Archive for the ‘Hormone Physician’ Category

Thursday, July 06, 2017 3:51 p.m. EDT

By Andrew M. Seaman

(Reuters Health) - Young women who suffer a concussion may be at increased risk of menstrual irregularities, at least for a few months, suggests a new U.S. study.

Researchers found that young women were nearly six times more likely to have irregular menstrual cycles after a concussion, compared to young women who were treated for non-head-related injuries.

After a concussion, women should talk to their healthcare providers about the increased risk, said senior author Anthony Kontos, of the University of Pittsburgh Medical Center Sports Medicine Concussion Program. It's important, he added, "for care providers to be concerned about menstrual patterns and encouraging women to track that after their injury."

Irregular menstrual cycles may disrupt the body's hormones and lead to delayed body development in young women, Kontos told Reuters Health. Hormone disruption can also lead to poor bone health.

Concussions result from a hit or blow to the head that causes the brain to move back and forth or twist inside a person's skull, according to the Centers for Disease Control and Prevention.

A study last year by the Seattle Sports Concussion Research Collaborative estimated that up to 1.9 million children in the U.S. experience a sports-related concussion each year. Girls are also known to have a more difficult concussion recovery than buys, Kontos and his colleagues write in JAMA Pediatrics.

Hormone disorders are known to occur after traumatic brain injuries, they add. Some research has suggested menstrual disorders are more common after those types of injuries, too.

For the new study, the researchers recruited 68 girls and women, ages 12 to 21, who were recovering from concussions. The participants received a text message every Sunday night for about four months linking to a survey that asked about their menstrual cycle. They were asked about bleeding, new injuries, possibly pregnancies and birth control.

Sixty-one young women with non-head-related injuries were also surveyed every week.

About 24 percent of concussion patients had at least two abnormal menstrual cycles during follow-up, compared to 5 percent of patients with other types of injuries.

Kontos said concussions might increase the risk of irregular menstrual cycles by disrupting the hypothalamic-pituitary-ovarian axis, a group of hormone-emitting glands that often act in concert.

Dr. Jeffrey Bazarian, an emergency physician and brain injury expert at the University of Rochester Medical Center in New York, told Reuters Health a concussion could interfere with the pituitary gland in the center of the brain.

"Its possible that this also happens to males and the question is how does it effect them," said Bazarian, who was not involved in the new study.

The researchers can't yet explain their findings, however. Nor can the study prove concussions actually cause abnormal menstruation.

Kontos also said it's unclear whether the increased risk of abnormal menstrual patterns lasts beyond four months.

"We dont know beyond that," he said. "Its one of the studies wed like to do."

SOURCE: http://bit.ly/2sRbdp9 JAMA Pediatrics, online July 3, 2017.

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Concussions tied to menstrual problems in young women - WHTC

JENNIE McKEON @JennieMnwfdn

MARY ESTHER The tragic death of a 7-week-old child left in a van earlier this week is a reminder of how dangerous Florida heat can be.

Okaloosa County sheriff's deputies were called to a home in Mary Esther about 9:30 p.m. Sunday, where they found infant dead inside a van. A family member was not aware that the child's mother had placed the baby in the rear-facing car seat inside the van after church about 12:45 p.m.

Investigators are still waiting for results of the autopsy from the Medical Examiner's Office, sheriff's office spokeswoman Michele Nicholson said.

"This is a tragic event that we are continuing to investigate, and will provide more information when the evidence, facts and interviews are concluded and reviewed," she added in an email statement.

According to the website KidsAndCars.org, an average of 37 children in the United States die from heat-related deaths after being left inside vehicles. Since 1990, about 800 children have died of vehicular heat strokes.

Niceville physician Wayne Justice has made it a personal mission to help save families from experiencing those tragedies after reading about one in the summer of 2013.

"I know how busy life can be. I have two kids who were 7 and 4 at the time," Justice said. "I started to think ... when doctors put patients on ventilators we have sensors to measure carbon dioxide. I'd love to see some kind of device in cars that monitors temperature and carbon dioxide."

Justice enlisted friends Dr. Kit Kuss and engineer Mark Denney to come up with a prototype. In January 2016 they received a patent on the XTRAS (Extreme Temperature Rescue Alarm System). He sees the device being installed in the dome light or TV monitors in cars that could sense motion, CO2 levels and temperature.

"The device would alarm parents by phone or call 911," he said. "Maybe even crank up the car and turn the AC on. It could also save pets."

As a father and a doctor, Justice said he would like to see his prototype developed into a life-saving device. He's hoping to work with KidsAndCars.org, (KAC), which works to raise awareness about the dangers inherent to children in or around motor vehicles, and the National Highway Traffic Safety Administration to do more testing and get the finished device in cars.

"I see it as a baby shower gift," he said. "You give monitors and the XTRAS."

According to KAC, in more than half of the cases in which a child is left in a hot car, the person responsible for the child left them unknowingly. Neuroscientists say brains can go on "auto pilot" and go through the day's schedule without noticing changes in the routine.

Justice also points out children can get accidentally locked in cars with the child safety lock features.

"It's horrible and devastating," he said. "I would love to see this implemented in cars and save lives."

See more here:
Local doctor wants to save kids from hot cars - The Northwest Florida Daily News

Either the 22-year news embargo has been lifted or the Broadcasting Thought Police havent yet arrested WFANs Richard Neer for media malfeasance in the first degree. What he said on the air Monday morning, after all, previously was an act of sedition.

Neer cast some practical doubt on a fellow who for years was presented to Americans not only as the greatest in his sport (which was true for a while), but also as the worlds greatest son, husband, father and human: Tiger Woods. Yet Neers still at large, not yet in custody.

Neer noted that Woods, that morning, had tweeted he was out of drug rehab, although not quite. Drug and rehabilitation didnt make the cut. The message read: I recently completed an out of state private intensive program. I will continue to tackle this going forward with my doctors, family and friends.

Whatever this is.

Neer said this strikes him as one of those dubious two-week miracle cures, thus hes not convinced Woods is properly dealing with an addiction for which he might need intensive treatment.

Neer might have added that this tweet, in the month following Woods 3 a.m., lost-in-space, DUI arrest, carried the stink of a Team Tiger public relations ploy, as it was sent in the midst of the July Fourth holiday. Public relations folks often have high-profile clients choose to release statements that dont reflect particularly well on them at times that make the least possible news.

But what, other than Woods ability to shoot lower than everyone else, has not been accompanied by the doubtful, followed by media-excused absences of common sense?

He tweeted that after an intensive program he was working with my doctors.

In 2009, with the finest doctors in this country to select from, Woods and company chose Canadian Anthony Galea, who was flown to Florida a reported 14 times to treat Woods knee.

Two years later, Galea pled guilty to smuggling illegal drugs and human growth hormone into the United States.

Woods and Galea claimed the doctor administered no illegal treatments. So then why would Woods fly him in from Toronto? He couldnt have been similarly, legally treated by a U.S.-accredited physician?

But to even hint that this made less sense than it did nonsense went widely ignored. Woods was entitled to escape such logical doubt while his career has been laced with the stench of fraud.

His closely followed, far-flung and expensive amateur career surely was financed by his father after the monolithic rep firm, IMG, hired Earl Woods as a talent scout, as if Dad scouted other talent. Tiger then belonged to IMG the instant he turned pro, thus Team Tiger thumbed its nose at USGA rules prohibiting amateurs from having agents.

His come-out, attitude-enriched Nike commercial had Woods, who previously had insisted that he didnt want to be known for his race, saying, There are still courses in the United States that I am not allowed to play because of the color of my skin.

But as the most celebrated amateur since Bobby Jones, no such thing, as a Nike rep later admitted, was true. Woods, however, often played and practiced at a course in Houston that excluded women.

In 1997, when Woods skipped a PGA event in the U.S. to play a tournament in Thailand, the media reported Team Tigers claim: he was playing in Thailand to honor his mothers heritage. What a son!

That $500,000 appearance fee to play in Thailand? Shhh. Dont ruin it! After all, that weeks PGA Tour winner won only $270,000.

But Woods has always been guarded and enabled by fractional truths, if not lies, blissfully indulged or advanced by media.

Of course, no one rolled over and played dead for Woods more often than TV, its golf voices allowing him to be the only player entitled to act like a foul-mouthed spoiled brat, even into his late 30s, without a discouraging word about what was impossible for viewers to not hear or see.

During the 2010 Ryder Cup, as Woods and Steve Stricker were losing their second team match, NBCs Johnny Miller identified the problem: Stricker. It was his fault.

Yet it was clear to even miniature golfers that Stricker was playing better than Woods.

Into NBCs booth entered Colin Montgomerie, guest commentator. Apparently unfamiliar with the rules of Tiger Woods American TV coverage, the Scotsman volunteered that Woods was playing poorly.

He has hardly hit a fairway or green in regulation, Montgomerie said.

OMG! Awkward silence. Montgomerie had no idea that no matter how conspicuous the truth, youre not supposed to say that, not about Tiger Woods.

And so despite the rank pandering and Woods continuing free fall, the media have done Woods no favors.

FOX Sports boss and former ESPN shot-caller Jamie Horowitz, this week was fired for alleged sexual misconduct. Employees must attend seminars to deter sexual harassment, yet its their bosses who are fired for it.

Its odd, too, how defense lawyers make public declarations of hard facts without possibly knowing them. Horowitzs attorney, Patricia Glaser, immediately knew that FOX, not Horowitz, was the guilty party:

The way Jamie has been treated by FOX is appalling, she said. At no point in his tenure was there any mention from his superiors or human resources of any misconduct or an inability to adhere to professional conduct.

Does that mean FOX owed Horowitz a warning to cut it out?

Glaser continued: Jamie was hired by FOX to do a job that until today he has performed in an exemplary fashion.

How does she know? Did she shadow Horowitz at work?

Finally, she said, Any slanderous accusations to the contrary will be vigorously defended.

So how can she be sure shes not slandering those who fired him?

Many high-powered attorneys are like Mike Francesa. They can publicly claim anything about anything and anyone as fact without knowing if its true, never to be held accountable.

Game 5 of the 1956 World Series, and we can hear John Sterling: Casey Stengel has seen enough, Suzyn. He has brought in eighth-inning man Dellin Betances. That closes the book on Don Larsen: Seven innings, no runs, no hits, no walks.

FOXs commercials for Tuesdays All-Star Game are off by at least a half-hour. The game will not begin at 7:30 p.m., but sometime after 8 p.m.

Damien Wilson, the Cowboys linebacker who was arrested Tuesday on two counts of aggravated assault with a deadly weapon a car and a rifle is a University of Minnesota man.

After Joey Chestnut again won the 2017 Nathans Hot Dog Eating competition on July 4, reader Mark Woloshyn was disappointed that ESPN didnt post Chestnuts postgame exit velocity.

Read this article:
WFAN voice breaks through media's wall of Tiger protection - New York Post

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A copy of the Declaration of Independence.

Following is the text of the Declaration of Independence in celebration of Independence Day, July 4th, 2017:

IN CONGRESS, July 4, 1776.

The unanimous Declaration of the thirteen united States of America,

When in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Natures God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States. To prove this, let Facts be submitted to a candid world.

He has refused his Assent to Laws, the most wholesome and necessary for the public good.

He has forbidden his Governors to pass Laws of immediate and pressing importance, unless suspended in their operation till his Assent should be obtained; and when so suspended, he has utterly neglected to attend to them.

He has refused to pass other Laws for the accommodation of large districts of people, unless those people would relinquish the right of Representation in the Legislature, a right inestimable to them and formidable to tyrants only.

He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their public Records, for the sole purpose of fatiguing them into compliance with his measures.

He has dissolved Representative Houses repeatedly, for opposing with manly firmness his invasions on the rights of the people.

He has refused for a long time, after such dissolutions, to cause others to be elected; whereby the Legislative powers, incapable of Annihilation, have returned to the People at large for their exercise; the State remaining in the mean time exposed to all the dangers of invasion from without, and convulsions within.

He has endeavoured to prevent the population of these States; for that purpose obstructing the Laws for Naturalization of Foreigners; refusing to pass others to encourage their migrations hither, and raising the conditions of new Appropriations of Lands.

He has obstructed the Administration of Justice, by refusing his Assent to Laws for establishing Judiciary powers.

He has made Judges dependent on his Will alone, for the tenure of their offices, and the amount and payment of their salaries.

He has erected a multitude of New Offices, and sent hither swarms of Officers to harrass our people, and eat out their substance.

