ghetto was singular. There is testimony of a meeting of senior Gestapo personnel and Nazi physicians Eichmann was also in attendance at which it was decided to liquidate the ghetto by means of starvation. According to their calculations, low-calorie food rationing would wipe it out in nine months.

They calculated a daily ration, just as we dietitians do.

It was racially derived rationing: Germans received more than 2,000 calories; Jews, less than 200.

There was a clear hierarchy [in the occupied countries]. First the Germans, then the Ukrainians, whose ration was about 1,000 calories; the Poles with 600; and the Jews, at the bottom, with 180 calories. As a dietitian, I must say that this is an incomprehensible number 180 calories a day means one slice of bread, one potato and soup, which was mostly water. I doubt that a portion of soup like that contained more than 10 calories. Thats nothing. My head started to spin.

I said to my colleague, dietitian Dror Ben Noah: Do you understand 180 calories? He too was shocked. I asked whether he had ever heard of the hunger disease study that had been conducted in the ghetto. He said he hadnt. Google turned up only a few results, referring to the fact that the study had indeed been carried out. The material itself the data, the findings simply doesnt exist on the web. We realized that we had to do something.

Well talk about the fate of the manuscript that documented the study shortly, but lets first consider the story itself. The plan to starve the ghettos residents didnt cause its liquidation, but it definitely took a toll. The bodies lying in the street, which we know all too well from photographs, were those of victims of starvation.

Its a lethal combination hunger and disease. The starvation plan mainly took the lives of the most vulnerable: the elderly, children, mothers of small children. Its also important to emphasize that the ration of 180 calories was provided in return for payment, and most people could not afford it, of course.

But in practice the ghetto inmates managed to obtain additional food, through smuggling, the black market and public kitchens.

The public kitchens of the Joint [the Joint Distribution Committee] gave out soup and that truly was one of the most amazing and moving things I learned on my trip, in connection with the research study. They declared that from their point of view, the distribution of the soup made it possible to give children in the ghetto an educational experience involving courtesy and cooperation.

The brutal hunger gave rise to horrors, undoubtedly. There was cannibalism. There was violence, people murdered and stole to get food. And yet, on the other hand, a bowl of watery soup could engender values. A social network. Support. You need to see the photographs of the orderly line where everyone is waiting patiently. Of the children sitting at sparkling-clean tables. Those who were fortunate in the ghetto existed on 800 calories a day, but that average consumption also gradually decreased, as time passed and resources dwindled.

Seeking validity

In February 1942, a group of Jewish physicians in the ghetto, led by Dr. Israel Milezkowski, decided to conduct an extensive study of the physiology and pathology of hunger there.

Milezkowski thought in practical terms. He wanted to understand how hunger disease could be cured. It was another physician, Dr. Julian Fliederbaum, who saw the potential of such a study, who created the whole research platform. He wrote that this was a singular opportunity to study hunger and that he wanted to do so with the best tools at his disposal, so that the results would have incontrovertible scientific validity.

An impressive research structure was indeed created. The study was divided into several sections, each led by an expert in a particular field. The topics researched included blood circulation, clinical aspects of starvation in children, bone marrow and more.

To begin with, the scale of the research project was immense. More than 100 participants, which is a huge study. By comparison, in clinical studies we conduct today, in a metabolic laboratory, having 10 subjects is considered a dazzling success. The ghetto study was carried out at the highest standards.

How could the researchers know that the subjects medical condition was due to hunger and not to a combination of that and other diseases?

The subjects were hospitalized in separate rooms that were strictly off-limits, to avoid infection. They were given medical tests and the results were recorded on the wall. Like a medical chart. The tests they administered were solely for research purposes, irrespective of the subjects medical condition.

Its sad and horrible, and its very hard for me to say this, but they also performed autopsies to ascertain that this was in fact the cause of death. Anyone who was found to have been suffering from a different disease was omitted from the study. The most difficult part was to collect the various findings from all sections of the research. The researchers spent the nights in the cemeterys [ritual] purification structure, collecting, summarizing, performing autopsies and writing up the findings as in a scientific article.

Jews were prohibited from engaging in scientific work. If theyd been caught, they all would have been executed.

The Judenrat [Jewish Council, established by order of the Germans] authorized the research. Its members understood the importance of the study, and also allocated resources to it. Money was needed to smuggle in equipment blood-test kits, for example. Most of the smugglers were women, because if the authorities caught a male smuggler they could check to see if he was circumcised and know immediately that he was a Jew. Imagine youre sending a female smuggler to get hold of some piece of medical equipment. She has no idea what it even is. What to ask for. So they draw her a detailed picture. As a professional, I can only admire their thinking.

For example, the researchers wanted to understand what happens to the energy usage of a person who loses weight. Thats a question that occupies the experts in our field even today. We measure it with special equipment and calculators, but they simply calculated it using a pen and paper. The subjects underwent a test for tuberculosis, as the physicians realized that they could draw inferences from this about the immune system. They examined the acidity of the digestive system, hormone levels. What was even known about hormones in the 1940s? Look, at that point in history, the finest medical minds of Central Europe were concentrated in the Warsaw Ghetto. All of them were Jews. It was absolutely a scientific hothouse horrifying and frightening, but a hothouse. They even did glucose-tolerance tests.

What I wonder is where they got sugar.

They used 75 grams of sugar per subject. Sugar was priceless in such a situation. One cannot imagine how much it was worth.

Act of defiance

Is it even imaginable how the researchers themselves stood up to it? After all, they were hungry themselves.

They were hungry. Picture it: a physician studying the disease he is himself is suffering from and from which he will also likely die. We know the stories about physicians who fell ill with diseases and tried to come up with medication to treat them; some of them succeeded. That is not the case here. They werent doing the research in order to save themselves. They did the research in the clear knowledge that they would suffer the identical fate: There were physicians who took part in the project, and died of hunger.

And the study ended with the Grossaktion the deportation and mass murder of the Jews in the ghetto during the summer of 1942.

The researchers final meeting was apparently held in August 1942, during that Aktion. Dr. Milezkowski informed the group that this would be the last one and announced that the findings had been hidden in the cemetery. Some of the physicians who had taken part in the study were also deported in the Aktion. As far as is known, a week after that meeting most of them were no longer alive.

Of those who led the study, only one survived. The manuscript was successfully smuggled out of the ghetto. Milezkowski himself apparently committed suicide. He wrote an introduction to the study, which is jolting: I hold my pen in my hand and death stares into my room.

Yes. He understood this was the end. He understood that if the study would survive and be published, it would perpetuate the memory of all the participants. He writes explicitly that this project is their response to the murderers, adding, I shall not wholly die. This is a story of unbelievable heroism. The way they functioned, under those conditions. The self-surrender, the transcendence. I cant understand where they found the inner fortitude to do all that.

The study gave them meaning.

What is more precious than meaning? The study is their act of defiance, the doctors revolt. We should note the courage of Prof. [Witold] Orlovski, the Polish colleague who safeguarded the manuscript. After the war, Dr. Emil Apfelbaum, the only one of the leaders of the study who survived, retrieved the text from Orlovski and passed it on to the Joint Distribution Committee. Because the JDC was then headquartered in France, the manuscript was translated into French and published in France. I dont know how many copies were printed probably only dozens.

In 1979, an English-language version was published in book form under the editorship of Dr. Myron Winick, an American expert on nutrition, under the title Hunger Disease: Studies by the Jewish Physicians in the Warsaw Ghetto. At the moment, the fate of the original manuscript is unknown.

True. No one knows where it is. By the way, even the Joint didnt know it had this material. I contacted the organizations historian and didnt let up, until one day she called and said, We have it. They produced the Polish and French versions, in 1946. The materials are in their archives.

Are copies of the English edition still available?

They exist but are rare. I found a few copies on Amazon and eBay. I bought them, because I think that every copy should be salvaged and preserved. The thing is that, because of our interest, and because we bought a few copies, we drove the price up. The first copy I bought cost $5. Now theyre going for $1,000. We are raising money to buy all the extant copies.

Lets talk about the studys relevance for our time. When you declare that you want to save it, the goal is not to place it in a museum. You want to make this body of knowledge available. From your perspective, its a textbook.

This study is super-relevant in terms of all the issues were dealing with today in the field of nutrition. People dont realize it, but most of our work in hospitals focuses on malnutrition thats generated by disease. Because we live in a society of abundance, we find it hard to understand that hunger exists. But such research is relevant also, lets say, when it comes to the metabolic or biochemical situation of people with advanced cancer a situation in which, even if there is plenty of food available, the body simply consumes itself. That condition is described in an unprecedented way in the study.

We understand today that a phenomenon like edema stems from hunger. But it wasnt yet known at the time the ghetto study was conducted. That study examined, proved and effectively diagnosed a disease that is today called the hunger disease. A disease that has various symptoms, and if treated at the relevant stage, if there is timely intervention can be cured with food.

That is an important point in itself that there is a point of no return, after which it becomes impossible to save a starving person by means of feeding. Can you describe the stages [development] of hunger disease?

The first stage is a decline in the reserves of fat. The second stage is an accelerated aging of all the body tissues. The final stage, which is relevant for our time, is called cachexia a sometimes irreversible decline in the mass of body fat and muscle; in children, it also affects the bones. At this stage, in cancer sufferers, for example, in order to help the patient, its necessary to treat the source of the cachexia. The tumor itself. The patient is fed, of course, but only if treatment of the cancer is successful will he be able to begin to recover.

The internal organs also respond to hunger with a process of shrinkage and nonfunctioning.

Autopsies performed during the study revealed a small liver, an enlarged spleen and a weakened heart muscle.

Winick writes that the physicians most important conclusion was that the rehabilitation process from hunger disease must be gradual. If the medics of the Allied liberation forces had known that, possibly many lives could have been saved. Many survivors died after liberation, simply because they ate.

That is a truly appalling story. Do you know what they were given? Condensed milk. The people who liberated them thought the survivors needed to be given something that would be both imperishable and rich in calories. But condensed milk is actually pure fat. Their body couldnt handle it. One of our fellow dietitians, Shulamit, second-generation [to Holocaust survivors], told us that when the Allies arrived in the camp where her father was, and distributed food, her father said: Take care of the others, I can wait. And thats how he was saved. If hed fallen on the food like all the others, he would have died on the spot.

When a person suffering from anorexia-induced cachexia comes to see me, we feed them very carefully. Ten calories per kilo of body weight, for example. At the same time, we start to correct the deficiencies in micronutrients, because that is what kills them. We add phosphorus, magnesium, vitamins. Without that treatment, all youre doing is bombarding the patient with calories, and the body just collapses. Only after we see a correction in those values can the caloric value be increased. Death resulting from food intake is a phenomenon we also have see among children in Africa, because of the good intentions of aid organizations, which simply didnt know what to do.

Generally speaking, its more difficult to assist undernourished children, because they need food in order to develop and not just in order to survive. When they dont receive food, the heart, the liver and the brain dont develop. It can be clearly seen that the process of collapse, which in adults lasted months, took weeks in children.

Unique point in history

I wonder if among the subjects in the ghetto there were those who were not in a terminal state, and who could possibly have been helped, but whose fate was sealed for the sake of the research.