He has kept among us, in times of peace, Standing Armies without the Consent of our legislatures.

He has affected to render the Military independent of and superior to the Civil power.

He has combined with others to subject us to a jurisdiction foreign to our constitution, and unacknowledged by our laws; giving his Assent to their Acts of pretended Legislation:

For Quartering large bodies of armed troops among us:

For protecting them, by a mock Trial, from punishment for any Murders which they should commit on the Inhabitants of these States:

For cutting off our Trade with all parts of the world:

For imposing Taxes on us without our Consent:

For depriving us in many cases, of the benefits of Trial by Jury:

For transporting us beyond Seas to be tried for pretended offences

For abolishing the free System of English Laws in a neighbouring Province, establishing therein an Arbitrary government, and enlarging its Boundaries so as to render it at once an example and fit instrument for introducing the same absolute rule into these Colonies:

For taking away our Charters, abolishing our most valuable Laws, and altering fundamentally the Forms of our Governments:

For suspending our own Legislatures, and declaring themselves invested with power to legislate for us in all cases whatsoever.

He has abdicated Government here, by declaring us out of his Protection and waging War against us.

He has plundered our seas, ravaged our Coasts, burnt our towns, and destroyed the lives of our people.

He is at this time transporting large Armies of foreign Mercenaries to compleat the works of death, desolation and tyranny, already begun with circumstances of Cruelty & perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized nation. He has constrained our fellow Citizens taken Captive on the high Seas to bear Arms against their Country, to become the executioners of their friends and Brethren, or to fall themselves by their Hands. He has excited domestic insurrections amongst us, and has endeavoured to bring on the inhabitants of our frontiers, the merciless Indian Savages, whose known rule of warfare, is an undistinguished destruction of all ages, sexes and conditions.

In every stage of these Oppressions We have Petitioned for Redress in the most humble terms: Our repeated Petitions have been answered only by repeated injury. A Prince whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people.

Nor have We been wanting in attentions to our Brittish brethren. We have warned them from time to time of attempts by their legislature to extend an unwarrantable jurisdiction over us. We have reminded them of the circumstances of our emigration and settlement here. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which, would inevitably interrupt our connections and correspondence. They too have been deaf to the voice of justice and of consanguinity. We must, therefore, acquiesce in the necessity, which denounces our Separation, and hold them, as we hold the rest of mankind, Enemies in War, in Peace Friends.

We, therefore, the Representatives of the united States of America, in General Congress, Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by Authority of the good People of these Colonies, solemnly publish and declare, That these United Colonies are, and of Right ought to be Free and Independent States; that they are Absolved from all Allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. And for the support of this Declaration, with a firm reliance on the protection of divine Providence, we mutually pledge to each other our Lives, our Fortunes and our sacred Honor.

The 56 signatures on the Declaration appear in the positions indicated:

Column 1

Georgia:

Button Gwinnett

Lyman Hall

George Walton

Column 2

North Carolina:

William Hooper

Joseph Hewes

John Penn

South Carolina:

Edward Rutledge

Thomas Heyward, Jr.

Thomas Lynch, Jr.

Arthur Middleton

Column 3

Massachusetts:

John Hancock

Maryland:

Samuel Chase

William Paca

Thomas Stone

Charles Carroll of Carrollton

Virginia:

George Wythe

Richard Henry Lee

Thomas Jefferson

Benjamin Harrison

Thomas Nelson, Jr.

Francis Lightfoot Lee

Carter Braxton

Column 4

Pennsylvania: Robert Morris

Benjamin Rush

Benjamin Franklin

John Morton

George Clymer

James Smith

George Taylor

James Wilson

George Ross

Delaware: Caesar Rodney

George Read

Thomas McKean

Column 5

New York:

William Floyd

Philip Livingston

Francis Lewis

Lewis Morris

New Jersey:

Richard Stockton

John Witherspoon

Francis Hopkinson

John Hart

Abraham Clark

Column 6

New Hampshire:

Josiah Bartlett

William Whipple

Massachusetts:

Samuel Adams

John Adams

Robert Treat Paine

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Anti tb drugs side effects pdf - Antioch Herald

Stress. Lets face it. We all have it. The people who dont read this article are simply in denial or arent ready to face it. Stress is the kudzu that looks pretty benign at first, but then takes over everything. It grows out of control. This can lead to adrenal fatigue, which well get into through a future column. We need to figure out how to become more aware of it in order to address it head on.

Stress comes in many forms be prepared, Im about to mention some examples. If they hit home with you, then that feeling you get deep in your chest as I mention them, is the stress response! Ever cram for a final test Stay up all night with a fussy child? Late for work? Have a big presentation to give? Need to get four kids to seven different places after school in traffic (I raised my hand on this one!)? Been diagnosed with an illness? Cancer?Facing a move? Retiring? And the list goes on. And heres the thing depending on how you mentally respond, any situation could or could not be stressful.

Stress disrupts sleep and eating habits, alters hormones, increases risk of illness and accelerates aging just to name a few. Its like a bridle to a horse it has the ability to influence everything else in our lives. Tired all the time Its probably stress causing that or could at least be a significant factor. Heres a good way to test if stress is built into your daily routine are you reactive or proactive most of the day? Do you just put out small fire after small fire answering your phone every time in dings? Responding to email every 5 minutes? Starting several tasks but not completing any before something else pulls you away? If your response is yes, then youre reactive. This is the opposite of proactive, which is the key to carrying around less stress. Proactive is planning and then having a good idea of how your day/week/month/year will unfold. In a life where reactive is the norm, stress is the norm.

As I eluded to above, many times stress is a decision we make in our minds. I have a wonderful friend who, God bless her, turns everything, even a decision about whether or not to put sugar in her tea, into a live or die, extreme stress and life altering decision. She lives in this uber-stress zone that I dont even have enough mental capacity or energy to fathom! This is just cruising for an early heart attack!

Another part of moving towards minimizing stress is that its counter cultural. Just watch a few commercials the American culture is all about being driven, doing more, having more, never settling, and on and on. Dont get me wrong, there are some good caveats to American culture, but the undue stress it put on us through, most times, unachievable expectations is not one of them. Its the perpetual drive for more that breaks us eventually. Sometimes we just need to have an awareness of the moment we are in and be content in that. I think it would lead to less stress not to mention likely freeing our time up more for ourselves, our families, sleep, and whatever else we wanted to do that felt less stressful and more rewarding.

Ever had someone sneak up and scare you?! Ill admit, Im that dad who does it to his kids! That feeling you get is adrenaline from your adrenal glands. How about long term stress, like having a weekly office meeting where you have to present accomplishments? Cortisol is the longer-term hormone released from the adrenals to adjust to stress. How about when that runs out? Like when youre a mother of an infant and you get up with them 2-5 times (yes, that many times for those of you who havent had children yet!) per night for up to a year?! Thats when cortisol reserves are depleted and you move towards burnout or adrenal fatigue. Stress tells your body through all these phases to release fancy things like interleukin-6 and C-reactive protein which cause inflammation. Inflammation is the gateway to almost all the long term issue related to stress like heart disease, high blood pressure, lowered immunity (i.e you get sick more often), poor wound healing, weight gain, insomnia, fatigue and memory impairment.

Well, if I left you there, it would be depressing and add to your stress. Heres a list of just a few simple things you can do to lower your stress level and get back to what normal should feel like:

1. Get more sleep. Just turn the TV off sooner or put your phone down and do it. Youll feel better.

2. Wake up 5 minutes earlier and use that time for quiet reflection and/or to plan your day youd be amazed what a difference this makes!

3. Turn you phone off for part of the day. Heresy, I know! But 20 years ago, if you were driving somewhere for an hour and a half, nobody could reach you and the world didnt end, did it?

4. Schedule your priorities dont prioritize your schedule. Cheesy I knowbut catchy!

5. Get bored. Spend some time doing absolutely nothing ironically, youll get something out of it!

6. Prepare and cook a meal with a significant other. Its therapeutic and will enhance your relationship.

Thats just a few things. There are thousands of other applications. The challenge for you today is to be aware of stress in your life and pick 1-2 things to do to address it. Trust me, itll put a smile on your face!

Dr. Thomas is a board-certified physician who operates Complete Health Integrative Wellness Clinic and Thomas Urology Clinic in Starkville.

This newspaper column is for informational purposes only and is, under no circumstances, intended to constitute medical advice or to create or continue a physician-patient relationship. If you have a medical emergency, you should immediately seek care from your nearest emergency room, and if you have specific health questions, you should consult your own physician.

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Only read this if you're stressed - Meridian Star

Dr. Carol Renke and her family practice exudes a familial atmosphere and thats exactly how she likes it. Her husband, Robert Renke, serves as practice manager; much of her staff has been with her for many years; and Renke gets to care for multiple generations of patients, ranging from adolescents to the elderly.

Ive gotten to see patients through different phases of life and I love getting to know them as people, not just their medical histories, she says. I make sure Im spending a little more time with my patients than I think most people are doing these days.

Her two staff physician assistants keep appointments open daily so sick patients can get same-day appointments rather than having to wait. Even with last-minute scheduling, Renke oversees the cases. I review everything. All the blood tests, all the X-rays, she says. And in the style of old-fashioned medicine, Renke insists on following up with a letter or a call after every test. Theres no, Oh if you dont hear from us, everythings fine, she explains. If you do a test, you want the results.

Read more from the original source:
Carol Renke, MD Top Doctors 2017 - Palm Springs Life

Fort Worth Star Telegram (blog)

It's time for baseball to allow the use of PEDs Fort Worth Star Telegram (blog) A former Major League Baseball trainer is fairly certain that ballplayers are using steroids again. That's if they ever really stopped, the trainer, who worked for more than 10 seasons with a big league ballclub, recently told me. It wouldn't ...

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It's time for baseball to allow the use of PEDs - Fort Worth Star Telegram (blog)

The "abortion pill" (actually two separate medications) can be taken up to 10 weeks after pregnancy, according to the FDA.

Roe v. Wade may have legalized abortion in America 45 years ago, but the fight it ignited is far from over. While abortion is still legal, many states have since passed laws that restrict access to abortion to varying degreesmaking it more expensive, difficult or even illegal in specific circumstancesto terminate a pregnancy. Todayabortion clinics are disappearing at a record pace,andMedicaid payouts to Planned Parenthood are in jeopardy.

As a result, many women do not have access to a safe clinical abortion.

The fact that a clinic exists in her state doesnt help a woman who lives far away from that clinic and has no way to get there, says Susan Yanow, a reproductive health consultant for the international nonprofit Women Help Women(WHW). Seven statesKentucky, North Dakota, South Dakota, Missouri, Mississippi, Wyoming and West Virginiacurrently haveonly one abortion provider, and Kentuckymay soon bethe only state with none.

Now some women are once again taking the procedure outside the doctor's office, outside the law, and into their own hands. While the days of the infamous wire coat hanger aren't quiteover, many women are turning to asafer method made possible by modern medicine: the abortion pill.

For those with access to a clinic, the abortion pill has become anincreasingly popular wayto legally terminate an early pregnancy. The Food and Drug Administration mandatesthat medication can only be prescribed by a healthcare provider "who meets certain qualifications";19 statesalso require that a physician be there physically to supervise the procedure.

Anti-abortion activists argue against the safety of using this method outsidea doctor's office, and have even argued that states should require stricter medical supervision for abortion medication. These drugs are dangerous. They are deadly. If they are mishandled, they result in serious injury, Kristi Hamrick, spokeswoman for the antiabortion groupAmericans United for Life, recently told The Washington Post.(Hamrick is not a physician.)

Butwomen who can't get the medication legally can and dobuy it illegally, either online or in Mexico. In fact, thisis fast becoming the primary option for womenwho lack others: In 2015, more than 700,000 Google users in the U.S. typed in queries about self-induced abortions, includingbuy abortion pills online and free abortion pills,according to theNew York Times. In May 2016,Glamourmagazine chronicled the stories of women seeking these pills inThe Rise of the DIY Abortion.

Thats why, in April, WHW launched its first website to assist American women undergoing medical abortions on their own. The new Trump administration and anti-abortion legislatures in many states are moving swiftly to push abortion out of reach, said Kinga Jelinska, the groups executive director, ina statementannouncing the move. The new website, Abortionpillinfo.com, provides women with confidential, one-on-one counseling on how to safely use theirabortion medicationregardless of where they may have obtained it.

It isn'tclear just how many women are seeking abortion medication outside of a clinic. To protect its clients, WHW does not disclose how many inquiries its trained counselors receive. But in the past several years,manywomenhave been charged for buying or taking it illegally, with several facing felony charges andjail time. As use of the abortion pill spreads outside the doctors office and into murky legal waters, we asked: How does this procedure work? And how safe is it?

...

While it's used by many abortion clinics, the name abortion pill is a bit misleading. Medical clinics actually administer two different types of medication: one mifepristone pill(which goes by the brand name Mifeprex), and four misoprostol tablets.

How does it work? The first dosea 200 mg mifepristone pillbegins the process by blocking the bodys progesterone, a hormone that is needed to continue a pregnancy in its early stages. Whenever a woman has a period, part of what stimulates that period is the withdrawal of progesterone, saysDr. Lauren Thaxton, an obstetrician-gynecologist in Albuquerque, New Mexico who has been performing abortions for six years

By blocking this hormone, the first pill helps break down the uterine lining that a woman normally sheds during her period, so that the embryo can detach from the uterine wall. After that happens (generally one to two days after taking the first mifepristone pill),a woman dissolves four 200 mcg misoprostol tablets in her mouth. This second medication, which is also used to induce labor, helps expel the detached embryo.

Misoprostol is in a class of medications called prostaglandins, saysobstetrician-gynecologist Dr. Daniel Grossman, who isthe director of Advancing New Standards in Reproductive Health and co-author of a recent paper exploring the possibility of moving early abortion medication over the counter. One of the effects of prostaglandins [is] that they cause whats called cervical ripeningmeaning causing the cervix to soften, open up, and become thinner. And it also causes the uterus to contract.

Misoprostol was first developed in the U.S. in 1973 to treat peptic ulcers,which it did by preventing harsh gastric secretions. But it had known,major side-effectson a pregnant uterus. In the 1980s, French researchers developed mifepristone,also known as RU-486, a pill that could be taken in sequence with misoprostol to induce an abortion. France legalized this regimen in 1988, andChina,Great Britain and Swedensoon followed suit.

In the U.S., reproductive rights activists hoped the FDA would adopt the method in the '90s, but anti-abortion activists helped delay its approval until 2000. When the U.S. first legalized abortion medication, it was available up to seven weeks after pregnancy. Women receiving it had to visit a clinic three timesonce to take the mifepristone, a second time to take the misoprostol, and a third time for a follow-up.

In 2016, the FDAextended the pregnancy period to 10 weeks and reduced the number of required visits to two, meaning that women could now take the misoprostol at home (though some states have restricted that as well). Today there are even clinicsthat aim tode-stigmatize the processby offering a "spa-like experience,"like a Maryland Carafem health center that offers hot tea and robes to women seeking medical abortions.

One to two weeks after taking the medication, the woman returns to the clinic to make sure the pregnancy has passed. When taken between nine and 10 weeks into a pregnancy, mifepristone and misoprostol are 93 percent effective at inducing an abortion, according to Planned Parenthood. The earlier they are taken, the more effective they are.

In 2014, almost half of U.S. hospital and clinical abortions performed before nine weeks were medication abortions, according to estimates from the Guttmacher Institute, a research and policy organization for reproductive rights. But if WHWs new counseling services, Google queries and the increase in articles on DIY abortionsare any indication, many moremedical abortions may be happening outside the clinic.

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Cara Harshman, a freelance writer and marketer in San Francisco, had her (legal) medication abortion in January. In an interview, she said that her symptoms of cramps, bleedingand nausea lasted for about five days after taking the misoprostol. By the time she had her follow-up appointment, she was stable and feeling healthy. She wrote about her experience on the Facebook group Pantsuit Nationin an essay she thenre-published on Medium and Shout Your Abortion.

The only health issue that came up during Harshmans abortion was a blood test showing she was Rh negative, a rare blood type, meaning she had to receive a shot of the medication RhoGAM after taking the misoprostol. According to Thaxton, most women are Rh positive. But if a woman is Rh neg, pregnant and having bleeding, she needs to receive RhoGAM to prevent alloimmunization in future pregnancies, which is a condition wherein the mother develops an immune response to fetal red blood cells, Thaxton wrote in an email.

Overall [a medicationabortion]is extremely safe, says Thaxton, who is also a member ofPhysicians for Reproductive Health.Common symptoms include nausea, cramping and heavy bleeding, similar to what women experience during a miscarriage. Thaxton generally tells her patients that if they soak through four maxi pads in two hours, that's too much bleeding, and they should consult their physician. Theres a rare risk of [too much] bleedingsometimes bleeding requiring a blood transfusionand that can be related to the risk that the pregnancy has incompletely passed, she says.

To prevent this, abortion providers will counsel women about whether they have a history of bleeding disorders before prescribing this method. Theres also a small risk of infections like endometritis(inflammation of the uterine lining)or the contraction of the bacterium Clostridium Sordellii, both of which can also occur after childbirth. However, Thaxton said that the instances of infections after medication abortions are extremely, extremely rare.

Women are always screened for health conditions that might make a surgical abortion a safer option than the abortion pill, Thaxton wrote in an email. But for the vast majority of women, the abortion pill is a safe, private, effective way to have an abortion."

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Both mifepristone and misoprostol are available to purchaseonline without a prescription, even though doing so isillegal under federal law (laws regarding inducing an abortion vary by state). Many women who have to resort to this method use only misoprostol, because itis easier to get on its ownand is available over (or under) the counterin many Latin American countries.

Texas women have been getting misoprostol at Mexican pharmacies for years, The New York Timesreported in 2013; whileabortion in Mexico is legally restricted, the medication is sold over the counter for ulcers.

Research has found that a larger amount of misoprostol is needed to induce an abortion on its own, and its usually less effective than the combined method. During the first 12 weeks of pregnancy, a woman who takes three 800 mcg doses of misoprostol orally at least three hours apart has an 85 percent chance of having a complete abortion, according toa 2007 study in theInternational Journal of Gynecology and Obstetrics.

Yet somestudies suggest that inducing an abortion using misoprostol alone is no less safe than the combined method. The World Health Organizationrecommends misoprostolas a safe alternative when mifepristone isn't available, andGrossman says he would use the misoprostol-only method if he didn't have access to mifepristone as well.

Over-the-counter abortion medication may sound pretty far-fetched in a country like the U.S., where even standard birth control requires a prescription in almost every state. Yet the fact that women are already managing their medication abortions on their own has led some to wonder: Could the abortion pill(s) ever be sold over-the-counter, asGrossman's study explored?

In a recent Guardian op-ed, he writesthat limited research suggests women who take abortion medication on their own are doing so safely, adding that there is no question that use of these medications has contributed to a reduction in abortion-related mortality worldwide. Abortion medication, he argues, could one day meet the FDAs requirements for over-the-counter drugs. In fact, the research group Gynuity Health Projects is already conducting an FDA-approved research project calledTelAbortion to test the safety of women using mail-order medication and online consultation to perform their abortions at home.

Of course, future research willbe needed to test these hypotheses. But even if the pill's at-home safety is confirmed,if history tells us anything, it's that efforts to make abortion more accessible will be fought every step of the way.

Visit link:
The Science Behind the Abortion Pill - Smithsonian

Each Tuesday, Doctor Rob Riley joins us on NewsCenter 16 at Noon to answer viewers' medical questions. Here are the questions he addressed on June 20.

Why do I get an earache when I sleep? It goes away once I'm up."

Dr. Riley: Several possibilities here. Some ear infections hurt more at night, perhaps due to fluid shifts that occur with lying flat. Sometimes dental problems can do this. If you're a mouth breather, drying out the throat at night can cause irritation to the bottom of the Eustachian tubes which we can perceive as ear pain. And it can be as simple as sleep position. If you're putting pressure on a nerve that goes to the ear as you sleep, that will get better when you get up and the pressure is relieved. In any event, if this problem persists, it's definitely worth a visit to your physician who can examine your ear canals, look at the middle ear spaces, look at your inside of your mouth and throat and see if there's something there that requires treatment.

"I know as we age we get a bit shorter. I've shrunk three inches and now my belly is getting bigger. I tell people that as I got shorter, my innards had to go somewhere. Is this explanation anywhere near the truth?"

Dr. Riley: Well, maybe. It's true that we all tend to lose a little height as we get older. The little shock absorbers between the bones of our spine tend to get a little flatter over time and it adds up. Losing three inches is a lot, though, and suggests some of the height loss may be due to compression of the bones themselves. So it may be a good idea for our viewer to be checked for osteoporosis as we have some treatments for that that may reduce the risk of bone fractures later in life. In terms of tummies pooching out, I suppose a shorter spinal column might contribute some, but it's more likely to be due to increased belly fat that's pretty common as we age.

Why does the inside of my body feel cold but my skin is burning hot?"

Dr. Riley: We don't know the age of our viewer, but temperature regulation issues are common as part of menopause. Classically, we think of women getting hot flashes, but temperature problems in general can accompany menopause. This time of year, a bad sunburn can cause people to get the chills. Another concern that comes to mind is thyroid disease. Thyroid hormone affects lots of body functions, including temperature regulation. Low levels of thyroid hormone can cause the person to feel cold when everyone else in the room is comfortable. This condition is much more common in women than in men and is diagnosed with a simple blood test. It's treated by giving people additional thyroid hormone that they can take in pill form. That often takes care of the problem.

Dr. Riley joins us from Memorial Family Medicine.

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Ask the Doctor: Earaches, getting shorter with age, temperature regulation - WNDU-TV

By DR. LORIE THOMAS As we age, there are many changes that take place in our bodies. One of these changes involves our bodies going through menopause. No one ever tells you that the aging process causes your skin to lose elasticity. For women, this may intensify many other changes that have already occurred with the effects of hormone changes and structural changes from pregnancy and childbirth. Elasticity is a result of the changes in collagen. Collagen is a structural protein found in skin that gives it strength, elasticity and replaces dead cells. Changes in collagen for a woman may lead to: Stress urinary incontinence, which happens when physical movement or activity puts pressure on your bladder Vaginal thinning, which reduces natural lubrication Vaginal dryness, leading to painful sex Many women find themselves embarrassed, frustrated, helpless and unlikely to ask a physician for help. Often, the standard medical recommendation of estrogen cannot be used for a woman due to a history of breast cancer, a blood-clotting disorder or heart risks. A woman may believe she has no options, but this may not be true as she could consider a laser procedure. This procedure helps rebuild the natural collagen of the vagina. A procedure called vaginal rejuvenation is a non-surgical treatment to restore a youthful state. Vaginal rejuvenation stimulates the regeneration of collagen and elastin. This procedure has a positive impact and improves urinary stress incontinence, vaginal tightness, vaginal dryness and the symptoms of postmenopausal atrophy. Vaginal rejuvenation is a 30-minute, noninvasive treatment where a specialized laser probe is inserted into your vagina to deliver light energy directly to your vaginal tissue to stimulate collagen production. Following your vaginal rejuvenation treatment, you can return to your normal daily activities immediately following treatment. However, you should avoid sexual intercourse for five days. Many individuals report that their vaginal rejuvenation procedure is more comfortable than having a Pap smear. Women wanting this procedure should consult with a physician to assure it is appropriate for them. Thomas is an obstetrician-gynecologist affiliated with Blanchard Valley Health System. Questions for Blanchard Valley Health System experts may be sent to: Weekend Doctor, The Courier, P.O. Box 609, Findlay 45839.

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Weekend Doctor - The Courier

ATLANTA - As an OBGYN with Piedmont Physicians in Newnan, Dr. Tia Guster gets asked a lot about what works for hot flashes.

"It's a little bit of trial and error," Dr. Guster says. "S you have to pack your patience hat on that one."

That's because the triggers are different for each woman, Guster says.

For some, drinking alcohol or caffeine can turn up the heat.

For others, stress, eating spicy food, just being in the heat can trigger that sweaty, flushed feeling.

So, Guster says, start by paying attention to what you're wearing.

"So keep it kind of loose, with flowing maxi-dresses, if you can, at all, wear that as a fashion trend," she says.

And try turning down the temperature at home.

For severe hot flashes, Dr. Guster says, ask your physician whether you're a candidate for hormone replacement therapy, also known asHRT, and what the risks and benefits are.

Your doctor may also prescribe non-hormonal medication to ease your symptoms.

And, Guster says, soy also works for some women.

"Legitimately, soy-based products are helpful, because they act essentially as estrogens in your body," she says. "And we've got those over-the-counter."

Steer clear of soy and soy products if you have a hormone-sensitive condition, like certain breast cancers.Guster says supplements like black cohosh, red clover and evening primrose oil may also help ease your symptoms.