I dont know. The findings show that they arrived in different stages of hunger. I find it hard to believe that any of them was in truly initial stages. Were talking about women who weighed 28 kilos [62 pounds]; elderly people who weighed 34 kilos. That is not a good situation. Its important to understand: They were given food in the ghetto hospital. Meager food, but still food. They were treated well. They were given painkillers. Their eye infections were treated. But it was impossible to save them.

Palliative care.

Yes. Their [suffering] was relieved as much as possible. And additionally, they were subjected to testing. The physicians carried out some of the tests on themselves, to set a reference point. Its all detailed here in the study. Systematically. With graphs they drew. Its simply out of the question that we dont have this material.

Overall, and for obvious reasons, there are very few studies about hunger. The best known of them is the Minnesota Starvation Experiment of 1944-45, which is controversial in itself.

That study was conducted on [draft-age young men]. What sort of malnutrition regime was imposed on them in the project? To consume 1,800 calories a day instead of 3,000 or 4,000. What would have happened if theyd had to subsist on the rationing that existed in the ghetto? God help us. Beyond that, the researchers didnt reach the achievements of the hunger study in Warsaw. The latters findings on how hunger affects the eyes, for example, is unparalleled.

The only way to arrive at such findings is through atrocities. Ethically and practically, there is no way to conduct a study of this kind. It could only have occurred at that point in history.

The doctors in the Warsaw Ghetto could also perform an autopsy to see exactly how hunger affected organs, but that was not an option in the Minnesota experiment. Its a wild historical drama: That horror is the greatness of the ghetto study; its the total opposite of the appalling studies the Nazis carried out in the Holocaust.

We havent spoken about the psychological effect of hunger.

At first there is whats known as hunger madness. People become violent. People are ready to do anything. Anything in order to eat and get food. Cannibalism can occur. Killing. Theft. The Minnesota study dwelt on this stage, because they wanted to understand the behavior of POWs; the study describes how they had to restrain the subjects with force because they were willing to do anything to get food. They wanted to eat everything, including non-foods. After the madness comes a stage of apathy. Youre hungry but you dont want to eat. Food is no longer of interest. The subjects in the ghetto study were already in that phase. They were apathetic.

That connection, between the studys historical importance and its scientific relevance, is rare.

Its findings are relevant. The method and the planning are relevant. Even the equipment they used is relevant. You know, I came back from Warsaw obsessed. My children cant take me any more. They tell me Im driving everyone crazy. I told the story of the research project to people I met in the supermarket. I just wanted to shout it out to the world. A month ago, I got back from another trip to Poland, this time to a conference in Krakow. It was unbelievable: The lectures revolved around the questions and the findings of the study. The knowledge theyre so proud of in 2019 it all already existed but no one knows about it. Its a scientific legacy of the first order.

The physicians in the ghetto had to decide either to despair of the situation and give up, or to tell themselves: I am a doctor and this is my way to fight back. They have not received sufficient scientific appreciation, certainly not enough for their greatness of spirit. Breakthrough studies like this one, studies that are milestones, are quoted and made use of for years upon years. This study remained in the dark. Today I can find through Google an article that appeared 30 years ago in the Lancet and order it. There is no access to the [text of the original] hunger disease study. Only those with a physical copy of the book can make use of it.

You and your colleagues have a plan.

Absolutely. First, we have to get hold of all the copies of the English-language edition that still exist and distribute them in relevant places: universities, laboratories, nutrition units in hospitals. The second thing I want to do is to get the book retranslated, from the Polish original. I dont know Polish, but even the superficial comparison I made shows that there are sections missing in the English and French versions. For example, the Polish version has the initials of all the names of the subjects. There are names of doctors who took part in the study and were omitted, and thus not perpetuated. I imagine that other things are also missing.

The aspiration is to translate the whole book anew and make it accessible, digitally, in libraries, in other sources. For people to work with it, study it, quote from it. And, of course, in the end we also want to have a Hebrew version, with notations and commentaries relevant for our time from expert physicians. On all these fronts we are moving ahead slowly but surely. It will all happen. We are goal-motivated. We will not give up.

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The secret starvation study conducted by Jewish doctors at Warsaw Ghetto - Haaretz

SAN RAMON, Calif., Oct. 11, 2019 /PRNewswire/ -- Surprising results in a new national survey find that consumers rarely trust popular celebrity endorsements for weight loss programs. In fact, according to the survey, conducted by LeanMD, Inc., nearly 60% of adults say medical professionals are their go-to-source for weight loss information. Although the weight loss industry paid out multi-million dollar sums to celebrities for their endorsements last year, including the Kardashians, Oprah Winfrey, Rob Lowe, Marie Osmond and Dan Marino, the survey uncovered the fact that less than 2% of consumers are inclined to take their advice.

Less surprisingly, the survey found that men and women across all age, regional and economic demographics, have attempted to lose weight. Over one third of respondents have lost between ten and 25 pounds in their lifetime.

LeanMD, Inc. is a medically supported weight loss program that features a mobile app and offers patients a way to lose weight safely and effectively. Additional findings from their survey of 1,022 adults age 18 to 65 from across the US include:

"Although the weight loss industry pours incredible amounts of money into celebrity endorsements, we were not surprised to find most adults prefer to get their medical advice from a medical professional," said Dr. Mark Musco, co-founder, CEO & Chief Medical Officer of LeanMD. "When we look at a patient, we see the entire person, including their lab results, medical history, body composition analysis, and more. As medical providers, we have access to all the tools needed to maximize patients' metabolism and help them reach optimum health levels. For example, we can check hormone levels, thyroid function and other key metrics; and we can prescribe medications to help the patient manage hunger safely."

Dr. Musco adds that losing weight can be risky especially if the patient has known (or unknown) health conditions and it is important to have weight loss and vital signs monitored consistently, to ensure weight loss is accomplished safely.

About LeanMD, Inc.LeanMD is a medically supported weight loss program that features a mobile app and offers patients a way to lose weight safely and effectively. Today, LeanMD has locations throughout California, Colorado, Hawaii, Indiana, Louisiana, Texas and Oregon, with new markets scheduled to launch. Learn more at http://www.leanmd.com.

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View original content:http://www.prnewswire.com/news-releases/national-survey-debunks-celebrity-endorsements-with-nearly-60-of-adults-claiming-medical-professionals-are-their-go-to-source-for-weight-loss-info-300937297.html

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National Survey Debunks Celebrity Endorsements with Nearly 60% of Adults Claiming Medical Professionals are their Go-To Source for Weight Loss Info -...

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Keeping the weight in check is a never-ending process. Even if someone gets set into a routine that becomes second nature, it is still basically work. Working to make sure the weight stays at the ideal level. But sometimes those people with a set routine start to see a weight gain. Slowly but surely the weight can inch up the scale.

What could possibly be causing this weight gain? There are plenty of reasons for this but the main reason that affects most people is a decrease in metabolism. As people grow older, their metabolism drops. Its just a fact of life. But sometimes it drops too steeply at too young an age. It can cause problems like weight gain or muscle mass decrease or trouble sleeping.

Trying to figure out if it is actually the metabolism levels that are causing these problems can be as simple as going to the doctor. But who really wants to go to the doctor? Nobody. Not because making sure the body is in top shape is a bad thing. Its because the entire process of going to the doctor is just a nightmare. Waiting forever and, even with insurance, spending too much money on what will end up being a 5-minute meeting with a doctor. Its mind-numbing.

Luckily, there is a way to get some health facts without having to go to the doctor. Cutting out at the middle man can only be a good thing. Over at EverlyWell, there are tons of options for take-home tests to get levels on all sorts of things. Testosterone levels or cholesterol levels can be checked from home with ease. And fittingly, EverlyWell also has a Take Home Metabolism Test.

The Take-Home Metabolism Test is really simple to use. Just order the test and it will be delivered pretty quickly to the home. Once it has arrived, enter the barcode on the box into the EverlyWell site. Then it is time to just give a little prick on the finger to extract a little bit of blood, then deposit some saliva into the prepackaged vials that come in the box. Pack them up and send them back to EverlyWell. From there, a board-certified physician will check the levels and send the results in on the EverlyWell platform.

What the doctor is going to look at is the levels of three key hormones. What the test will check out is cortisol, free testosterone, and thyroid-stimulating hormone levels. From there, the doctor will be able to figure out if the metabolism is not working at the highest functionality. And it is simple as can be. The Take-Home Metabolism Test is a lot simpler than having to get up and go to the doctor.

Being able to check out the metabolism levels at home with the Take-Home Metabolism Test is really the definition of convenient. There is nothing too difficult here. And from the comfort of home, each man can figure out what needs to be done with these results. There are plenty of ways to work around a metabolism deficiency. But they cant be utilized without the knowledge this test can provide. Get it now to get back on the right path.

Get It: Pick up the Take-Home Metabolism Test ($89) at EverlyWell.

Check out the great products and gear we recommend to Mens Journal readers.

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Get Your Metabolism In Order With This Take Home Test From EverlyWell - Men's Journal

Jordan Teitelbaum is a successful guy. Also, busy. At 32, the father of two is finishing an endoscopic sinus surgery fellowship (he specializes in removing brain tumors through the nose), looking for a job, paying the mortgage on his new house, and trying to be present in the life of the woman he married three years ago while attempting, in the spare moments he doesnt really have, to look ahead.

Im only partially into my thirties, I can see that this will be the most demanding decade yet, he laughs. Im trying to set up the rest of my life, not just for myself, but for my little family.

Teitelbaum doesnt sleep much. And hes far from alone. Doctors or not hell, parents or not American thirtysomethings tend to struggle with the stress of their third decade after the comedown from their mid-twenties before stabilizing in their forties, lightening up in their fifties, and peaking again in their sixties. (Research shows that happiness peaks at the age of 23 and 69, hold the jokes.) The ennui takes many thirtysomethings by surprise they tend to be, after all, more secure and stable professionally, personally and financially than twentysomethings but maybe it shouldnt. In 1968, ur-developmental psychologist Erik Erikson posited that there are eight stages of psychosocial development and that the sixth stage, Intimacy vs. Isolation, occurs between the ages of 18 and 40. This stage is characterized by significant emotional conflict in close relationships. If the stage is completed, people move on to have healthy, secure, and committed relationships. If not, they struggle to move on with their lives and face a heightened risk of loneliness and depression in the long term. In other words, thirtysomethings like Teitelbaum are playing a high stakes game.

No wonder theyre so stressed.

Regardless of lifestyle, personal well-being, as measured by Gross Domestic Product in aggregate, tends to bottom out in peoples thirties. Why? Because as thirtysomethings shed the impractical expectations they carried through their twenties, age, economic realities, and social changes deliver a combination punch that, emotionally speaking, puts many on their ass. And, yes, its worse for parents. Theres reason to believe that the early parenthood drives down well-being scores significantly. As rewarding as parenthood may be in the long-term, the short term is hard as hell.

Before we hit our thirties its acceptable to make mistakes both professionally and romantically. But as we get older, failure may feel more significant and lead to some loneliness and isolation, Karen Rosen, a psychotherapist and clinical social worker, explains. Combine this with the strain of sustaining a household and you have some adults who are really tapped out. Its a time of pretty strained resources.