"I think it's worth a try before you go to (prescription) medicine," she says. "But definitely bring all your stuff in and just have a conversation, like, 'Doc, I use this, and I use this. What do you think about this?'"

Finally, Guster says, exercise can be a huge help.

"It boosts your endorphins," she says. "It lowers your weight. It helps with your heart rate and your blood pressure. And all these things are excellent foundations for health."

You don't have to lift weights or run a marathon, Dr. Guster says.

"Just walk up and down your block for 30 minutes," she recommends. "It's also mind-clearing, which goes a long way."

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Tips for easing hot flashes - FOX 5 Atlanta

wbur Commentary

June 16, 2017

By Dr. Isaac Kohane

Quick: What is the hilly profile in the red figure below?

No, its not my fitness trackers daily step count, but youre close.

Its a set of daily weights, as measured by an electronic scale over a period of several weeks. More specifically, the daily weights of my 90-year-old mother, who continues to live in her own apartment despite all my offers. "I outlived Hitler and Stalin, she says. I can take care of myself."

She can, in fact, take care of herself, but Ive found over recent months that she can take care of herself far better with some digital help. And that experience, though only a single case, persuades me that recent spectacular gains in artificial intelligence could bode far better for our health than studies to date suggest. But also that caring, common-sensical humans will not be replaced by AI any time soon.

My mother has moderate heart dysfunction, and her physician has her on all the right medications, including a daily dose of Lasix, a "water pill" that makes you urinate more and thereby eliminate some of the salt in your blood. Yet last year, over several weeks, her legs became increasingly swollen with fluid, to the point that it oozed out of her skin. Her shins looked as if they were covered withtears. She was also in quite a bit of discomfort.

Her physician sent her to the emergency room, where an ultrasound showed that her heart was enlarged and pumping less effectively than it should. She landed in the hospital for a week, where the most important treatment she received was intravenous Lasix, a far more potent form than her usual pills.

By the time she left the hospital, her legs had not returned to normal but were visibly thinner. As I would have said as a callous medical student, she had been effectively "dried out." She was also considerably weaker from spending a week in a hospital bed, but regained her strength with the help of a physical therapist.

Six months later, a similar scenario played out, but worse. This time, she had to go to a rehabilitation facility after her hospital stay because she was too weak to care for herself or even to walk without help. I suppose if you survive malaria, starvation and typhus as a child, you must be made of tough protoplasm. After two weeks of intensive rehab, she was back at her apartment again.

But two hospital staysin such a short period concerned me. So I decided to try something that in my day job as a researcher in biomedical informatics the use of computing to advance medicine --I knew had been tried before by many health systems with highly variable and often disappointing results.Nonetheless, I was determined to make it work.

The Plan

The plan was to have her watch her weight daily, and every time there was any sign of increased fluid, to recommend an extra dose an extra pill of Lasix, to restore her fluid balance.

This type of thinking has informed doctors for decades. Outside the hospital, it has worked well for some, but multiple trials, several involving computerized alerts every week to change water-pill dosage, have not conclusively shown benefit.

On the other hand, a friends father, a physician, had defied the odds and lived for decades with severe heart failure by weighing himself daily and adjusting his medications accordingly. That was not a trial, true, but it seemed remarkable, and I wanted to emulate it.

Before I go further, let me confess that when I tell this story to my colleagues, especially those trained in internal medicine or cardiology, their responses range from outright alarm to pursed-lip disapproval. It only gets worse when I remind them that I trained in pediatrics. So lets be clear: Don't try this at home, kids. And I would emphasize that I did not remove my mother from her regular internists care. He remained as a safety net, and I communicated with him copiously.

Back to my story: The challenge was to manage my mother within the constraints of my demanding schedule. I decided the first, most crucial task was to get accurate weights sent to me promptly so that I could act on them. I decided to purchase an internet-enabled scale from Fitbit that allowed me to check my mother's weight via Fitbit's web application.

I asked my mother to weigh herself every morning before eating. In the first few weeks, if she forgot to weigh herself I could see that and would call her to nudge her. Within a month, I never had to remind her anymore. Instead, shed call me to see what I thought of her weight.

Now for the easy part, how to control fluid balance. Heart physiology is complex, and many have tried with only partial success to devise computational models that can predict how it will change with perturbations from diet, medications, disease or exercise. But I boiled it down to one question: How to determine whether she should take an extra Lasixon a given day?

I'll call my plan an algorithm, so it will sound authoritative:

1. If her weight increases by more than 1 pound in one day, recommend one extra Lasix pill. 2. If her weight increases by only 1 pound, then wait to see if it increases by another pound in the following two days, in which case, recommend an extra Lasix pill. And if she took the extra pill, then: 3. If the weight does not return to normal by the second day after the extra dose, then give one additional dose the third day. If on the third day the weight has not returned to baseline, go visit her in her apartment and see if her legs are swollen or if her breathing has changed.

This third part of the algorithm I labeled "visiting nurse." If I saw anything that worried me swollen legs, faster breathing, poor skin color I would call her doctor and ask him to evaluate her. At this point, wed be back in the conventional medical management world, but Id have a lot more useful information to share with her doctor than I would otherwise.

The algorithm also included sleuthing out the cause of the weight gain. On the phone Id go over what she had eaten. Often the culprit was a source of additional salt. Only after reviewing a typical salad and pasta dinner would I learn that shed enjoyed a dozen delicious salt-loaded crackers.

Just having these "debugging" phone calls after a weight gain caused these diet-borne risks to be eliminated rapidly. They also provided my mother with a very concrete sense of which foods to avoid.

So What About AI?

Now back to the graph I shared above. It shows a few weeks of what has gone on for over a year. I managed each of those peaks according to the algorithm. Through the miracle of the internet and smartphones, I was able to run the algorithm even when I was in a distant part of the globe to give a talk or on a family vacation.

Best of all, my mother hasn't even come close to needing to go back to the hospital. Her legs remain completely unswollen. Also, I never called her doctor about persistent fluid gain because that part of the algorithm was never triggered.

Moreover, after a few months, my mother startedcallingme to let me know that she had already implemented the algorithm for that day, because shed gotten tired of waiting for me to call her with my recommendation.

So what about AI? If computers can now win Texas hold 'em poker with imperfect information and bluffing human beings, surely they can manage patients like my mother?

Im not so sure.

A frail, elderly patients health may be influenced by single or multiple perturbations that span the full spectrum of human experience: How much salt was in yesterdays food, the appearance of a skin infection on a leg, change in thyroid hormone levels, increased fluid loss due to apartment heat after an air conditioner failure, sad news causing mood changes causing decreased exercise.

That is only a partial list of the challenges that my mother has overcome in the past year.

And though it may seem straightforward, managing an outpatient with heart failure is far more difficult than the apparently more complex tasks that have been featured in the success of "deep learning": finding cancer cells in a pathology slide, or signs of diabetic disease in a photograph of a retina.

Even more challenging: How does a computer program obtain trust and persuasive powers so that skeptics like my mother will comply with recommendations? What discussions, diagrams, pressures or incentives will be sufficient to convince someone who may not be feeling well at all to change a behavior, a medication or diet?

These skills are hard to come by in humans, let alone computers.

So should we give up? On the contrary. Lets not fall into the trap of "the Superhuman Human Fallacy" the demand that computers perform better than even the best of humans. A more useful comparison is to the way humans actually perform.

Even with imperfect hardware and simplistic algorithms, my mother's doing better than before, when weeks would pass between physician visits and treatment adjustments. Im confident she and many other patients can do better still, but only if we shore up the two sides of the clinical compact.

On the one side, organized medicine has to change its practice so that it can ingest the day-to-day or even minute-to-minute measurements made of our fast-growing chronically ill and aging population, and transduce these data into timely treatment. But without thoughtful and broad application of AI techniques into the process of health care, our already struggling and stressed health care workforce will simply be not able to meet this challenge.

And on the other side, AI cannot replace family and friends as guardians of health not now and perhaps not ever.

AI may be good at chess and Go, and at developing expertise once reserved for doctors in arcane areas such as reading X-rays. But AI does not do well at understanding the wide world, at picking up mood or subtle signs of distress, at convincing a resistant human to listen to the doctor. We don't need AI for that; we need a caring village.

Dr. Isaac Kohane is the inaugural chair of the Department of Biomedical Informatics at Harvard Medical School.

Excerpt from:
What My 90-Year-Old Mom Taught Me About The Future Of AI In Health Care - WBUR

In the past half-century, this tiny object has gone from feminist icon to dangerous villain to, incredibly, feminist icon once again. And no, we're not sure why the background is pink.

The IUD is a clever little T-shaped object that does a really good job of babyproofing your uterus. Its relatively safe, last up to 10 years, and is 20 times better at preventing pregnancy than birth control pills, the patch or the ring. Today the IUD, which stands for intrauterine device, has become so trendy that you can find it on necklaces and earrings on Etsy, and read upfront memoirs by women about their experiences. But it wasnt always this way.

In the 1960s and '70s, the device started hittingits stride as an icon of liberated feminism. But in the mid-'70s, disaster hit. For decades, the IUD was roundly shunned in the United States by women and doctors alike. Today it is by far the most-used reversible contraception method in the world, with 106 million women relying on it for long-term contraception. And yet its still relatively rare in the U.S., wherenearly half of all pregnancies are still unintended.

That may be changing. Directly after President Trump took office, news outlets reported on the rush for long-acting birth control, speculating that the new urgency was fueled byfears that the administration would slash Obamacare requirements forinsurers to cover intrauterine devices and other forms of contraception, as well as stop Medicaid reimbursements for Planned Parenthood.(Most forms of the IUD, it turns out, can outlast a presidential term.) Suddenly, it seemedthat the IUD was destined to become a symbol of modern feminism once again.

To which longtime IUD-users say: Duh. What took you so long? Lets go back to the beginning.

Two Strands of Coarse Silkworm Gut

In 1909, a German medical journal published a paper on a funny-sounding device meant to prevent pregnancy. The device, according to the article, consisted of two strands of coarse silkworm gut united by a thin bronze filament, which were inserted into the uterus using a female bladder catheter (ouch!). The idea behind this and other early IUDs was that putting foreign objects in the uterus tended to sparkan inflammatory response that made life tougher for sperm, says David Hubacher, an epidemiologist who studies contraception at FHI 360, a human development nonprofit.

Prior to this point, the main form of internal contraception was known as an interuterine device, a device made of metal or silkworm-and-glass that was originally used for "therapeutic purposes."This device had a major drawback: it crossed both the vagina and the uterus, thus connecting the uterus to the outside environment by way of the vagina. In a time when gonorrhea was more common and had no good cure, these devices resulted in a high rate of pelvic inflammatory disease.

The 1909 papers title, Ein Mittel zur Verhtung der Konzeption (a means of preventing conception), was no doubt shocking to readers at the time, for whom birth control was a taboo topic, according to acontemporary medical journal. That might explain why, although it was the first genuine IUD, it seems not to have been widely used. It wasn't until 1928 thata German physician named Ernest Grafenberg developed a variation on the silkworm gut IUD, made of metal filaments shaped into a ring, which became more well-known.

Still,regulation was poor. As IUDs increased in popularity, so didreports of cases of pelvic inflammatory disease associated with them. By the late 1940s, only a miniscule number of American women were using European IUD technology, says Hubacher,who haswrittenon thehistoryof the device.

The IUD's first heydaydovetailed with the liberated 1960s and '70s. They got another bump when, in the 1970s, Senate hearings featuring safety concerns over the birth control pill pushed many women toward the IUD. Soon the little device had become, in the words of one doctors 1982 history of the IUD, the unofficial status symbol for the liberated woman. IUDs were worn as earrings even as bras were being burned.

It seemed the IUD was finally destined to have its day. At one point in the '70s, nearly 10 percent of American women using contraception were choosing an IUD. But then, just as it had become the anti-pregnancy choice du jour amongliberated women, one popular model turned out to be deadly. Enter: Dalkon Shield.

An American Tragedy

Today just the name "Dalkon Shield" evokes collective wincingamong a certain generation.In the 1970s, this crab-shaped IUD model was beginning to be linked with reports major health problems including pelvic inflammatory disease, septic abortions, infertility and even death. In 1974, amid media reports, congressional hearings and falling sales, the devices manufacturer suspended sales. ByJuly 1975, there were 16 deaths linked to the device, according to the Chicago Tribune.