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There are plenty of economic factors that exacerbate thirtysomethings economic concerns. Financial experts recently estimated that the age of 31 is the most expensive year of peoples lives on average, costing people about $61,000. This is a consequence of a combination of big bills, such as weddings, buying a house, having a baby, and paying for a honeymoon, on top of everyday expenses, but does not include retirement savings or money to support a family in the long-term that will cost extra. That means that, with the average salary hovering just over $44,000 among full-time employees, plenty of people spend their third decade going into debt. This is more the case now than historically because of the outsized effect of the Great Recession on Millennials. Americans born between 1981 and 1996 have fallen short of every generation of young adults born after the Great Depression, amassing less wealth than their parents and grandparents higher levels of education. Men and women in their thirties are marrying at the lowest rates on record, and the U.S. birth rate is similarly the lowest it has been in 32 years.

Though the job market has recovered since cratering in 2008, Millennials remain behind when it comes to earning, wages adjusted seemingly forever down after entering a job market at cut-rate salaries, and thats on top of decades of wage stagnation. It doesnt help that student debt has exploded. The average debt after graduation is about currently $30,000, nearly double what it was in the 1990s.

What can people in their thirties do other than white knuckle it through the toughest time of their lives?

The not-so-great good news for Millennials is that many owe less because they have fewer assets. In 2016, homeownership rates fell to 36 percent among people under 30, compared to nearly half of Baby Boomers who owned homes at the same age. This has inevitably driven down home ownership rates overall to the lowest in half a century, 63 percent, compared to nearly 70 percent in 2005, when the subprime lending bubble was about to burst. The problem is not that Millennials are unmotivated or unaware of their generational shortcomings. Research out of Stanford found that most people over 25 actually want to get married by the age of 27, buy a home by 28, and start at family by their 29th birthdays. But since the ability to accomplish these goals has decreased with every generation, those between the ages of 25 and 34 want them the most. But thanks to the rise of the gig economy and false promises of hustle culture, they are the least set up to achieve them.

And heres the thing: Thirtysomethings would be feeling the burn even if none of those things was true. Why? Because thirtysomethings are in a high resource demand part of their lives. They are, on average, supporting a kid, making car payments, and trying to invest or investing in real estate. They are also incurring the costs of working (commuting isnt free) while also spending on activities designed to help them maintain social connections that seem increasingly tenuous. If weddings make peoples twenties expensive, everything makes peoples thirties expensive. This is a lesson people tend to learn in the fifties, when they report being about five to six percent happier than those in their thirties in no small part because theyve made it to lower demand, higher resource point in their lives.

Theres a reason why grandparents often seem so much happier than new parents. They have money.

They also have kids. That might sound odd, but theres a difference between having young children and having grown kids. Research suggests that having grown kids increases well-being profoundly and that having young children does not. Individuals who invest the struggle that is their thirties into having children, like Teitelbaum, generally experience higher levels of happiness in their fifties, whereas those who do not either flatline or become worse off.

A recent study of over 55,000 people 50 and older demonstrated this, along with other work published in 2011 and 1994. Parents are not invariably happy, but they become happier once children achieve economic independence and move out. This is presumably because grown kids provide social and emotional support and keep their parents engaged in a way that infants can not and do not, forcing their parents to look for meaningful connection elsewhere.

And that search, as many can attest, becomes hard after the party-hardy twenties come to an end. A study of over three million men and women found that the number of friendships they had started to decline in their mid-twenties, dropped off dramatically throughout their thirties, and did not begin to rebound again until their mid-forties, when their kids were older and more self-sufficient. The problem? Thirtysomethings just dont have the bandwidth to maintain many close relationships and lose touch with the outside world as a result. And this takes a massive toll. Friendship has been found to lower blood pressure and BMI, increased longevity, improved psychological health, and increase individuals ability to cope with rejection. For thirtysomethings, this is particularly dangerous. Consider Maslows hierarchy of needs. Its called a hierarchy for a reason: If people cannot elevate themselves to a point where they feel a sense of belonging, they will not be able to elevate themselves further and get a sense of self-esteem. This makes the inevitable diaspora of the thirties friends moving for work, love, and to have children profoundly destabilizing on a personal level.

Our basic needs such as food, sleep, shelter, and safety are the staples of our well-being. Lack in any of this can, in the long run, have detrimental effects on our health, Dr. Lina Velikova, a physician and sleep expert. When those needs are not met, it is that much harder for people to experience deeper feelings of fulfillment.

Its also worth dwelling on that second need for a moment because sleep and sleep related issues define, in many senses, the experience of living through ones thirties.

Sleep starts to naturally decline in sleep that starts at the age of thirty, exacerbating mental and emotional strain. Deep sleep specifically, also known as delta sleep, which supports memory and learning as well as facilitates hormone production, declines by some 50 percent by the time people enter their thirties. A massive review of literature published in 2017 found that this may be a result of aging brains fail to recognize signals of tiredness or exhaustion. The result is usually a combination of insomnia and sleepiness, the haze of early middle age. Parents, who lose an average 109 minutes of sleep every night for the first year of their childrens lives, struggle more.

People who sleep less than the recommended seven-hour minimum produce more stress hormones like cortisol, experience more inflammation, and are at a higher risk for certain types of cancers. Sleep deprivation can also lead to sexual dysfunction. Because thirtysomethings are often unaware of a biological transition taking place, they may misdiagnose symptoms of sleeplessness as signs of true sexual dysfunction, mood disorders, or even burnout.

Long story short, because of tiredness and feelings of abandonment, thirtysomethings focus bad energy on themselves. And all that self-reflection can exacerbate the problems.

In America, psychoanalysis really took off because it spoke to consumerism, it spoke to privileging the individual over the collective or community, and spoke to the inward, almost egotistically if overdone self-reflection, psychotherapist Michael Aaron explains.

The American wellness industry, broadcasting messages about hustling, seizing the day, getting perfect skin, meditating, and eating the right CBD vitamins, offers, at best, half-measures.

The problem is that individualism rarely makes anyone feel better. An overwhelming amount of evidence suggests that, for better or worse, immediate resources and environment move the needle the most when it comes to overall well-being. Immediate resources, thanks to increased spending, and environment, thanks to social shifts, are the two places that thirtysomethings tend to feel like theyre losing ground. Does therapy solve that? Only if therapy promotes social behaviors and only if it helps dad and mom find time to see friends. Pre-modern man didnt have these problems.

Aaron cites French sociologist mile Durkheims seminal 1897 work, Suicide, in which Durkheim demonstrates a strong link between industrialization and suicide rates. He concludes that capitalism makes it harder for individuals to meet their basic needs while maintaining close interpersonal relationships.

People were feeling atomized, and less of a sense of community, and feeling more alone and isolated. In losing their sense of community, they were more likely to experience depression that could lead to suicide, Aaron explains. Durkheims point is that we cannot minimize the role of the broader society in the way it affects people.

The American wellness industry, broadcasting messages about hustling, seizing the day, getting perfect skin, meditating, and eating the right CBD vitamins, offers, at best, half-measures. Rather than being empowered to solve problems by thinking socially, Americans are pushed towards consumer solutions. It is remarkable how many of those solutions are sold at considerable cost to people in their thirties.

So what can people in their thirties do other than white knuckle it through the toughest time of their lives? Making more of an effort to address basic social and emotional needs is obvious, but may not be practical for everyone. Time is short (especially for parents). But sleeping more, participating in active financial planning, and asking for help are all good ideas. And, as with all things, expectations are key and, research proves, strongly correlated with happiness and well-being. Thirtysomethings who expect to be crushing it, likely wont. Those who understand that they may have to sacrifice short-term well-being for long-term stability, on the other hand, will likely make it through unscathed.

Every day is a marathon, but I am happy precisely because I have two great kids, a talented and takes-care-of-most-things wife who is the dopest mom, and I am doing well in my career, says Teitelbaum. He pauses for a second to consider his success. Drained is a good word for it, he adds.

Teitelbaum claims he is happy. And thats critical. Happiness and well-being are different. While happiness is considered a temporary state or feeling, well-being is a more permanent stasis based on health, happiness, welfare, and prosperity. If well-being is the meal, then happiness is the butter. The good news is that happiness is not off the table for people in their thirties, especially parents of young children, and represents one area where they can gain traction. It may be a few years before you can get a full nights sleep, workout, eat right, or hang out with your buddies regularly, but it is possible to be content and proud of the hard work getting done.

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The application provides an instant and fast responding source for its users. Applications are of different types that inspire people and to use for specific reasons. Almost every app has unique and special attention and attraction to specific communities for some purpose.

Applications can be of different topics and can represent different ideas that attract the communities and engage them for specific tasks. The use and the requirements depend upon its features and the demands for which people ask for immediate response. Innovators and creative planners always inspire from the massive range of ideas and never lose their energies and requirements for which they wait for. From education to entertainment, almost every type of mobile apps are available for the peoples interests and to facilitate them at the maximum level. Almost every idea requires special consultancy, need and value for its users. People can make sure what they need and what type of plans can facilitate them to relax to worries and to enjoy the online convenient access to solve their issues.

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Get latest information about medical testsalong with complete prescription and timing; TSH Thyroid Stimulating Hormone,Blood Sugar/Glucose Fasting, Ultrasound Whole Abdomen, CBC Haemogram, E.C.G.,X-Ray Chest PA View, Lipid Profile, Thyroid Profile, Search more testsinformation and awareness can be got from this recommended app. Different typesof appointments with doctors can be made with the help of this quick respondingapp. Find the online list of Top Hospitals in different regions and do youronline consultation to find a doctor. Book doctorappointments with Cardiologist, Oncologist, Nephrologist, Neurologist,Orthopedist, Obstetrician & Gynecologist, Dermatologist, General Physician,Search more specializations with 50% off offer by getting online access. Thereare numerous other inspiring feature ideas which are helping the interestedcommunities to solve their interests relevant issues and to facilitate themaccording to their satisfaction level.

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Latest Application Ideas for Online Consultancy and Other Activities - iLounge

Some women think that if they are not overweight, there is no need to do exercise or work out. However, it is a common mistake. Exercise is very important as it provides various health benefits besides weight loss.

Did you know exercise releases endorphins, which are feel-good chemicals? If you know the benefits of working out, you will stay motivated to do it regularly. We have compiled a list of benefits of regularly working out so that you can get out of your bed and get going.

What are the risks of not exercising?

A sedentary type of lifestyle can increase the risk of health problems such as cardiovascular disease, type 2 diabetes, cancer, or osteoporosis. It can also lead to premature death from all causes such as complications of being overweight and obesity.

In many parts of the world, the number of overweight and obese people is increasing rapidly. Overweight and obesity are two of the major health issues caused due to not working out, while there are many more than these two. Therefore, it is advised that you take time out of your busy schedule to work out and see the benefits yourself. Here are a few of those benefits:

1. Prevents muscle loss

Over time, our bodies are not able to build muscles efficiently. Also, our muscles break down more quickly as compared to when we are young. If we make the workout a part of our regular schedule, we can not only maintain our muscle mass but can also increase it.

As a woman, if you work out regularly, you can keep your metabolism high. This will give you the strength and endurance to complete your everyday tasks. You can also prevent falls, which can be a life-changing experience for some of the adults.

2. Exercise improves sleep

Sleep is important to look and feel good because your body does the repair work during sleep. You get to replenish vital nutrients and vitamins during sleep. A growth hormone is secreted during sleep that helps to rebuild skin and hair, which is why it is called beauty sleep!

As per a survey, it was discovered that women find it more difficult to sleep or stay asleep as compared to men. This tendency may get even more troublesome during motherhood, monthly hormonal changes, or at the time of menopause. However, regular exercise can help improve sleep.

3. It increases your energy levels

A regular workout can help you increase your energy levels. Apart from being an energy booster for healthy people, it is a good solution for those suffering from various medical conditions. As per a study, regular exercise helped reduce the feelings of fatigue, which had complained about persistent fatigue.

You can combat chronic fatigue syndrome (CFS) and other serious illnesses through regular workout. It has also proven to increase the energy levels in people suffering from diseases such as HIV/AIDS, cancer, multiple sclerosis, etc.

If you want, you can also include supplements in your diet to get a better physique and higher energy levels. Body Iron Inside Out is an awesome website to check out the reviews of other users and see how they are benefited by taking particular supplements.

4. Reduces PMS symptoms and menstrual cramps

Some women find it difficult to deal with Premenstrual syndrome (PMS) and menstrual cramps. However, studies suggest that regular exercise or workout is an effective way to reduce PMS symptoms and menstrual cramps.

Apart from reducing PMS symptoms, it is also effective for dealing with mental issues such as stress and irritability, which are very common among women. Working out during your menstrual periods has proven to improve your mood and reduce menstrual pain.

5. It helps you control your diabetes

Along with taking the right kind of diet to lower blood sugar levels, working out regularly is a great add-on. It increases your insulin sensitivity so that your cells can use the available insulin to take up glucose in a much efficient way.

An increase in insulin sensitivity can help delay your need for medication or let you use smaller doses than before. We all know exercise helps in reducing weight, which will, in turn, help you get your diabetes under control.

6. Weight Management

One of the most common and known benefits of workout is weight management. Working out regularly helps increase your caloric expenditure, which in turn will help you lose weight or maintain your ideal weight.

Regular exercise can help enhance your metabolic rate, which can make weight management a much simpler affair for you. It will also keep the obesity-related and heart-related diseases away from you.

Bottom Line

Regular workout offers many benefits that can enhance and improve nearly all aspects of your physical and mental health. It increases the production of hormones that are responsible for making you happier and help you sleep better.

Your skin will glow, you will lose weight, the risk of acquiring chronic diseases decreases, and your sex life improves tremendously. It helps improve sexual desire, function as well as performance in both men and women. You must do regular workout, whether it is aerobic or a combination of aerobic and resistance training, to get a healthier life.

However, you must consult a physician before starting any kind of workout so that you do it properly, especially if you have some pre-existing health issues.

Continue reading here:
6 Benefits of Workouts for Women - Don't Just Look Healthy, Be Healthy - Siliconindia.com

Shauna Stewart Douglas was struggling with infertility. It caught her and husband, John, by surprise.

I assumed that if you can get pregnant once, then you can get pregnant again, Douglas told Fox News.

She had become pregnant almost two years earlier with her daughter, but this time around even in vitro fertilization (IVF) wasnt working.

At age 35, Douglas found herself struggling with secondary infertility.

People always say to imagine what you want your kitchen table to look like in the future when youre thinking about how many kids to have, Douglas said.

And in my mind it has been my husband and all of our kids and that was all fading away. It was all going away.

Reports estimate that over 3 million couples in the United States face secondary infertility, which is the inability to become pregnant or to carry a baby to term after previously giving birth.

Dr. Kecia Gaither, an OB-GYN and director of perinatal services at NYC Health + Hospitals/Lincoln, says several conditions can cause secondary infertility like obesity, polycystic ovary syndrome (PCOS), the use of some medications, prior surgery, endometriosis, issues with cervical mucus and the age of both partners.

Many health conditions can be present without symptoms, until such a time as the couple wishes to become pregnant, Gaither told Fox News.

If there is an issue within a year of trying in couples less than 35 years of age or after six months in couples older than 35, its time to see your physician.

Douglas, founder of Permission to Profit, said they tried two rounds of IVF with the second time ending in miscarriage before they decided that they couldnt do it anymore.

Maybe it would have happened if we had kept on going and trying again and again, but I couldnt do it, I just I couldnt do the rollercoaster anymore.

Douglas said a medical condition, which she preferred not to disclose, and her age of almost 36 when they started trying for their second child, most likely led to her secondary infertility.

The biggest culprit typically in secondary infertility is the ovarian reserve, Dr. Brooke Hodes Wertz, a reproductive endocrinologist at NYU Langone Fertility Center told Fox News.

The ovary loses eggs in number and quality over time. So it gets harder to get pregnant over time.

Treatment for secondary infertility is the same as it is for primary infertility. Doctors should first start with an evaluation of both partners, Wertz said.

Youre going to do a semen analysis for the male partners, Wertz explained.

The females typically undergo blood testing that can look at how their ovaries are doing as well as testing to look at the inside of their cavity, whether its a hysterosalpingogram or an ultrasound, to look at the cavity and make sure the tubes are open.

The most common blood tests for women are called FSH (follicle-stimulating hormone), which give a reflection of the egg quality and AMH (anti-mullerian hormone) which show the number of eggs the patient has.

If there appears to be an issue, a doctor may recommend certain treatments at a fertility clinic.

We have simple treatments which involve oral medicine and often taking the sperm and releasing it very close to where the egg gets released, Wertz said.

And then we have more aggressive treatments like in vitro fertilization (IVF).

IVF typically uses fertility drugs to induce ovulation and then extracts the eggs and fertilizes them with sperm in a lab. Once the embryo forms, doctors then transfer the embryo into the uterus.

Wertz also recommended egg freezing as a way to possibly avoid secondary infertility.

We have the ability to freeze eggs and embryos when the ovaries are younger and put them back in at an older age when it would have been harder to get pregnant, Wertz said. A lot of women dont realize a couple of years makes a difference.

While there have been success stories among women who have frozen their eggs when they are over 40 years old, Wertz said it is preferable to freeze your eggs earlier in life, ideally before the age of 35.

Even though Douglas, now 41, didnt think that more rounds of IVF would give her family a second child and her daughter a sibling, there was another option for her adoption.

Families are made up in all kinds of different ways and, for us, we have a biological child and we have an adoptive child, Douglas said.

Going down that path was an incredibly beautiful thing because now we have my son, which is amazing and Im really grateful for that.

Excerpt from:
Secondary infertility: Why it happens to couples who have already had successful pregnancies - New York Post

Isabelle is a Newcomb College Institute Reproductive Rights & Reproductive Health intern and a Planned Parenthood Gulf Coast intern.

As abortion restrictions sweep across Louisiana, many are growing fearful that those seeking an abortion may now take matters into their own hands. These restrictions greatly decrease accessibility to medically safe abortions, putting individuals at risk of disability and death when making a choice about their own bodily autonomy.

With the passage of a series of abortion bans in Louisiana this summer, care options are scarce for reproductive health organizations like Planned Parenthood Gulf Coast, which provided for 13,185 patients statewide from 2017-18 in family planning. In particular, the passage of the heartbeat bill this summer prohibits abortions once a fetal heartbeat is detected, which often is as early as six weeks into pregnancy.

The Louisiana House of Representatives has also passed an amendment stating that no provision in the constitution can be used to protect the right to abortion or require the funding of abortion. Several more passages add further limitations to the mix, making it more difficult for physicians to transparently provide care for current and potential patients.

These restrictions will make self-managed abortion more common. Self-managed abortion is defined as an individual managing their own abortion without the guidance of a licensed medical professional. One is more likely to choose self-managed abortion should clinical care be unavailable, inaccessible or undesirable all aspects that are shaped by multiple socioeconomic, cultural and political factors.

When abortions were illegal in the 1950s, self-managed abortions were estimated at 200,000 to 1.2 million per year. These abortions were often carried out in back alleys where the individual often endured danger and abuse.

Other at-home treatments included ingesting malaria medicines, smearing potassium permanganate in the vagina and inserting foreign objects such as coat hangers. These caused chemical burns, shock and infection, and remain some of the lasting scars of a time before Roe v. Wade.

Today, the use of medication abortions is becoming increasingly common. While it has a higher success rate, many side effects some of which are fatal occur. In clinics, mifepristone and misoprostol are used together to manage abortions and have earned the moniker the abortion pill. Mifepristone blocks progesterone, the hormone required to preserve the uterine lining, while misoprostol aids in shedding to end the pregnancy. It is effective 96% of the time.

Yet, for self-managed abortions mifepristone is much more heavily regulated and often times only misoprostol is accessible, with a lower success rate of 85%. Misoprostol itself is typically prescribed for stomach ulcers and miscarriages.

Despite its status as an essential medicine by the World Health Organization, misoprostol is illegal to use without a prescription in the United States. It is still considered an over-the-counter drug in Mexico, however, under the name of Cyrux. Its $30 price tag makes it a much more affordable option than the abortion pill, which can fall around $500.

Information about this drug is circulated throughout the internet. The WHO provides a general protocol to follow on its website, for pregnancies up to 12 weeks.

Those with later-term pregnancies use forums as medical information to estimate proper dosages. These dosages depend on the stage of pregnancy, which often can be difficult information to obtain without medical guidance.

It is in these cases when exact details are scarce that misoprostol can be extremely harmful. The side effects include abdominal aches, intense pain, excessive bleeding and tearing of the uterus, with symptoms lasting longer the further along the pregnancy is. In cases of complications, it may be necessary to see a physician.

Since these symptoms mirror miscarriage symptoms and there are no tests that can detect misoprostol in the system, it is in the best legal interest of the patient to withhold this information from the doctor.

At least 20 arrests of women who have ended their pregnancies without clinical supervision have occurred. Now, many of the recent bills are taking a step further by criminalizing medical practitioners who assist women in clinical abortions, creating fear for all involved.

Self-managed abortions are often a last-ditch effort or the only affordable option for many individuals. Their symptoms are painful and long-lasting, without a guarantee of success.

Yet, with aggressive and harmful legislation closing in on reproductive health options and threatening medical practitioners in Louisiana, this will ultimately begin to limit the availability of clinical abortions and force individuals to make more risky choices.

A version of this article originally appeared in Newcomb College Institutes newsletter, ReproNews.

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Louisiana laws will lead to life-threatening self-managed abortions - Tulane Hullabaloo

Life for many transgender individuals involvesa constant struggle of being misgendered or referred to by the wrong pronoun or name. In many aspects of their lives, this ranges from annoying to personally invalidating. But when it comes to healthcare, it can be dangerous or even deadly.

Whats happening is that with a lot of transgender patients, the provider isnt being notified that the patients due for a procedure because these systems are not accurately pulling in the correct information, Chris Grasso, associate vice president for informatics and data services at the Fenway Institute, one of the worlds largest LGBTQ-focused health centers, told Healthcare IT News. Whats happening is when you see higher rates of cancer, lower rates of screening, a lot of it is because these systems arent actually incorporating things like anatomical inventory. So [for] someone whose sex is listed as female but they actually dont have a cervix, were sending them a letter that they really shouldnt be receiving that says Youre due for your pap smear.