By 1987, the New York Times was reporting that as many as 200,000 American women have testified that they were injured by the device and have filed claims against the A.H. Robins Company, the one-time maker of Chapstick Lip Balm. (The Washington Post cited more than 300,000 victims.) The manufacturer filed for bankruptcy in 1985, and a $2.4 billion trust was established in the late 80s for women whod been affected. The failure of Dalkon Shield would have consequences for decades to come.

Between 1982 and 1988, the use of IUDs and other long-acting reversible contraceptives in the U.S.declined significantly. That year, updated devices came out that met new FDA safety and manufacturing requirements, but the damage had been done. The shadow of the Dalkon Shield hung over the entire market, dissuading American women from even considering IUDs even as their popularity in Europe grew.

Mary Jane Minkin, a clinical professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine, says that in the 80s, when she discussed contraceptive options with her patients, IUDs were not even considered as a remote possibility. There was no person who would have let me put one in, she says.

In 1996, The Washington Post ran a story about a family planner from New Jersey working with IUD-using populations in Senegal, Nigeria and Kenya who herself had trouble finding an American physician willing to give her one. (At that time, only 1.4 percent of American women using birth control were using an IUD.) A year later, a Virginia physician trying to test a new IUD for market reported that he couldnt give the device away for free.

The reasons for the Dalkon Shields problems are still a topic of debate. During the fallout of the devices problems, researchers reported that a major problem with the device was the particular design of the Dalkon Shields tail string, which is used bothto help women make sure the device is still in place, and to aid in its eventual removal. Unlike other IUDs at the time, the string on the Dalkon Shield was made not of one filament but of many tightly wound filaments.

According to expert testimony in legal cases and reporting from that time, the multifilament string acted as a wick, pulling bacteria and sexually transmitted viruses into the wombs of Shield wearers, as The New York Times put it in 1987.

But Hubacher and Minkin say it was never clear how much the devices tail string was at fault. Rather, says Minkin, who was an expert witness on behalf of a trust later established to pay out women hurt by the device, the objects pronged, crab-like shape made it difficult to insert. That, possibly combined with poor doctor training, meant that it probably wasnt being placed correctly, she says. As a result, some women got pregnant while wearing the devices, leading to septic abortions and, in some cases, death.

She and Hubacher add that another potential danger for women was the fact that screening for pre-existing STIs like chlamydia and gonorrhea wasnt as good in the 1970s as it is now. Inserting an IUD into a woman with an infection might have spread that infection, potentially leading to pelvic inflammatory disease, which can cause infertility.

What's certain, however, is that the Dalkon Shield's failure rippled out to Americans' perceptions of all IUDs.After the controversy, all but one were pulled from the market by 1986. Even today, says Megan Kavanaugh, a senior research scientist at the Guttmacher Institute, some young women she interviews say their mothers have told them to avoid the devices.

Contraception's Gold Standard

Over the last 15 years, cultural attitudes toward this maligned device have been warming. Ameican IUD use has been on the upward swingsince the early 2000s, and several new brands have hit the market featuring names like Skyla, Kyleena and Liletta(apparently theres a mandate that new IUDs sound like pop stars). In the years 2011 to 2013, around one in 10 American women aged 15 to 44 who relied on contraception usedan IUDa five-fold increase over the previous decade, according to data from the Centers for Disease Control.

A safe IUD is the answer to all birth control prayers, writes a woman on Huffington Post who put her two teenage daughters on the device. I switched over a year ago from the pill to an IUD, and it has made a world of difference, writes another, adding: "I am EXTREMELY forgetful, and it is how we ended up with my now-5-year-old!" A gynecologist who herself wears an IUD recently wrote about the advantages of using a form of birth control that youre supposed to forget.

Kavanaugh attributes the change in great part to a recognition within the scientific community that modern IUDs are extremely safe. It helps, she adds, that a younger generation of women and doctors dont have the strong negative associations as those who grew up during the time of the Dalkon Shield. The American College of Obstetricians and Gynecologists now recommends the IUD as the gold standard of birth control, calling them safe and appropriate... These contraceptives have the highest rates of satisfaction and continuation of all reversible contraceptives.

These days there are two major types of IUDs: hormonal and copper. The copper IUD, physicians believe, is toxic to sperm, slowing and damaging the little wrigglers as they swim toward the egg like heat-seeking missiles. The hormonal IUD releases progestinthe synthetic version of the naturally-produced hormone estrogen, and the same hormone found in the pillwhich makes cervical mucus thicker and more hostile to sperm. While the mechanisms are different, the result is the same: Never the twain shall meet.

Hubacher and Minkin attribute the safety of modern-day IUDs to a number of factors. First of all, screening for STIs is much better nowadays. In addition, because they use copper or hormones rather than merely plastic, modern-day IUDs aremore effective at preventing pregnancy. (That means that IUD users are less likely to get pregnant, which can lead to medical issues like ectopic pregnancy.) Moreover, if the multifilament string was ever at fault, modern-day IUDs use single filament strings, eliminating that potential cause of infection.

Many physicians now back the IUD so much that it's become something of a cause to champion. Kavanaugh points to an organization in Washington, D.C. and a task force in New York City that promote IUD use and offer insertion training to medical professionals. IUD advertising has increased, and magazines like Cosmopolitan and Elle are running stories singing the praises of these tiny objects. Rates of IUD use have been growing across many demographic groups, says Kavanaugh, and the pace is especially rapid among young women. Now, a woman who becomes sexually active at 17 but doesnt want a baby till shes in her late 20s might be a good candidate for an IUD that lasts years.

Anecdotally, gynecologists say theyre seeing a major increase in demand. About six months [ago], I was doing one to two IUD insertions a week and now Im doing one to two a day. It's a huge increase,"says Brandi Ring, an ob-gyn in Denver whos part of a new generation of doctors and patients embracing the IUD. As of 2012, 10.3 percent of women who use contraception were using an IUD slightly more than what it was before the Dalkon Shield fiasco. Of course, because the U.S. population has grown, that means more women in the United States are using an IUD than ever before, Hubacher says.

I break it down for my patients in terms of how often they have to remember or think about their birth control, says Ring. I start with the pill, and I say: In the next year you will have to think about your birth control 365 times. For your IUD, you have to think about it twice: once to tell me you want it, and once when I put it in. Even better, because the IUD gets inserted by the doctor and lasts for years, theres little opportunity for user error. It has a failure rate of about one percentcompared to condoms, which have a 13 percent failure rate over the course of a year, or the pill, at 7 percent.

That said, the IUD isnt perfect. Both formscan cause bleeding and cramping directly after insertion, and ParaGard (the copper version) is known in some cases to initially make periods heavier and cramping more intense. It is possible, while rare,that an IUD could perforate your uterus, particularly if you have never had children or have recently given birth; this serious riskusually happens during insertion. There is also small risk that your body willexpel the device.(Check here for morecommon side effects for each type of IUD.)

The financial downside to IUDs is that women need to pay a chunk of change upfront, depending on insurance coverage. The price ranges: Right now, Obamacare generally covers the bulk of the cost of getting an IUD, sometimes leaving women with a few hundred dollars. Meanwhile, the cost of getting one without any insurance could be upwards of $1000 dollars, according to Kavanaugh.But over the long-term, the IUD ranks among the most cost-effective of contraceptives once you factor in things like the cost of unintended pregnancy.

In the end, it's your body, your choice. But if you do go forth and get an IUD, know that the tiny device in your uterus comes with a long and tangled history.

See more here:
From Medical Pariah to Feminist Icon: The Story of the IUD - Smithsonian

Aging is a normal process the body goes through, but not all of the symptoms that are frequently attributed to the normal aging process should be directly connected to aging some may be associated with other illnesses such as hyperthyroidism or hypothyroidism.

Hyperthyroidism, or too much thyroid hormone, in the elderly is often difficult to diagnosis. While multiple symptoms may be present in a younger population, the elderly may only present with one or two symptoms. According to the Cleveland Clinic, in the elderly population, "typical symptoms (such as weight loss, fatigue, tremors, palpitations, atrial fibrillation, anxiety, depression, shortness of breath, heat intolerance, eye symptoms and anemia) may be absent or attributed to aging or another chronic illness." As such, subtle signs should be looked for.

symptoms

Symptoms and signs of hypothyroidism may include weight gain, sleepiness, dry skin and constipation; however, a lack of these symptoms does not negate a diagnosis. To make a diagnosis in the elderly patient, doctors often need a high index of suspicion.

When attempting to diagnosis hypothyroidism in the elderly, doctors often look at a person's family history of thyroid disease, past treatment for hyperthyroidism or a history of extensive surgery and/or radiotherapy to the neck.

Due to the high incidence and prevalence of irregular heart rhythms, congestive heart failure, weight loss, nervousness and muscle weakness in our elderly, it is wise to carefully review with a physician the possibility of such illness being related to hypothyroidism.

Knowledge is the key. Tests, such as T4 and T3U (or T3 Uptake), can be performed to help evaluate the presence of either hyper or hypothyroidism. Replacement hormone therapy (L-T4) is effective in hypothyroidism, whereas in hyperthyroidism (the over production of thyroid hormone) an antithyroid medication is often prescribed to reduce production of the thyroid hormone with sedatives and beta-blockers utilized to treat the associated rapid heart rate and nervousness.

talk to your doctor

The issue here is that many seniors are never diagnosed properly as having hyper or hypothyroidism but, rather, are told their symptoms are typical of anyone in their stage of the aging process. It requires both the family and the physician of the elder to carefully review the mishmash of symptoms that plague us as we age, sort out what is "normal" in the aging process and what might be associated with some other diagnosis (such as hypothyroidism).

Simple tests can determine if the suspicions are valid. Treatment is relatively benign and, in the case of hyperthyroidism, can often be normalized in three to six months with subsequent medication therapy less aggressive in nature.

Bottom line: Don't simply assume that when a physician proclaims that you have an issue (i.e., high cholesterol) that you should begin to receive medication therapy to help reduce those cholesterol levels (given that diet and exercise did not lower the levels significantly); ask why the cholesterol is high to begin with you may find it's high due to hypothyroidism. Remember, knowledge is power.

Judson Haims is the owner of Visiting Angels Home Care in Eagle County. Contact him at 970-328-5526 or visit http://www.visitingangels.com/comtns.

Originally posted here:
Vail Daily column: Thyroid issues in the elderly often difficult to diagnosis - Vail Daily News

according to the doctors statement, the procedure is quick, painless, and doesnt require stitches. The pellets are inserted under the skin just above the hip, and will last three to four months.

The doctors office statement said that Forbes magazine recently reported on several studies regarding the effects of adding testosterone pellets to conventional hormone replacement therapy.

Researchers found that women taking testosterone have reduced incidences of breast cancer, and that testosterone can suppress breast cell proliferation and improve the common symptoms of menopause.

One patient, 44, had surgically induced menopause through a hysterectomy when she was 35.

I would say truthfully I felt a little dead inside, the doctors statement quoted her as saying.Nothing seemed fun anymore. I slept a lot. I had spurts of memory loss. I was just miserable.

That patient has been receiving both testosterone and estrogen pellets for nearly six years, and said its changed her life.

After the pellets are inserted, within 48 hours, I will wake up, and I will know my system has taken it in, she said. My brain fog is gone. I sleep better. You dont have the dips that come with oral medications. Its a more consistent release. The pellets have helped me with anxiety, weight loss, libido, mental clarity. Its like night and day.

Without hormone replacement therapy, Savage said, women are increasingly at risk for serious health consequences that also include osteoporosis, heart disease, Alzheimers and diabetes. The doctors statement came with the usual disclaimers making no promises and providing appropriate warnings.

See the rest here:
Sex super for women of any age: Implanted testosterone pellets ooze into your now-hot bod? - MyNewsLA.com

Silicon Valley thinks our bodies need a reboot. PayPal founder and Donald Trump booster Peter Thiel, who plans to live for 120 years, has publicly discussed taking human-growth hormone (and expressed interest in blood transplants from young people). Google spun off Calico in 2013 to defeat the inevitability of aging. Software engineers fast for days and order custom stacks of nootropics, or brain-enhancing substances, to gain a cognitive edge. One venture capitalist, requesting anonymity, said at a dinner he recently attended several people opened up boxes to pop nootropic pills before the first course.

Theres no end to the experimentation people will undertake in pursuit of productivity, even if most treatments and supplements dont yet have strong evidence or FDA approval. That hasnt phased the patients that Dr. Molly Maloof sees in her Silicon Valley practice. This is a place where people dont give a flying fuck what they do with their minds and bodies, she said.