Missed cancer screenings are just one example of a ways that mishandling data for transgender people puts them at risk. For instance, things like reference ranges for lab tests can also cause harm if the system pulls them for the wrong sex.

Having accurate information is also increasingly important as the EHR moves from a billing tool to a resourcefor population health.

The EHR was created for a documentation tool, but now we want it to be a lot smarter. We want it to provide us with more statistics, and more data, and how do we best care for these patients, said JoAnne Dombrowskas, MSHI, RN, manager of MGH's eCare clinical informatics team.

And, perhaps more important than any of that, when every staff person at a hospital greets a transgender person with the right name and uses the right pronouns, theyre more likely to stick around, come backand get the care that they need.

One special thing about this community ispeople talk to each other, Mitch Kellaway, a training specialist in MGH's Patient Access Services department, said. Whos safe? Who knew the word genderqueer when I said it and didnt bat an eye? And people, trans folks, nonbinary folks, genderqueer folks really notice those things. And it cant just be the clinicians. We [front desk and registration staff] get to them first, and they could walk out the door before they see a physician. So I tell the staff you really have a part in helping these folks get better care.

Grasso says that Fenway has been including SOGI information (sexual orientation and gender identity) in its own EHR since 1997, and started documenting it systematically about 10 years ago.

But a couple moves on the federal level have hastened a national adoption of SOGI fields in the EHR: In 2016, the US Bureau of Primary Healthcare at HRSA began requiring that all federally-qualified health centers collect and report that data. And in January 2018, thanks in part to the work of Grasso and her colleagues, having fields for SOGI data became a requirement for Meaningful Use.

Several years ago, the Healthy People 2020 initiative and the Institute of Medicine convened national experts, reviewed the existing literature and concluded that there really are unique health disparities experienced by gender and sexual minority people that are best addressed by making gender and sexual minority patients visible within healthcare, so we know what everyones SOGI is and can provide tailored patient-centered care based on that information, so that gender and sexual minority people can enjoy the same standard of health as the general population, saidAlex Keuroghlian, MD, who serves as director of the National LGBT Health Education Center at Fenway as well as the MGH Psychiatry Gender Identity Program.

Keuroghlian and Grasso agree that movement on the federal level has represented praiseworthy progress and have even conducted research thats starting to show that when the question is asked, LGBTQ+ individuals self-report at expected rates. But theres a lot of work still to do.

The first step is to have distinct fields in both the clinical and registration record for sex assigned at birth, legal sex, gender identity, and sexual orientation, as well as fields fornames used and pronouns. Legal names and sexes still need to live in the system because those are generally the names and sexes found on a patients insurance.

But Keuroghlian and Grasso believe the next step is anatomical inventoriesthat will put an end to assumptions about what organs someone has based on their sex.

A key part of this is to build in anatomical inventories that track body modifications people have had, so you could do preventative cancer screening based on the retained organs in someones body and not just on their chart sex, Keuroghlian said. Thats the future. Thats really where things need to go.

In addition to inventories, Grasso cited a need to make sure that interoperability initiatives like FHIR keep up with these new fields. The sensitivity of SOGI information, for patients who might not be out, adds another layer of complexity.

So if someones going to see a specialist outside your organization, they may feel like its helpful to share that information ahead of time or there may be times when they dont want to, she said. So we should be able to add those controls within the system.

Massachusetts General has been incorporating SOGI information into the clinical side of its EHR for a few years, but the push to get that information entered at registration is only about a year old. As of now, patients can even update some fields gender identity, name used and sex assigned at birth through the patient gateway.

The data infrastructure and training initiative runs parallel to the hospitals transgender health program, a special clinic offering primary care, hormone therapy treatmentsand mental healthcare to trans patients. This month, the clinic opens up pediatric as well as adult care options.

Primary care is really important, Robbie Goldstein, MD, the medical director of the Transgender Health Program, said. I dont think this works with just prescribing hormones and just having a space for people to come in and get testosterone, estrogen, whatever it may be. The reality is that there are a lot of things that come up related to gender. And to have a primary care doctor and a primary care practice who can manage those issues is incredibly helpful.

I also think theres a component of not making people tell their stories a million times, added Ariel Frey Vogel, MD, an internist and pediatrician who recently joined the program. Feeling known and heard. So when Robbie meets with a new patient, its with the social workers. Dallas [Ducar, who offers mental health care] is there if needed. Its all very integrated and embedded. In any medical care model theres a lot of things feeling very disjointed, so what were trying to do is make a model where it doesnt feel disjointed, where youre not repeating yourself over and over again, and where things feel really integrated.

Ducar, a psychiatric nurse practitioner who also joined the clinic recently, noted that the clinic has done a good job of creating a welcoming environment.

Something that Ive seen in my recent time here is, patients come in and visit even if they dont have an appointment with a provider, which is pretty spectacular, she said. They just want to spend their time here. With LGBTQ health and mental health theres not always been the best history. So being able to reduce that stigma and integrate with primary care allows for much easier conversations about mental health and for the conversation not just to be about whats going wrong with you, but whats going right with you.

Extending that welcome throughout the whole hospital is an ongoing project atMGH. That includes training both physicians and staff to not only use the systems, but to ask the right questions and project a safe and welcoming environment.

If were not asking these questions in a fully inclusive and affirming healthcare environment, it all falls flat, Keuroghlian said. You cant just do one thing and not the other. People need to feel safe [during phone intake] before they walk in the door, after they walk in the door, [with] what kind of materials, postersor pamphlets are in the waiting room. [They want to be asked] what is your sexual orientation, your gender identity, your sex assigned at birth. We also have to ask about name and pronouns and then transmit that information so that other staff can communicate correctly.

Preliminary research suggests that discomfort with SOGI questions tends to be more imagined than actual, Keuroghlian said.

There was a large study that found that 78 percent of staff were convinced patients would refuse to provide their sexual orientation, but the same study asked patients and only 10 percent of patients refused to provide their sexual orientation, he said. Another study had two demographic forms, one with SOGI information, one without. It found that there was no difference in people being offended by the form with SOGI questions than the one without, and the percentage offended at all was only 3 percent.

In Kellaways firsthand experience, when it comes to patients, the ones who need the new fields tend to be appreciative and the ones who dont will just brush the question off. And staff tends to be most concerned about learning the right terminology to ask the questions without offending anyone.

And when it comes to staff, their concerns tend to be more about "getting it right,"and evaporate once theyve been trained.

I think a lot of folks sit on this ability to add SOGI to the registration record even if they could because theyre make assumptions about discomfort, Kellaway said. Discomfort on the side of the patients being asked, and discomfort on the part of the staff that have to do the asking. From my experience, you would be surprised and you have to have faith in your staff. As people who care about patients, they feel the need to be educated in order to get it right, the terminology, the scripting. But they chose to get into healthcare for a reason.

Another assumption that isnt borne out by the data is about which sorts of hospitals are willing to adopt SOGI data nationwide.

When we looked at the data we actually looked at it by rural versus urban areas, Grasso said. And the rural areas actually did a better job of collecting and reporting data. And this is where the data becomes so critical, because I think it really can dispel some of those fallacies that gay people dont live everywhere or transgender people dont live everywhere, or people arent getting care at small places or dont want to provide that information in a small health center, because in fact they do, and theyre actually doing a better job of collecting it.

Massachusetts General is far from the only hospital in the country working on improving care for transgender and nonbinary patients. But the staff there is making a dedicated and visible effort and they hope other hospitals will follow suit.

If anyone is ever reading this article and feel like theyre waiting for that culture change, and dont know when its going to start, one thing that we really know is with the large rate of suicide in the trans community, one thing that brings that down to average levels across the nation is support, Ducar said. Its a team effort. Everyone has a part to play, and surely, no matter where you are in your journey everyone can offer support.

Goldstein added that the demographic trends will favor hospitals that go out of their way to serve this community

This is the right thing to do but its also the smart thing to do, because this is a growing population, he said. Right now about 0.5 percent of the adult population identifies as trans or nonbinary. Recent research has shown that about 2 percent of people under the age of 18 in the US identify as trans or nonbinary. This is a growing population that is going to come into the healthcare system and wed better get it right, because otherwise theyre going to go someplace else.

Ultimately, though, it isnt the business savvy that drives Goldstein, Frey-Vogel, Keuroghlian, Grasso, Ducar, Dombrowskasand Kellaway.

We have a mission to take care of everyone whos around us, and that includes the trans and nonbinary communities, it includes anyone who walks in that door, said Goldstein. So every time I meet with hospital leadership about trans health and why its so important, I always say This is part of our fundamental mission. We are doing this because trans folks are walking through the door every single day. They need to have a bathroom they feel comfortable going to, they need to have an EHR that understands who they are, and they need to have a doctor or nurse taking care of them whos capable of understanding who they are and what is their gender identity.

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More inclusive EHRs can help extend welcome, save transgender lives - Healthcare IT News

The prime objective of Endocrine Testing Market report is to help the user understand the market in terms of its definition, segmentation, market potential, influential trends, and the challenges that the market is facing. Deep researches and analysis were done during the preparation of the Endocrine Testing Market report. The readers will find this report very helpful in understanding the market in depth. The facts and data are represented in the report using diagrams, graphs, pie charts, and other pictorial representations.

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By TestEstradiol (E2) Test, Follicle Stimulating Hormone (FSH) Test, Human Chorionic Gonadotropin (hCG) Test, Luteinizing Hormone (LH) Test, Dehydroepiandrosterone sulfate (DHEAS) Test, Progesterone Test, Testosterone Test, Thyroid Stimulating Hormone (TSH) Test, Others (Gastrin, Thymosin, Secretin, etc.)

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Endocrine Testing Market Cost Analysis, Revenue And Gross Margin Analysis With Its Important Types And Application 2019 - The Washington Observer

Targeted treatments approved this year for three aggressive breast cancers illustrate the ongoing advances in the field of medical oncology, local cancer doctors say.

There is more hope in the world of cancer, Medical Director Ibrahim Sbeitan said at Conemaugh Cancer Center in Johnstown. We dont lose as many of our patients to cancer. Its much better for cancer than 10 years ago.

One of the new treatments was proven through clinical trials that included patients with UPMC Hillman Cancer Centers, which has locations in Johnstown, Altoona, Indiana and Latrobe.

We were part of that trial through Hillman and UPMC, Clinical Services Director Rashid Awan said at UPMC Hillman Cancer Center, John P. Murtha Pavilion, 337 Somerset. St., Johnstown.

We are trying to be innovative for our patients right here in Johnstown, he said.

The three new medical oncology drugs target specific characteristics in previously hard-to-treat breast cancer and other cancers.

There are three groups of receptors that are targets for cancer drugs.

The Centers for Disease Control and Prevention website compares them to three locks on a door. One is a receptor for the hormone estrogen; another is a receptor for the hormone progesterone; the third is human epidermal growth factor protein, abbreviated HER2.

If the cancer has any of those receptors, doctors have developed keys to open them for targeted treatments.

Two of the new treatments alpelisib and ribociclib are improving the odds for patients with metastatic cancer that has receptors for the hormones, but not for HER2.

The third atezolizumab has been shown to help those with triple-negative breast cancer, which has been difficult to unlock because it is negative for all three receptors.

Hormone therapy has been the standard of care for patients with metastatic hormone-receptor positive, HER2 negative cancer. However, after initial improvement with the hormone medicine, the cancer has usually advanced.