The general practitioner wants to see real medical rigor behind people trying to hack their health. Her concierge medicine practice in San Francisco serves a small number of patients for anywhere from $5,000 for an initial assessment to upwards of $40,000 per year for comprehensive care (every patient has a second, primary care physician as well). Her clients are often engineers and executives looking to hit peak performance, or recover from an over-stressed work-life. Maloof, who earned her medical degree from the University in Illinois in 2011, sees part of her work as ensuring they they are doing it safely, backed up by the maximum amount of evidence.

Too often, she says, executives and entrepreneurs place performance above health. All these people are not stupid but what used to be domain expertise is now everyone claiming to be the expert, she says.

Maloofs data-heavy approach begins with a battery of testsmeasuring thousands of biomarkers in allto understand her patients at the cellular level. By analyzing the results, she can prescribe food and lifestyle tailored to every individual, alongside standard western therapies. Only then does she consider pharmaceutical-grade supplements. If needed, she helps patients practice harm reduction with performance-enhancing substances from nootropics to micro-dosing LSD. Her philosophy, she says, is to do more than cure sickness, but to enhance health.

Investors are betting this approachoptimizing ones health through deep analysis of their genetics, physiology, and psychologybecomes the standard of care. Technology, they argue, will ultimately bring down prices so its affordable for almost everyone. Today, Maloof estimates less the 1% of private medical practices take this approach, but companies like Color Genomics, Forward, Nootrobox, Arivale, Metabolic Code, Habit, and Viome are already aiming to go mainstream.

Maloof is surprised at the cavalier acceptance of DIY health at the intersection of technology and personalized medicine. People will spend months researching which computer they will buy and then two minutes researching the nootropic brand theyre about to put into their body, she says.

Maloof sat down with Quartz to talk about her work and the future of personalized medicine. The interview was condensed and edited for clarity.

Can you describe your practice?

My practice has basically been an emergent phenomena: What if a doctor decided to optimize health instead of just fixing illness? The first thing Ive done differently is Ive positioned myself as a doctor who is aiming to improve the human condition rather than just get you from sick to not-sick.

Theres this spectrum of disease. Most people are in the sick-to-average part of that spectrum. The athletes and movie stars of the world are at the opposite end at the optimal part of the spectrum.

Theres this space between average and optimal that is a very grey area. Its been sort of commandeered by the wellness industry: the people who perpetuate mindfulness, fitness, and nutrition, but maybe dont have any rigorous medical training. And, as such, havent actually learned the basic science of the human body and how biology, physics, and chemistry works.

How did your practice begin?

I thought, if I was in a perfect world, What would I want my health experience to look like? I basically decided I would want a doctor to listen to me, and listen for a long time. In an ideal situation, it takes about two hours to ask all the questions I would want.

In a perfect world, your body is like the airplane and Im the co-pilot

The second thing is that, typically when you get blood drawn from a doctor, you might get 10 biomarkers or lab [tests]. Thats just not very much information. And they dont usually tell you theres something wrong with you unless its really wrong. In my practice, Im looking at 170 chemical biomarkers. Instead of normal or abnormal, Im looking at a range of whats good.

Instead of just looking at blood, Im looking at blood, urine, stool and saliva. Instead of just chemistry markers, Im looking at chemistry, metabolomics (chemical fingerprints of cellular processes), genomics, microbiome (microorganisms), hormone tests, and Im starting to look at immunology markers.

Thats a very different experience. In a perfect world, your body is like the airplane and Im the co-pilot and were using all these tools to identify if there are issues going wrong with the engine.

How does your typical day go? How would a patients visit to your office be different?

A typical patient is first going to have a meeting with me to go through all these questions, Ill gather all the data and then send a phlebotomist to their house [to draw blood].

I get all the information back and then I sit back down with the patient and we will go over all of the report together. And that will take up to an hour and a half.

At the end of that, we edit the decision together. So we decide what we we want to do. I come up with a summary, a one- to two-page summary, and then create a schedule for all their supplements and their nutrition, and then basically hand off the recommendations to any staff they have to help implement it, or just to them.

Then Ill check in with them in a couple weeks via text or via email or the phone and then well repeat the process. Well take some of the labs that we did and then well repeat that on a quarterly basis. And then well go over the changes we see over time.

Q: How long would a typical patient be with you?

The real benefit comes after working for a year. Six months to a year is the minimum amount of time that we should be working together. And the patients who tend to go off the program, they come back to me eventually and theyre like, Yeah, I fell off the wagon and I want to jump back on. But it takes some commitment because you want to optimize health.

The patients that dont do the best are the ones that think that everything is about the supplements, and everything is about the right supplements. Supplements are like the last mile of optimization.

The first and foremost thing you need to do is recognize that this is not an overnight fix. Youre not just going to feel amazing overnight. Its actually about building these changes over time, and it makes a lot of difference if you recognize its like compounding interest.

And the thing about it is that its not rocket science, but a lot of it is actually knowing what is right for your body and your lifestyle. And thats going to be different for different people.

Q: Thats tough what youre describing. How many stick with it?

I work with mostly entrepreneurs, investors, and executives. So I tend to work with people who, when I first evaluate whether or not theyre a fit for my practice, I can assess how willing are they to do the things that Im asking them to do? If theyre a six out of 10, then Im not going to ask them to do that.

The patients that dont do the best are the ones that think that everything is about the supplements, and everything is about the right supplements. Supplements are like the last mile of optimization. They can make a really big difference. But fundamentally, if your lifestyle is a disaster, for those people its about actually showing them whats happening in their lifestyle and showing them how food is affecting them, giving them continuous glucose monitors, getting them heart-rate variability monitors, so they can glean some real insight around whats happening day-to-day.

Q: What are some of the more dangerous things patients come in doing?

A big problem I see people buying everything they read on Bulletproof Coffee. Im just like, Guys, [Bulletproofs founder] Dave Asprey has not figured everything out. First and foremost hes a salesman and a marketer. And secondly he is a bio-hacker, and so lets get real.

Everything hes recommending! Bulletproof Coffee [which has as much as 4 tablespoons of fat or oil per cup) is probably the worst idea that a person can do in terms of their health. The problem is theres a large number of people that will have much higher rates of cholesterol, and some people will be fine on it. And people do it wrong: they add sugar to it, or eat sugary things, or dont have the right genetics for that level of fat consumption.

Ive seen three patients now with really, really high cholesterol levels. Way, way above normal. Im like, What are you drinking in the morning? What does your routine look like? They say, You know, I start my day with Bulletproof Coffee And Im like, Are you? Oh no.

Is what youre doing scalable?

What Im doing right now is not scalable at all. Ive been doing this practice in order to figure out what does scale. Because if you look at all this information, youll start to see things that make sense for larger populations of people, and I think this is where medicine could go if we had more convenience.

Can this become a standard of care for most people, or will it be concierge medicine forever?

Here are few things that have to happen.

The health care system needs to recognize that what they are doing isnt working for chronic disease, first and foremost. Second of all, we need large-scale studies on this kind of medicine.

Im looking at interventions from the perspective of what is the most sound, evidence-based recommendation I can make for this individual. If it doesnt have evidence, why doesnt it. Chinese medicine may not have much evidence in the western model but it has thousand of years of people using it. The question is, Is it totally bullshit? Well, probably not. Theres probably some truth in it.

Then we need doctors who want to learn how to do this. We have to be able to train them how to do this. When I was in med school, I thought there was a lot missing from my education: what about lifestyle, what about what happens after the patient goes home after the visit to the hospital?

The kitchen is no longer the medicine cabinet. The kitchen is now the place of ultra-toxicity and disease.

I saw this giant problem in my education, and I actually designed a course called, Physician Heal Thyself, Evidence-based lifestyle. I brought in all these doctors who are experts in sleep medicine, sleep, fitness nutrition, food as medicine, functional medicine, integrative medicine, osteopathy and acupuncture. I got them all in a room and said I want you to teach students what were missing. We need to make this medical school education and have to implement this into the board certification programs as well as board exams. If its not required, its not going to be taught.

Finally, we need to be able to prescribe these things. We need food companies to do the research to show their food has outcomes that can improve human health. If we believe its medicine, then we need to study food as medicine. And we have to put it through the same rigor that we put drugs through. Thats going to happen. Were not that far way, but one of the biggest things that needs to happen is a culture shift.

Where do you think a practice like yours will be in five years?

The way to explain this question is actually to look to the past. When I was trying to figure out if what I was doing was special, I started doing some research on doctors in antiquity. I found an interesting pattern.

Most people in Greek and Roman times considered their kitchen to be their medicine cabinet. The women of the world were responsible for managing a lot of illness through food. So food as medicine was fairly widespread, but the wealthy and the gladiators and the kings, all of these people had special doctors.

Theres always been doctors working with the elite and working with the athletes of the world. But the difference between now and then, is that the kitchen is no longer the medicine cabinet. The kitchen is now the place of ultra-toxicity and disease.

I think in five years, Im going to be, hopefully, speaking to the entire country through media and through public health campaigns (Im going to build a platform around this) trying to bring back what we knew for thousands of years about how food can treat our disease and how plants are a source of healing and how the way that we are living our lives in modern times is antithetical to optimal health.

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A doctor is helping Silicon Valley execs live their best life for $40k a year - Quartz

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A new research study out of Brigham and Womens Hospital in Boston, Massachusetts, found a possible connection between hormones and hearing loss among menopausal women.

The study, which will be published in Menopause, the journal of the North American Menopause Society, focused on data collected from 80,972 postmenopausal women. The self-reported study indicated that menopausal women who undergo hormone therapy for extended periods of time are at a greater risk for hearing loss.

More: Is Hormone Replacement Therapy Right for You?

Previously, it was believed that hormone therapy would actually improve hearing loss in menopausal women.

The finding from this observational study that women who underwent menopause at a later age and used oral hormone therapy had greater hearing loss was unexpected but should lead to more testing in a randomized, clinical trial,says Dr. JoAnn Pinkerton, executive director of NAMS.

Menopause usually occurs in women over the age of 45 and brings with it symptoms like vaginal dryness, hot flashes and mood swings.

While the Brigham and Womens Hospital-led study does present a comprehensive set of facts supporting hearing loss among women who use HRT, the overall benefits and risks of undergoing hormone replacement therapy should be discussed with a physician.

More: It's Super-Common to Miss These Symptoms of Hormonal Imbalance

In an effort to make the conversation about menopause a more exhaustive one, the JAMA network published a one-sheet that can help women when speaking to their physicians.

By Vivian Nunez

Originally published on HelloFlo

See the original post here:
The Unexpected and Unwanted Side Effect of Hormone Therapy - SheKnows.com

By Cara Rosner, Conn. Health I-Team Writer

A genetic test that helps doctors determine how best to treat breast cancer and whether chemotherapy is likely to help is significantly more likely to be administered to white women than blacks or Hispanics, a Yale University study has found.

The test, called Oncotype Dx, uses gene expression to gauge how early-stage breast cancer is affecting patients gene activity. It uses the information to determine how likely cancer recurrence would be, and physicians and their patients can use that knowledge to decide how to proceed with treatment.

Yale researchers analyzed a group of more than 8,000 Connecticut women who were diagnosed with hormone receptor positive breast cancer between 2011 and 2013, and found significant racial and ethnic disparities in use of this new gene test, said study leader Dr. Cary Gross, a member of Yale Cancer Center and professor of medicine and epidemiology at Yale School of Medicine.

It reinforces that, at the same time we are investing in developing new treatments and new testing strategies and were promoting them with great excitement, we really need to double-down our efforts to eliminate disparity, Gross said.

Breast test disparity

Here are some key statistics from a Yale University study about Oncotype Dx, a genetic test for breast cancer patients.

The study from that, among the Connecticut women for whom the test was recommended under national guidelines:

51.4 percent of white women received it

44.6 percent of black women received it and

47.7 percent of Hispanic women received it.

Among women for whom national guidelines did not recommend the test:

21.2 percent of white women received it

9 percent of black women received it and

9.7 percent of Hispanic women received it.

Among the Connecticut women for whom the test was recommended, Yale researchers found 51.4 percent of white women received it, compared with 44.6 percent of black women or 47.7 percent of Hispanic women.

One local doctor said the findings are disconcerting, but not surprising. Its long been known that women of color have lower rates of breast cancer screening, and are less likely to have mastectomies or breast reconstruction surgery, typically because they dont have access to or cant afford the services, said Dr. Denise Barajas, medical director of Griffin Hospitals Hewitt Center for Breast Wellness in Derby.