Bodys own defense system

Prior to the Food and Drug Administrations approval of atezolizumab in March, chemotherapy was still the main option for triple-negative breast cancer, Sbeitan said.

The drug, sold under the brand name Tecentriq, is the first immunotherapy drug approved for triple-negative cancer.

Immunotherapy is starting to break into triple negative, Sbeitan said.

Although he acknowledges that the treatment hasnt been around long enough to show long-term survival, Sbeitan says it has slowed progression with less side effects.

Block that protein

The UPMC Hillman patients were part of the MONALEESA clinical trials funded by Novartis Pharmaceuticals Corp. of Switzerland for its Kisqali brand of ribociclib.

Awan explains ribociclib and other CDK4/6 inhibitors block the CDK proteins to slow cell growth.

Cancer cells use the protein to grow, he said. Its like fuel for them. This blocks the fuel and there is very good response.

The drug is also significant because the study focused on younger, premenopausal breast cancer patients, Physicians Weekly said, citing Dr. Sara Hurvitz of the University of Southern California Los Angeles Janssen Comprehensive Cancer Center. For women under 45, breast cancer is a leading cause of cancer deaths.

This is the first study to demonstrate improved survival for a targeted therapy, Hurvitz said at an American Society of Clinical Oncology press conference covered by Physicians Weekly.

Find the mutation

The third new treatment uses a different approach to target a sub-group of advanced-stage hormone-positive, HER2 negative patients.

Alpelisib, sold as Piqray, targets cancer with a mutation known as PIK3CA that has grown despite hormonal treatment.

The drug is used for postmenopausal women and men with breast cancer.

Normal cells became cancer because a mutation took place, Sbeitan said. We try to find the mutation and reset the mutation.

Block by block

Sbeitans colleague, medical oncologist Sheetal Higbee, says alpelisib is one of the second-line cancer drugs that is used for patients who dont respond to the standard treatments. The second- and third-line drugs help patients live longer while more treatments are developed.

Their life with cancer is a lot more bearable, she said at the Conemaugh Cancer Center. We have been giving them hope because we have so many options.

Progress may seem slow, Sbeitan admits, but the results have begun to show.

Cancer treatment is a block by block treatment, Sbeitan said.

You have to have the attitude that each treatment is going to add to the last.

One of Conemaughs patients has been receiving treatments for metabolic cancer since 2006.

She is fully functioning, Sbeitan said.

Although treatments for some cancer is curative up front, Sbeitan says most require ongoing treatments. And there may be setbacks, he adds.

For those patients, the goal is to allow them to enjoy a longer quality of life while keeping the cancer at bay.

They are living cancer-free, he said. We dont use the word cure.

Awan compares it to chronic conditions such as diabetes and heart disease. All can be controlled with medication and lifestyle changes.

They can live with the disease and have a normal life, he said.

Slowing progress

It is getting more challenging to develop new treatments because of existing cancer care, successes, medical oncologist Dr. Michael Voloshin said at UPMC Hillman in Johnstown.

Researchers dont want to be depriving cancer patients of the proven standard of care in order to test experimental treatments.

We have a lot well mapped out on how to treat cancer, Voloshin said.

Continued here:
Breast cancer awareness | 'There is more hope': Three new drugs available in fight against disease - TribDem.com

A recent article published by Catholic news outlet LifeSiteNews alleged that the drugs used to treat gender dysphoria in some transgender children are linked to thousands of deaths.

The story went viral on right-wing news websites such as the Christian Post and the Daily Wire. According to CrowdTangle, a social media metric platform, these posts including shares by Daily Wire founder Ben Shapiro and commentator Matt Walsh are currently some of the top performing LGBTQ-related content on Facebook and Twitter.

The problem is: the thousands of people who die while taking these drugs are likely the terminally ill cancer patients who receive hormone blockers to fight hormone-sensitive cancers, like prostate cancer, according to experts.

Joshua Safer, a professor of medicine and the executive director of the Mt. Sinai Center for Transgender Medicine and Surgery, said Lupron, or leoprolide acetate, is used for treating precocious puberty, infertility and certain types of cancer, particularly prostate cancer.

Prostate cancer is worsened by the presence of certain hormones, so people fighting this disease are sometimes given hormone blockers puberty blockers to slow the cancers progression.

I think all they did is went into the FDA database and looked at reports, Safer said. Theres no study here, thats just a big smorgasbord of reports and so the problem with that is you don't even know that those deaths are connected to the agent they are reported to be connected to.

Much more likely, Safer said, is that the 6,370 deaths over four decades the FDA lists as connected to this drug are in terminally ill cancer patients who are prescribed Lupron as a palliative, not curative, treatment.

They wouldnt even be using it if they werent at risk of death, Safer said of the drugs use in prostate cancer patients.

The American Cancer Association estimates that there are roughly 30,000 deaths from prostate cancer annually in the United States.

The original LifeSiteNews story, which was modified after initial publication, said that the UKs National Health Service is investigating these drugs. A spokesperson for the NHS told NBC News that no special review is being launched into the use of this drug for the treatment of gender dysphoria and noted that all transgender health care services are regularly reviewed.

The NHS own guidelines for the treatment of children with gender dysphoria notes that psychological support and puberty suppression have both been shown to be associated with an improved global psychosocial functioning in youth. Both interventions may be considered effective in the clinical care of psychosocial functioning difficulties in adolescents with [gender dysphoria].

Every decision in medicine involves weighing risks and benefits, said Jack Turban, a resident physician in psychiatry who researches transgender youth at the Massachusetts General Hospital. Turban said that for trans youth, the potential mental health benefits of pubertal suppression far outweigh any potential risks.

Allowing puberty to progress is not a neutral decision for many transgender youth, Turban said. Many of these youth see their mental health drastically deteriorate as puberty starts to progress. While pubertal suppression is reversible, puberty itself is not.

Heron Greenesmith, a senior research analyst at Political Research Associates, tracks anti-transgender rhetoric in mainstream media and said the article exemplifies LifeSiteNews' membership in the Christian-right anti-transgender disinformation ecosystem.

LifeSite platforms the small number of anti-trans researchers, academics, and right-wing professional associations, giving their work a veneer of scientific validity, Greenesmith said. Advocacy organizations can then cite LifeSite, in turn giving their advocacy a veneer of journalistic independence."

Gillian Branstetter, a spokesperson for the National Center for Transgender Equality, said the publication of this article was dangerous.

Transgender youth face a public health crisis in this country, and families must already fight through significant barriers to accessing adequate health care, Branstetter wrote. Much like vaccines, I would encourage news outlets and social media to be extremely sensitive to the risks posed by lies about transition-related health care promoted by bad actors.

NBC News has reached out to LifeSiteNews for comment.

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A viral fake news story linked trans health care to 'thousands' of deaths - NBCNews.com

Sgt. Anna Lange filed a lawsuit against the county where she works in Georgia for refusing to allow her health insurance plan to cover gender-affirmation surgery. Audra Melton for NPR hide caption

Sgt. Anna Lange filed a lawsuit against the county where she works in Georgia for refusing to allow her health insurance plan to cover gender-affirmation surgery.

A sheriff's deputy in Perry, Ga., filed a lawsuit in federal court Wednesday against the county where she works for refusing to allow her health insurance plan to cover her gender-affirmation surgery.

Sgt. Anna Lange came out as transgender in 2017, after working in the Houston County Sheriff's Office since 2006. She has taken hormone therapy and outwardly changed her appearance over the past three years to treat gender dysphoria, the distress resulting from the mismatch between her sex assigned at birth and her gender identity.

Her next step was going to be gender-affirmation surgery, but that plan came to a halt when, as NPR previously reported, her insurance provider denied coverage for the procedure, based on an exclusion specified by her employer.

Now, Lange is suing the Houston County Board of Commissioners to remove that exclusion. Early on Wednesday, she and her lawyer, Noah Lewis of the Transgender Legal Defense and Education Fund, filed suit in U.S. District Court in Macon, Ga., alleging unlawful discrimination under federal and state equal protection clauses, Title VII of the Civil Rights Act and the Americans with Disabilities Act.

County officials did not return calls for comment.

Lange's case is the latest in the U.S. to challenge the exclusion of transgender care from state and municipal employee insurance plans and could create legal precedents for cases across the South.

Other transgender people have won similar fights elsewhere. The managers of Wisconsin's state employee insurance program excluded transgender employees from coverage but later reversed that decision. Separately, two University of Wisconsin employees sued the state and won. Another lawsuit successfully challenged transgender exclusions in Wisconsin's Medicaid plan.

Earlier this year, Jesse Vroegh, a transgender employee of the Iowa Department of Corrections, won a lawsuit he'd filed after being denied coverage by his employer's health insurance plan.

And in Georgia, the state's university system recently settled an insurance exclusion claim for gender-affirmation surgery filed by Skyler Jay, known for his appearance on the Netflix series Queer Eye. In addition to changing its employee health plan to be inclusive of transgender care, the university system paid Jay $100,000 in damages.

"The university clearly agreed that it was discrimination," says Lange's attorney, Lewis, who also represented Jay. "That's why they wanted to do the right thing and remove the exclusion."

In 2011, another Georgia case, Glenn v. Brumby, set the legal precedent protecting transgender people from employment discrimination. However, that case did not address discrimination in employee benefits and, like Jay's case, many that deal with benefits have been settled out of court, according to Lewis.

The Affordable Care Act, which took effect in 2014, specifically prohibits discrimination by health insurance issuers on the basis of gender identity, and Title VII of the Civil Rights Act also has been interpreted to prohibit such discrimination.

Despite broad legal consensus that transgender insurance exclusions are unlawful, state and local governments continue to pursue expensive legal fights to preserve them. The issue remains contentious for many social conservatives.

"Ultimately, what's happening is that, politically, I presume they think it's unpopular or they think they have to defend" the law or regulation, says John Knight, an attorney with the American Civil Liberties Union.

Resisting paying for such care can be more expensive than providing it. Not including the costs of state attorneys' salaries or appeals, Wisconsin's litigation against the employees of its university system cost the state more than $845,000, while Iowa's cost about $125,000.

Furthermore, the cost of managing untreated gender dysphoria can outweigh the costs of providing transgender-inclusive health care, according to a 2015 study.

"Given the small number of people who actually need this kind of care and the large pool of people, it will have absolutely no impact on the total cost of insurance for any state," Knight says.

While settlements such as Jay's may be good for individuals, they do not require institutions to admit wrongdoing and do not result in a legal precedent that other, lower courts must follow.

"The court doesn't have to look at that settlement and say, 'Oh, this was discrimination,' " Lewis says. "Transgender workers in the South are being left behind, which is why we're seeking a court ruling to clearly establish that this conduct is unlawful throughout the South."

Lange's suit argues that the county's exclusion of transgender health care from coverage was deliberate: In documents Lewis obtained under the Freedom of Information Act, Kenneth Carter, the county's personnel director, opted out of compliance with Section 1557 of the Affordable Care Act, which prohibits discrimination by health programs on the basis of gender identity.

"Houston County will be responsible for any penalties that result if the plan is determined to be noncompliant," he wrote in a letter to a representative of Anthem Blue Cross and Blue Shield, which administers the plan.

Carter did not return calls for comment.

Lange's case could end up before the 11th U.S. Circuit Court of Appeals, yielding a decision that could influence other courts in Alabama, Florida and Georgia. And, if the ruling is in Lange's favor, Lewis says, that would signal that transgender exclusions should be removed nationwide.

Lange's suit argues that the county's exclusion of transgender health care from coverage was deliberate. Audra Melton for NPR hide caption

Lange's suit argues that the county's exclusion of transgender health care from coverage was deliberate.

In its next term, the U.S. Supreme Court will hear three cases that will determine workplace protections of LGBTQ individuals, including one case involving a transgender woman.

Lange says she merely wants the same protections everyone else has. The co-workers with whom she shares a health plan might have used "something on the policy that I may never use or need, but it's covered," she says. "When it's finally something that I need that one of my co-workers will probably never use or need, mine's excluded. And that's just not fair."

Keren Landman, a practicing physician and writer based in Atlanta, covers topics in medicine and public health. Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.

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Access To Transgender-Related Health Coverage Is The Focus Of A Georgia Lawsuit : Shots - Health News - NPR

A man who received chimeric antigen receptor-T cell therapy shares his firsthand account.

Backer received a diagnosis of diffuse large B-cell lymphoma (DLBCL). It is the most common type of non-Hodgkin lymphoma, which affects nearly 75,000 people mostly men in the United States each year.

Despite multiple rounds of chemotherapy and a stem cell transplant, Backers disease kept relapsing. Then he participated in a clinical trial involving chimeric antigen receptor (CAR)-T cell therapy, which has left him cancer-free for almost three years. With this type of immunotherapy, a patients T cells are removed, altered in a lab and then reinfused in the hope that they will attack cancer cells.

Dr. Frederick L. Locke, a medical oncologist at Moffitt Cancer Center in Tampa, Florida, isco-lead investigator of the pivotal ZUMA-1 trial, which led to the Food and Drug Administration (FDA) approval of the second available CAR-T cell therapy, Yescarta (axicabtagene ciloleucel). During the National Comprehensive Cancer Network 2019 Annual Conference, Locke, Backer and Alix Beaupierre, a transplant nurse coordinator, took a 360-degree look at CAR-T cell therapy.

LIMITED OPTIONSOutcomes in refractory aggressive non-Hodgkin lymphoma are poor, Locke explained. Patientsare often treated upfront with combination chemotherapy, as Backer was. He initially wenton a chemotherapy regimen commonly known as R-CHOP Rituxan (rituximab), cyclophospha- mide, Adriamycin (doxorubicin), Oncovin (vincris- tine) and prednisone. He achieved a complete remission and went back to work.

We can cure up to about 60% of patients with initial chemotherapy, and thats pretty remarkable, Locke said. Unfortunately, 40% of patients either dont respond to chemotherapy or progress.

Backer was among that 40%. He relapsed about a year later and started on a new chemotherapy regimen with a planned autologous stem cell transplant, which would involve removing his own stem cells and later putting them back into his body to help fight the cancer. This treatment plan cures only about 5% of patients, Locke said. Prior to CAR-T cell therapy, more chemotherapy would have been next.

In the United States, two CAR-T therapies are available to patients with certain types of cancer. The first, Kymriah (tisagenlecleucel), was approved in August 2017 for patients up to 25 years old who have acute lymphoblastic leukemia that relapsed or did not go into remission with other treatments. Two months later, the FDA approved Yescarta to treat adult patients with certain types of large B-cell lymphoma who have not responded to or relapsed after at least two other kinds of treatment.In patients with DLBCL, durable responses the length of time that a partial or complete response is observed because of treatment have been seen in 40% of patients who received CAR-T cell therapy. We think we can cure about 15% of people, Locke said. We need these patients referred and referred early.

A NUCLEAR BOMBBacker first read about CAR-T cell therapy on clinicaltrials.gov, an online registry of all clinical trials that anyone can access to see what might be enrolling participants. Im the typeof person who needs a plan A and a plan B, Backer said.I received a plan A, but the plan B in the case of the transplant failing was not encouraging.

He reached out to Moffitt Cancer Center Tampa is not far from where he lived in Orlando, Florida to see if he was eligible. He wasnt. In December 2015, Backer went ahead with the stem cell transplant. A few months later,he again relapsed with growths all over his body butthis made his participation in the ZUMA-1 clinical trial possible. Being a participant in a clinical trial is scary and daunting at the same time, he said. I remember sitting there with the transplant coordinator and they handed me a 27-page consent form, and I could barely read page one. Ijust wanted to sign. I was ready to sign anything right then and there.

Although potentially curative, CAR-T cell therapy is not without risk. Patients can develop two serious side effects. Cytokine release syndrome, caused by a large, rapid release of cytokines (small proteins importantin cell signaling) into the blood from immune cells affected by the immunotherapy, can be life-threatening. Neurological events, such as confusion, tremor and seizures, can also occur.

Despite lengthy discussions with his medical teamat Moffitt and reading the consent form, Backer said,he wasnt fully prepared for the coming side effects and recovery when he went forward with CAR-T therapy in June 2016. Thats when the nuclear bomb set off, he said. Within 12 hours of receiving the infusion, he experienced severe chills, violent shaking and a high fever, and also felt certain he was experiencing side effects that were affecting his brain.

About two days after Backer received the reinfusedT cells, the infectious disease team rushed him in for a CT scan. They found no infection and no signs of the cancer.

For me, it was a miracle treatment, Backer said.

Locke has been following patients enrolled in ZUMA-1 for more than two years and said that half are still alive.

BEING PREPAREDBacker admitted that going in with a full understanding of CAR-T cell therapy would have made the experience dramatically different.

After seeing patients and their loved ones in distress, care providers at Moffitt Cancer Center learned to smooth the process, Beaupierre said. For instance, the 27-page document has been broken down into one-page educational handouts and shorter consent forms. The team also created a flow sheet and that grew to a detailed patient calendar. All CAR-T therapy recipients also now have a dedicated nurse and social worker.

In addition to those resources, Backer said, peer-to-peer support would be helpful.

As CAR-T cell therapy continues to evolve and be explored in the treatment of other cancer types, experts are learning more about how it works and how to improve the process.

For Backer, quality of life has changed a bit. Initially, he received blood and platelet transfusions every two weeks for several months following CAR-T cell therapy. Although he is back to work full time, he runs the risk of being exposed to other diseases and viruses. Its always at the back of my mind, he said. I wear a mask and goggles at work but still get sick.

He spends his free time hiking and fishing and feels blessed to still be alive. It worked out for me, and here we are 33 months into this thing, Backer said.

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Walking in His Shoes - Curetoday.com

Men with breast cancer had a higher mortality rate when compared with women with breast cancer, reported a cohort study recently published in JAMA Oncology. This overall finding aligns with what previous studies have found and highlight the need for better awareness about male breast cancer.

Most people with breast cancer are found to have breast cancer because they have a lump in their breast, and you would think that in men it would be easier to find a lump in the breast, saidJoanne Mortimer, MD, director of City of Hopes Womens Cancer Programs, who was not involved with the study, during an interview with CancerNetwork. Unfortunately, people's suspicion about what's going on in the breast of a man is not the same as a woman.

The study was conducted using the National Cancer Database, and 1,816,733 patients with a breast cancer diagnosis between January 1, 2004, and December 31, 2014 were identified. The totals were 1,800,708 women and 16,025 men.

Men with breast cancer had a significantly worse overall survival (OS) rate (45.8% vs 60.4%; P < .001), 3-year OS rate (86.4% vs 91.7%; P < .001), and 5-year OS rate (77.6% vs 86.4%; P < .001) compared with women with breast cancer, according to the data.

Even when men were diagnosed at the same disease stage as women, their survival outcomes were still inferior. For the 5-year OS rate, men had worse survival than women at stage I (87.8% vs 92.5%; P < .001), stage II (78.9% vs 85.9%; P < .001), stage III (63.3% vs 70.1%; P < .001), and stage IV disease (21.4% vs 25.1%; P = .007).

Several factors were associated with a higher mortality rate among men, including age, clinical characteristics, treatment received, access to care, and race/ethnicity.

However, when all these factors were controlled for, men still have worse survival. The study authors pointed out that this suggests that other factors, particularly additional biological attributes, treatment compliance, and lifestyle factors, should be identified to help in eliminating this disparity.

Clinical and treatment characteristics were the primary factors linked to worse survival, they added.

Clinical characteristics and undertreatments were associated with 63.3% of the excess mortality among male patients, the authors wrote.

The cohort study also revealed that a higher proportion of men were diagnosed with more advanced disease, yet less likely to receive standard treatment. For example, men with hormone receptor-positive breast cancer were less likely to receive adjuvant endocrine therapy compared with women.

These endocrine therapies are very effective at increasing the cure rate of breast cancer, Mortimer. It's unfortunate that these men did not get endocrine therapy as part of their treatment.

In fact, Don Hoffman, a male breast cancer patient who Mortimer helped care for, exemplifies the importance of early detection and proper treatment for men.

Man or woman, early detection is a lifesaver, said Hoffman. He noticed the nipple and areola on his left breast were flatter than usual and had his breast checked by his primary care physician. A mammogram showed a small mass, which was treated. My early detection probably made me a better candidate to live longer.

To Hoffman, one reason why men may be diagnosed later on, when outcomes are worse, is a mans attitude toward seeking medical care. A man's attitude is, Oh, I can tough this out, this is not a big deal, Hoffman said. I think that mindset works against men.

Disclosures:

Wang F, Shu X, Meszoely I. Overall Mortality After Diagnosis of Breast Cancer in Men vs Women. JAMA Oncol. Published online September 19, 2019.

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Men with Breast Cancer Have Worse Mortality, Highlight Need for Better Awareness - Cancer Network

BARCELONA, Spain Final overall survival (OS) results from the MONARCH 2 and MONALEESA-3 trials show consistent OS benefits with the cyclin-dependent kinase 4/6(CDK4/6) inhibitors abemaciclib (Verzenio, Lilly) and ribociclib (Kisqali, Novartis). The new data establish the foundation for adding these drugs to endocrine therapy in the treatment of patients with hormone receptor positive, human epidermal receptor negative (HR+/HER2-) advanced breast cancer (ABC).

The new results were presented here at the European Society of Medical Oncology (ESMO) 2019 Annual Meeting and were published online September 29 in JAMA Oncology.

The results from MONARCH 2 show that after a median follow-up of approximately 4 years (47.7 months), patients with HR+/HER- ABC lived significantly longer with the combination of abemaciclib and fulvestrant. Median OS was 46.7 months with the combination and 37.3 months with fulvestrant alone (hazard ratio [HR], 0.757; 95% confidence interval [CI], 0.606 0.945; P = .0137).

This is a statistically significant and clinically meaningful improvement in OS, commented first author George Sledge, MD, Stanford University School of Medicine, California.

"The main take-home message from this study and from other similar studies is that CDK4/6 inhibitors significantly prolong the time patients remain in remission and significantly improve overall survival. Therefore, it is very reasonable to think of these as standard-of-care options for patients with metastatic breast cancer," Sledge commented in an ESMO statement.