Research has also shown that minority women also are more likely to die from breast cancer.

This is just another area where were unfortunately seeing that certain groups dont have the same access, Barajas said.

Disparities found

The study also found disparity among women for whom national guidelines did not recommend the test. In that group, 21.2 percent of white women, 9 percent of black women and 9.7 percent of Hispanic women received it.

The findings were unsurprising not just to Barajas, but also to Dr. K. M. Steve Lo, a hematology oncologist and breast cancer expert at Stamford Hospitals Dorothy Bennett Cancer Center.

Its part of the overall problem with our health care system, Lo said. Minority women are less insured, underinsured, and have more out-of-pocket expenses to put out in one way or another. As a result, there will be less use of technology across the board. It needs to change but, unfortunately, I dont see a movement toward that in the near future. Its a systemic problem, and its a problem that we as a society need to address.

Barajas said that one of the most upsetting things about the Yale study, is that its first breast cancer-related disparity shes aware of involving a physician-led treatment. Mostly, Barajas said, its patients who opt not to have the treatment.

This test is offered by oncologists, for the most part," she said. Youd like to think that an oncologist would treat all women the same.

The only reason Barajas could think of for a woman who is eligible for the test not being offered it is that shes said she isnt interested in chemotherapy.

Removing guesswork

Having access to Oncotype Dx can greatly impact womens outcomes, Gross said. Even after a biopsy or tumor removal, he said, its still difficult to know which patients are at higher risk for their cancer coming back again. There are many, many subtypes of breast cancer. (The test) takes some of the guesswork out of it.

The test has become the standard of care for certain types of early-stage cancer, Lo said.

It helps physicians narrow down those women who really do benefit from treatments like chemotherapy, he said. That is crucial, he added, because it means many women who would not benefit from chemotherapy no longer are subjected to the process, the expense and the side effects.

Oncotype Dx is most frequently used on women who have stage 1 cancer that has not spread to the lymph nodes, Lo said, but its likely it will be used on women whose cancer has attached to lymph nodes.

In light of the studys findings, Gross team plans to examine data from a broader group of women to see why the disparities exist. Researchers will look at whether women are more or less likely to get the test depending on which hospital treats them, or whether there are disparities within hospitals.

Gross also said research should be done to determine if the tests $4,000 price tag though covered by many insurance companies is a barrier to some patients, and more breast cancer patients should be educated about national guidelines and recommendations.

This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org)

Hearst Connecticut Media staff writer Amanda Cuda contributed to this report.

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Women of color less likely to have breast cancer test - CT Post

The Scientist

Bioengineered 'Pancreas' Effective in First Patient The Scientist Type I diabetes had rendered a 43-year-old woman dependent on insulin, until doctors restored her body's ability to produce the hormone with engineered islet cells transplanted into her abdomen, according to a New England Journal of Medicine report ... and more »

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Bioengineered 'Pancreas' Effective in First Patient - The Scientist

Forbes

Why Is The Risk Of Getting Cancer Higher Than It Used To Be? Forbes FSH and LH hormones are above the normal range when a woman is in menopause and this is a very reliable test for menopause that your doctor can order. Usually in menopause it is the progesterone that is no longer produced by the body because the ...

See more here:
Why Is The Risk Of Getting Cancer Higher Than It Used To Be? - Forbes

When it comes to aging well and living the optimal life, its hard to find a greater advocate than physician Theresa Ramsey. Hosts John Wenzlau and Millie Oakeson of Successful Aging on Independent Talk 1100 KFNX invited Ramsey back to the show to discuss the myriad of topics related to living life to the fullest and in the most pro-active healthy way possible.

Ramsey, from The Center for Natural Healing, is a physician, speaker, lifestyle expert and author. She is a regular expert guest on the television show, Your Life A to Z, and her focus in her clinical practice is in lifestyle and preventative aging with bio-identical hormone replacement.

Ramsey points out that our bodies eventually quit producing estrogen, progesterone and testosterone hormones when we go through menopause and andropause. In order to keep our cellular make up in the best shape possible to fight cancer, heart disease, osteoporosis and dementia, these hormones are essential. The added benefit to bio-identical hormone replacement is like having a newly charged battery - we will feel better, sleep sounder, have more energy and feel sharper.

Oakeson asked what role our thyroids play in overall good health and Ramsey said, The thyroid is my favorite hormone, because it turns on every cell. Its very important that your thyroid is functioning correctly, because, when it isnt, you become tired and lethargic. This prompted the questions of how important melatonin and vitamin D3 are to our bodies.

Ramsey said, Melatonin is the strongest antioxidant and it also helps us get that deep sleep at night that our brains and bodies need so desperately.

Equally important is vitamin D3, because it helps to absorb calcium and promote bone growth and strength.

As their conversation continued, it was apparent that our whole system works better when our cells are at ease and our hormones are in-sync. Lack of sleep, low energy, the inability to lose weight, foggy memory and stress are all due to the fact that we arent taking care of our health.

Ramsey kept emphasizing the need to keep our hormones at the optimal levels, but we also need to be cognizant of what we eat. By eliminating sugar and minimizing consumption of carbohydrates, eating vegetables and protein as our main food sources, we give our bodies the energy to thrive. As to the question of exercise, Ramsey says its best not to over exercise. Its healthy to increase your heart rate and then recover in a 10-minute span twice a day and it is very important to keep moving.

In closing, it was obvious they had only begun to scratch the surface of how to have optimal health throughout a lifetime, but it was also evident that Ramsey will continue her quest to inform and educate about the choices we can make to live a life well lived.

For more information on these topics or to ask a question, visit http://www.successfulaging.info. Tune in every Tuesday to Independent Talk KFNX 1100, as we continue to explore Successful Aging.

More:
Successful Aging and the important role hormones play - Glendale Star

Hormone replacement therapy (HRT) of the male-to-female (MTF) type is a form of hormone therapy and sex reassignment therapy that is used to change the secondary sexual characteristics of transgender and transsexual people from masculine (or androgynous) to feminine. It is one of two types of HRT for transgender and transsexual people (the other being female-to-male), and is predominantly used to treat transgender women. Some intersex people also receive this form of HRT, either starting in childhood to confirm the assigned sex or later if the assignment proves to be incorrect.

The purpose of this form of HRT is to cause the development of the secondary sex characteristics of the desired sex, such as breasts and a feminine pattern of hair, fat, and muscle distribution. It cannot undo many of the changes produced by naturally occurring puberty, which may necessitate surgery and other treatments (see below). The medications used in HRT of the MTF type include estrogens, antiandrogens, and progestogens.

While HRT cannot undo the effects of a person's first puberty, developing secondary sex characteristics associated with a different gender can relieve some or all of the distress and discomfort associated with gender dysphoria, and can help the person to "pass" or be seen as the gender they identify with. Introducing exogenous hormones into the body impacts it at every level and many patients report changes in energy levels, mood, appetite, etc. The goal of HRT, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their gender identity.

Some medical conditions may be a reason to withhold hormone replacement therapy because of the harm it could cause to the patient. Such interfering factors are described in medicine as contraindications.

Absolute contraindications those that can cause life-threatening complications, and in which hormone replacement therapy should never be used include histories of estrogen-sensitive cancer (e.g., breast cancer), thrombosis or embolism (unless the patient receives concurrent anticoagulants), or macroprolactinoma. In such cases, the patient should be monitored by an oncologist, hematologist or cardiologist, or neurologist, respectively.

Relative contraindications in which the benefits of HRT may outweigh the risks, but caution should be used include:

As dosages increase, risks increase as well. Therefore, patients with relative contraindications may start at low dosages and increase gradually.

Hormone therapy for transgender individuals has been shown in medical literature to be safe when supervised by a qualified medical professional.[1]

Inducers of CYP3A4 and other cytochrome P450 enzymes can reduce the effects of MTF HRT. (For a list of CYP3A4 inducers, see here.)

Estrogen is one of the two major sex hormones in women (the other being progesterone), and is responsible for the development and maintenance of female secondary sexual characteristics, such as breasts, wide hips, and a feminine pattern of fat distribution. Estrogens act by binding to and activating the estrogen receptor (ER), their biological target in the body. A variety of different forms of estrogen are available and used medically. The most common estrogens used in transgender women include estradiol (which is the predominant natural estrogen in women) and estradiol esters such as estradiol valerate and estradiol cypionate (which are prodrugs of estradiol). Conjugated equine estrogens (CEEs), marketed as Premarin, and ethinylestradiol are also sometimes used, but this is becoming less common. Estrogens may be administered orally, sublingually, transdermally (via patch), topically (via gel), by intramuscular or subcutaneous injection, or by an implant.

Prior to sex reassignment surgery, dosages of estrogen for transgender people are often higher than replacement dosages used for cisgender women. Hembree et al. (2009) recommend "maintain[ing] sex hormone levels within the normal range for the persons desired gender".[2] Dosages are typically reduced after an orchiectomy (removal of the testes) or sex reassignment surgery. However, that practice has been carried over from an era in which very high doses of estrogen were required to decrease testosterone, since antiandrogens were not used concurrently. Today, high doses of a less potent estrogen estradiol, which is endogenous to the human body, rather than the riskier ethinylestradiol and conjugated estrogens used in the past are recommended during the first ten or so years of HRT, with or without an orchiectomy or sex reassignment. After that period, dosages can be reduced.

Androgens, such as testosterone and dihydrotestosterone (DHT), are the major sex hormones in men, and are responsible for the development and maintenance of male secondary sexual characteristics, such as a deep voice, broad shoulders, and a masculine pattern of hair, muscle, and fat distribution. In addition, they stimulate sex drive and the frequency of spontaneous erections and are responsible for acne, body odor, and male-pattern scalp hair loss. Androgens act by binding to and activating the androgen receptor (AR), their biological target in the body. In contrast to androgens, antiandrogens are drugs that prevent the effects of androgens in the body. They do this by preventing androgens from binding to the AR or by preventing the production of androgens. The most commonly used antiandrogens in transgender women are cyproterone acetate, spironolactone[citation needed], and GnRH analogues.

The most commonly used antiandrogens for transgender women are steroidal: spironolactone and cyproterone acetate. Spironolactone, which is relatively safe and inexpensive, is the most frequently used antiandrogen in the United States. Cyproterone acetate, which is unavailable in the United States, is more commonly used in the rest of the world.

Spironolactone is a potassium-sparing diuretic that is mainly used to treat low-renin hypertension, edema, hyperaldosteronism, and low potassium levels caused by other diuretics. It can cause high potassium levels (hyperkalemia) and is therefore contraindicated in people who have renal failure or already-elevated potassium levels. Spironolactone prevents the formation of androgens in the testes (though not in the adrenal glands) by inhibiting enzymes involved in androgen production.[3][4][5] It is also an androgen receptor antagonist (that is, it prevents androgens from binding to and activating the androgen receptor).[6][7][8][9][10]

Cyproterone acetate is a powerful antiandrogen and progestin that suppresses gonadotropin levels (which in turn reduces androgen levels), blocks androgens from binding to and activating the androgen receptor, and inhibits enzymes in the androgen biosynthesis pathway. It has been used as a means of androgen deprivation therapy to treat prostate cancer. If used long-term in dosages of 150mg or higher, it can cause liver damage or failure.[11][12][13][14][15][16][17][18][19]

Non-steroidal antiandrogens used in HRT for transgender women include flutamide, nilutamide, and bicalutamide, all three of which are primarily used in the treatment of prostate cancer in cisgender men.[20][21] Unlike steroidal antiandrogens such as spironolactone and cyproterone acetate, these drugs are pure androgen receptor antagonists. They do not lower androgen levels; rather, they act solely by preventing the binding of androgens to the androgen receptor. However, they do so very strongly, and are highly effective antiandrogens. Bicalutamide has improved tolerability and safety profiles relative to cyproterone acetate, as well as to flutamide and nilutamide, and has largely replaced the latter two in clinical practice for this reason. Enzalutamide is a more recently introduced non-steroidal antiandrogen with even greater potency and efficacy as an antiandrogen than bicalutamide, but it is still under patent protection and in relation to this is currently (and for the foreseeable future) extremely expensive. Moreover, enzalutamide has been found to act as a negative allosteric modulator of the GABA receptor and has been associated with central side effects such as anxiety, insomnia, and, most notably, seizures (in 1% of patients), properties that it does not share with bicalutamide.