A similar benefit was seen with the combination of ribociclib and fulvestrant in MONALEESA-3. After a median follow-up of 39.4 months, median OS was not reached with the combination of ribociclib and fulvestrant; it was 40.0 months for patients who received fulvestrant alone (HR, 0.724; 95% CI, 0.568 0.924; P = .00455).

"This is a significant, practice-changing report, in that we are now saying that patients with advanced breast cancer will have an overall survival benefit if they get the CDK4/6 inhibitor ribociclib up front at the time of their recurrence, even if they have not had any prior endocrine therapy at the time of presenting with metastatic disease," commented first author Dennis J. Slamon, MD, PhD, from the David Geffen School of Medicine at the University of California, Los Angeles.

Commenting for ESMO, Matteo Lambertini, MD, of the IRCCS Policlinico San Martino Hospital, University of Genoa, Italy, said, "Uniquely, MONALEESA-3 is the only trial with a CDK4/6 inhibitor to include patients with endocrine-sensitive as well as those with endocrine-resistant disease. This is the first time we have seen improved overall survival with a combination of a CDK4/6 inhibitor plus fulvestrant in first line."

The two trials had different patients populations: MONARCH 2 enrolled premenopausal, perimenopausal, and postmenopausal patients, whereas MONALEESA-3 enrolled only postmenopausal patients. However, a separate study (MONALEESA-7, whih included 1400 patients) reported positive OS results for premenopausal women with HR+/HER2- ABC who received ribociclib and fulvestrant. Slamon said that together, the two MONALESSA trials demonstrated a consistent and meaningful benefit with multiple endocrine therapy partners regardless of menopausal status.

"These are clinically highly meaningful data and are a game changer," commented ESMO expert Nadia Harbeck, MD, of the Breast Center at Ludwig Maximillians University in Munich, Germany. She was speaking at a press briefing at which the results from both trials had been highlighted.

These data will ensure that CDK4/6 inhibitors become the standard of care in treating patients with HR+/HER- ABC and should be used first line because they substantially improve patient outcomes compared with antihormonal treatment alone, Harbeck commented.

"We can never guarantee that patients will come back for second-line therapy. We should give the best drugs first," she said.

Harbeck was optimistic that, in light of the significant OS benefits, costs of these drugs will be reimbursed and that the drugs will be available for those who need it.

Besides abemaciclib and ribociclib, palbociclib (Ibrance, Pfizer) in combination with endocrine-based therapy is also available for use in the first-line and second-line settings of ABC. However, the OS data for this agent were not statistically significant.

At the press conference, questions were raised as to whether the mechanisms of resistance of the three available CDK4/6 inhibitors overlapped, whether they can be given in sequence, and what would dictate the use of one drug over another.

Slamon indicated that although in clinical practice, physicians have been using CDK4/6 inhibitors in sequence, cross-resistance mechanisms should preclude their being used in sequence after resistance develops.

Sledge noted that not enough patients have been followed for long enough and warned that cross-trial comparisons should not be made. In addition, he pointed out that the HRs from progression-free survival (PFS) and OS are impressive and are similar in the studies. "Primary efficacy does not provide any information on the superiority of one drug over the other," he said, but he suggested that the different toxicity profiles may favor one over the other.

Medscape Medical News asked Laura M. Spring, MD, a breast cancer expert from the Massachusetts General Cancer Center in Boston, Massachusetts, for her views on these data and how she integrates CDK4/6 inhibitors in her clinical practice.

Spring explained that CDK4/6 inhibitors are now given in conjunction with endocrine therapy for HR+/HER2- ABC unless there are toxicity concerns for patients. As an example, she indicated that an older patient with only osseous disease who expresses concerns about the side effects of adding a second agent could be given CDK4/6 in the second line after progression occurs with endocrine monotherapy.

The three CDK4/6 inhibitors are similar in efficacy, but they have distinct side effect profiles, she observed. The incidence of neutropenia is higher with ribociclib and palbociclib, whereas diarrhea is a concern with abemaciclib. QTc prolongation is a possible concern with ribociclib, and patients have to be monitored routinely with electrocardiography, Spring noted.

"That is why choosing one over another may be dictated by the other medicines patients are taking as well as their comorbidities," she said. If a patient is taking medication for QTc prolongation, she would be less likely to receive ribociclib, whereas a patient with gastrointestinal problems would be less likely to receive abemaciclib, she said.

All three agents have shown similar PFS benefit in their respective trials. However, the OS benefit now reported with ribociclib and abemaciclib was statistically significant, whereas that reported for palbociclib was not, although there was a trend showing better survival. That data come from the PALOMA-3 trial, which compared the combination of palbociclib and fulvestrant with fulvestrant for patients whose disease had progressed after initial endocrine therapy.

Despite that, patients who received the combination were at a significantly 28% reduced risk for death or progression, Spring observed.

She suggested that the lack of statistical significance was a detail that would most likely be significant only to a purist, owing to the fact that the benefit of these agents as a class is established.

She also noted that OS was the secondary endpoint for all three studies, that PALOMA-3 was not powered to show significance for OS, and that longer follow-up may be needed.

In addition, the patients in PALOMA-3 were heavily pretreated, which is likely to affect clinical outcomes.

Several experts cautioned against making cross-trial comparisons. "The three studies have key eligibility differences, and cross-trial comparisons are not warranted," Spring said.

Spring told Medscape Medical News that, as a standard of care, a physician in the United States can order any of the three agents, depending on the type of insurance coverage a patient carries. The OS data may provide a boost for abemaciclib and ribociclib, she suggested.

Sledge added that at least in the United States, indications overlap for all three CDK4/6 inhibitors and all are already approved in the second-line setting; thus, reimbursement is not likely to change much. "I think it is more likely that the docs will change. When you have an OS advantage, that changes how we feel about a drug," Sledge told Medscape Medical News.

However, Spring pointed out that palbociclib was the first CDK4/6 inhibitor to be approved, and many physicians have a greater "comfort level" with its use.

Ease of dosing and ease of dose reduction are also factors to take into consideration, she added. Abemaciclib is taken twice daily on a continuous dosing schedule, whereas ribociclib and palbociclib are given once daily on a 3-week-on, 1-week-off schedule. Because of its packaging, it is easier to reduce the dose of ribociclib without writing a new prescription, she observed.

"In prescribing CDK4/6 inhibitors to patients, it is important to discuss with them the differences between the agents, which in large measure are minor," Spring said. "But sometimes a small difference makes a big difference to a patient," she added. Some patients may prefer continuous dosing with abemaciclib, whereas others may discount that factor because the drug has to be taken twice daily, she said.

Spring recommends sequencing with another CDK4/6 agent, ideally only in the context of a clinical trial. In MONARCH 2, Sledge reported that subsequent CDK4/6 therapy was provided to 5.8% of patients who experienced disease progression with abemaciclib and fulvestrant.

MONARCH 2 randomized pre-, peri-, and postmenopausal patients with HR+/HER- ABC to receive abemaciclib twice daily on a continuous dosing schedule in addition to fulvestrant (n = 446) or fulvestrant alone (n = 223). These patients were endocrine-therapy resistant but had received no more than one prior endocrine therapy, and they had received no chemotherapy for ABC.

In addition to the new results for OS, reported above, Sledge also presented updated data for PFS (the primary endpoint). Median PFS was 16.9 months with the abemaciclib combination and 9.3 months with fulvestrant. With a hazard ratio (HR) of 0.536, patients who received the abemaciclib combination were at a significantly 44% decreased risk for progression or death (P <0.0001). Three-year PFS was nearly three times higher with the abemaciclib combination: 29.9% vs 10.1% for patients who received fulvestrant.

"At three years, three times as many patients on the combination remain progression free [compared those who received fulvestrant]," Sledge said.

Time to initiation of chemotherapy was an exploratory endpoint of the study. The abemaciclib combination was associated with a 60% delay in the time to initiation of chemotherapy. Median time to initiation was 22.1 months for fulvestrant, vs 50.2 months for the combination (HR: 0.625; P <0.0001).

Sledge reported that there were no additional safety signals and that the safety profile of abemaciclib was consistent with that reported in the primary analysis.

MONALEESA-3 randomly assigned 726 patients with HR+/HER2- ABC to receive oral ribociclib on a 3-weeks-on, 1-week-off dosing schedule in addition to fulvestrant (n = 484) or fulvestrant alone (n = 242). Slamon noted that approximately 50% of patients received these therapies in the first-line setting.

Updated data for the primary endpoint of PFS showed that median PFS was significantly longer for patients who received the combination (20.6 months vs 12.8 months for fulvestrant; HR, 0.587).

In addition to the median OS results reported above, Slamon reported that landmark 3-year OS was 67.0% for patients who received the combination and 58.2% for those who received fulvestrant. In this second prespecified analysis, the P value crossed the prespecified boundary for establishing superior efficacy, Slamon observed. The OS benefits were seen across all subsets of patients, including those distinguished on the basis of site of metastases and line of therapy.

"There was a significant delay in time to first chemotherapy," Slamon observed. The median time to first chemotherapy was not reached in patients who received the combination; it was 29.5 months for those who received fulvestrant.

No new safety signals were observed. Slamon reported on the incidence of grade 3/4 adverse events of special interest with the combination (vs fulvestrant):

Neutropenia: 57.1% vs 0.8%

Hepatobiliary toxicity: 13.7% vs 5.8%

Pulmonary disorders: 0.2% vs 0% (no cases of grade 3/4 pneumonitis or interstitial lung disease were reported)

QTc prolongation: 3.1% vs 1.2% (no episodes of torsades de pointes were observed)

At the meeting, discussant Sibylle Loibl, MD, of the German Breast Group and Goethe University, Frankfurt am Main, Germany, provided some context for the new data.

She noted that each trial had slightly different patient populations. Importantly, patients in MONALEESA-3 were the least heavily pretreated, whereas those in PALOMA-3 were the most heavily pretreated. As the level of pretreatment increased across the trials, the median PFS also decreased, she noted. More heavily pretreated patients will also have a shorter median OS, she noted.

In summarizing the data, Loibl indicated that CDK4/6 inhibitors improved PFS in the first-line and second-line settings of metastatic breast cancer, which translates to an improvement in survival. Improvement in outcomes was seen irrespective of pretreatment, menopausal status, endocrine sensitivity, and site of metastases. A meta-analysis of all the CDK4/6 trials data will likely reveal potential differences in subgroups, she said.

Sledge reports relationships with Eli Lilly, Pfizer, Syndax, Symphogen, Verseau, and Tessa. Slamon reports relationships with Biomarin, Pfizer, Vertex, Lilly, and Novartis. Spring reports relationships with Novartis, Lumicell, Puma, Merck, and Tesaro. Loibl reports relationships with AbbVie, Amgen, AstraZeneca, Celgene, Eirgenix, Novartis, Pfizer, Puma; Roche, Samsung; Seattle Genetics, Teva, Vifor, Daiichi, Cepheid, Myriad, PRIME, and Chugai.

European Society for Medical Oncology (ESMO) 2019 Annual Meeting: Abstracts LBA6_PR (MONARCH 2), LBA7_PR (MONALESSA-3),presented September 29, 2019.

JAMA Oncol. Published online September 29, 2019. Full text

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Now With Survival Benefit, CDK4/6 Inhibitors in Breast Cancer - Medscape