Non-steroidal antiandrogens may be an appealing option for those who wish to preserve sex drive and function[22] and/or fertility,[23] as well as for those who desire more selective action with fewer side effects than spironolactone and cyproterone acetate (which increase the risk of depressive symptoms, among other adverse effects).[24] Bicalutamide specifically may also be a safer drug than cyproterone acetate or spironolactone, as it has a much lower risk of hepatotoxicity relative to cyproterone acetate and, unlike spironolactone, has no risk of hyperkalemia or other antimineralocorticoid-associated adverse reactions. However, bicalutamide does have a very small risk of hepatotoxicity itself, as well as of interstitial pneumonitis.

In both sexes, the hypothalamus produces gonadotropin-releasing hormone (GnRH) to stimulate the pituitary gland to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This in turn cause the gonads to produce sex steroids such as androgens and estrogens. In adolescents of either sex with relevant indicators, GnRH analogues such as goserelin acetate can be used to stop undesired pubertal changes for a period without inducing any changes toward the sex with which the patient currently identifies. GnRH agonists work by initially overstimulating the pituitary gland, then rapidly desensitizing it to the effects of GnRH. After an initial surge, over a period of weeks, gonadal androgen production is greatly reduced. Conversely, GnRH antagonists act by blocking the action of GnRH in the pituitary gland.

There is considerable controversy over the earliest age at which it is clinically, morally, and legally safe to use GnRH analogues, and for how long. The sixth edition of the World Professional Association for Transgender Health's Standards of Care permit it from Tanner stage 2 but do not allow the addition of hormones until age 16, which could be five or more years later. Sex steroids have important functions in addition to their role in puberty, and some skeletal changes (such as increased height) that may be considered masculine are not hindered by GnRH analogues.

GnRH analogues are often prescribed to prevent the reactivation of testicular function when surgeons require the cessation of estrogens prior to surgery.

The high cost of GnRH analogues is a significant factor in their relative lack of use in transgender people. However, they are prescribed as standard practice in the United Kingdom.

Certain antiandrogens do not reduce testosterone or prevent its action upon tissues, but instead prevent its metabolite, dihydrotestosterone (DHT), from forming. These medications can be used when the patient has male-pattern hair loss and/or an enlarged prostate (benign prostatic hyperplasia), both of which DHT exacerbates. Two medications are currently available to prevent the creation of DHT: finasteride and dutasteride. DHT levels can be lowered up to 6075% with the former, and up to 9394% with the latter. These medications have also been found to be effective in the treatment of hirsutism in women.

Progesterone, a progestogen, is the other of the two major sex hormones in women. Unlike estrogen, progesterone is not overtly involved in the development of female secondary sexual characteristics, and is instead involved mainly in the menstrual cycle and pregnancy. For this reason, progestogens are not commonly prescribed for transgender women. However, there may be a role of progestogens in breast development (though controversial and disputed) and in regulation of skin and hair,[citation needed] and progesterone specifically may have positive effects on sex drive, sleep, and levels of anxiety. Moreover, due to their antigonadotropic and/or antiandrogen effects, progestogens can be useful in helping to suppress the effects of androgens in the body. The most common progestogens used in transgender women include progesterone and progestins (synthetic progestogens) like CPA and medroxyprogesterone acetate (MPA). These drugs are usually taken orally, but may also be administered by intramuscular injection.

High doses of progestogens exert negative feedback on the hypothalamic-pituitary-gonadal axis by activating the progesterone receptor. As a result, they have antigonadotropic effects that is, they suppress the gonadal production of sex hormones such as androgens. As such, sufficient dosages of progestogens, such as cyproterone acetate, gestonorone caproate, hydroxyprogesterone caproate, megestrol acetate, and MPA, can considerably lower androgen levels. In addition, certain other progestogens, such as cyproterone acetate, megestrol acetate, drospirenone, and nomegestrol acetate, bind to and block the activation of the androgen receptor.[25] On the other hand, certain other progestogens, including 19-nortestosterone derivatives like levonorgestrel, norgestrel, norethisterone, and norethisterone acetate, as well as, to a lesser extent, the 17-hydroxyprogesterone derivative MPA, have weak androgenic activity because they bind to and activate the androgen receptor similarly to testosterone, and may produce androgenic effects such as acne, hirsutism, and increased sex drive.[26][27][28]

Progestogens, in conjunction with the hormone prolactin, are involved in the maturation of the lobules, acini, and areola during pregnancy: mammary structures that estrogen has little to no direct effect on.[29] However, there is no clinical evidence that progestogens enhance breast size, shape, or appearance in either transgender women or cisgender women, and one study found no benefit to breast hemicircumference over estrogen alone in a small sample of transgender women given both an estrogen and an oral progestogen (usually 10mg/day medroxyprogesterone acetate).[30] However, the authors of the paper stated that the sample size was too small to make any definitive conclusions, and that further studies should be carried out to confirm whether progestogens significantly affect breast size and/or shape in transgender women.[30] As of 2014, no additional study had looked at the issue.[31] Anecdotal evidence from transgender women suggests that those who take progesterone supplements may experience more full breast development, including stage IV on the Tanner scale (many transgender women do not develop Tanner stage V breasts).[citation needed] However, there have been no formal studies with sufficiently large sample sizes to confirm this.[31]

Progestogens reportedly alter fat distribution (e.g., by increasing fat in the buttocks and thighs),[32][33] increase sex drive (specifically progesterone, via its active metabolite allopregnanolone; this does not occur through activation of the progesterone receptor),[34][35] cause increased appetite and weight gain (only in combination with estrogen),[33] produce a sense of calm (i.e., anxiolysis), and promote sleep (i.e., sedative and hypnotic effects).[36][37][38][39]

Progesterone specifically is essential for bone health[citation needed] and seems to have a role in skin elasticity and nervous system function.[40] Other effects seen with progesterone include reducing spasms and relaxing smooth muscle tone; reducing gallbladder activity; widening bronchi,[41] which helps respiration; reducing inflammation and immune response; and normalizing blood clotting and vascular tone, zinc and copper levels, cell oxygen levels, and use of fat stores for energy.[citation needed] Progesterone also assists in thyroid function and bone building by osteoblasts.[citation needed]

The main effects of HRT of the MTF type are as follows:[42]

The psychological effects of hormone replacement therapy are harder to define than physical changes. Because HRT is usually the first physical step taken to transition, the act of beginning it has a significant psychological effect, which is difficult to distinguish from hormonally induced changes.

Highly developed breasts of transgender woman induced by hormone therapy.

Breast, nipple, and areolar development varies considerably depending on genetics, body composition, age of HRT initiation, and many other factors. Development can take a couple years to nearly a decade for some. However, many transgender women report there is often a "stall" in breast growth during transition, or significant breast asymmetry. Transgender women on HRT often experience less breast development than cisgender women (especially if started after young adulthood). For this reason, many seek breast augmentation.Transgender patients opting for breast reduction are rare. Shoulder width and the size of the rib cage also play a role in the perceivable size of the breasts; both are usually larger in transgender women, causing the breasts to appear proportionally smaller. Thus, when a transgender woman opts to have breast augmentation, the implants used tend to be larger than those used by cisgender women.[44]

In clinical trials, cisgender women have used stem cells from fat to regrow their breasts after mastectomies. This could someday eliminate the need for implants for transgender women.[45]

In transgender women on HRT, as in cisgender women during puberty, breast ducts and Cooper's ligaments develop under the influence of estrogen. Progesterone causes the milk sacs (mammary alveoli) to develop, and with the right stimuli, a transgender woman may lactate. Additionally, HRT often makes the nipples more sensitive to stimulation.

The uppermost layer of skin, the stratum corneum, becomes thinner and more translucent. Spider veins may appear or be more noticeable as a result. Collagen decreases, and tactile sensation increases. The skin becomes softer,[46] more susceptible to tearing and irritation from scratching or shaving, and slightly lighter in color because of a slight decrease in melanin.

Sebaceous gland activity (which is triggered by androgens) lessens, reducing oil production on the skin and scalp. Consequently, the skin becomes less prone to acne. It also becomes drier, and lotions or oils may be necessary.[44][47] The pores become smaller because of the lower quantities of oil being produced. Many apocrine glands a type of sweat gland become inactive, and body odor decreases. Remaining body odor becomes less metallic, sharp, or acrid, and more sweet and musky.[citation needed]

As subcutaneous fat accumulates,[44] dimpling, or cellulite, becomes more apparent on the thighs and buttocks. Stretch marks (striae distensae) may appear on the skin in these areas. Susceptibility to sunburn increases, possibly because the skin is thinner and less pigmented.[citation needed]

Antiandrogens affect existing facial hair only slightly; patients may see slower growth and some reduction in density and coverage. Those who are less than a decade past puberty and/or whose race generally lacks a significant amount of facial hair may have better results. Patients taking antiandrogens tend to have better results with electrolysis and laser hair removal than those who are not. In patients in their teens or early twenties, antiandrogens prevent new facial hair from developing if testosterone levels are within the normal female range.[44][47]

Body hair (on the chest, shoulders, back, abdomen, buttocks, thighs, tops of hands, and tops of feet) turns, over time, from terminal ("normal") hairs to tiny, blonde vellus hairs. Arm, perianal, and perineal hair is reduced but may not turn to vellus hair on the latter two regions (some cisgender women also have hair in these areas). Underarm hair changes slightly in texture and length, and pubic hair becomes more typically female in pattern. Lower leg hair becomes less dense. All of these changes depend to some degree on genetics.[44][47]

Head hair may change slightly in texture, curl, and color. This is especially likely with hair growth from previously bald areas.[citation needed]Eyebrows do not change because they are not androgenic.[48]

The lens of the eye changes in curvature.[49][50][51][52] Because of decreased androgen levels, the meibomian glands (the sebaceous glands on the upper and lower eyelids that open up at the edges) produce less oil. Because oil prevents the tear film from evaporating, this change may cause dry eyes.[53][54][55][56][57]

The distribution of adipose (fat) tissue changes slowly over months and years. HRT causes the body to accumulate new fat in a typically feminine pattern, including in the hips, thighs, buttocks, pubis, upper arms, and breasts. (Fat on the hips, thighs, and buttocks has a higher concentration of omega-3 fatty acids and is meant to be used for lactation.) The body begins to burn old adipose tissue in the waist, shoulders, and back, making those areas smaller.[44]

Subcutaneous fat increases in the cheeks and lips, making the face appear rounder, with slightly less emphasis on the jaw as the lower portion of the cheeks fills in.

HRT causes a reduction in muscle mass and distribution towards female proportions.[citation needed]

Male-to-female hormone therapy causes the hips to rotate slightly forward because of changes in the tendons. Hip discomfort is not uncommon.

If estrogen therapy is begun prior to pelvis ossification, which occurs around the age of 25, the pelvic outlet and inlet open slightly. The femora also widen, because they are connected to the pelvis. The pelvis retains some masculine characteristics, but the end result of HRT is wider hips than a cisgender man and closer to those of a cisgender woman.[citation needed]

HRT does not reverse bone changes that have already been established by puberty. Consequently, it does not affect height; the length of the arms, legs, hands, and feet; or the width of the shoulders and rib cage. However, details of bone shape change throughout life, with bones becoming heavier and more deeply sculptured under the influence of androgens, and HRT does prevent such changes from progressing further.

The width of the hips is not affected in individuals for whom epiphyseal closure (fusion and closure of the ends of bones, which prevents any further lengthening) has taken place. This occurs in most people between 18 and 25 years of age.[citation needed] Already-established changes to the shape of the hips cannot be reversed by HRT whether epiphyseal closure has taken place or not.[citation needed]

Established changes to the bone structure of the face are also unaffected by HRT. A significant majority of craniofacial changes occur during adolescence. Post-adolescent growth is considerably slower and minimal by comparison.[58] Also unaffected is the prominence of the thyroid cartilage (Adam's apple). These changes may be reversed by surgery (facial feminization surgery and tracheal shave, respectively).

During puberty, the voice deepens in pitch and becomes more resonant. These changes are permanent and are not affected by HRT. Voice therapy and/or surgery may be used instead to achieve a more female-sounding voice.

Facial hair develops during puberty and is only slightly affected by HRT. It may, however, be eliminated nearly permanently with laser hair removal, or permanently with electrolysis.[citation needed]

Mood changes, including depression, can occur with hormone replacement therapy. However, many transgender women report significant mood-lifting effects as well. The risk of depressive side effects is more common in patients who take progestins. Medroxyprogesterone acetate, in particular, has been shown to cause depression in certain individuals,[59][60][61][62][63] perhaps by affecting dopamine levels.[64]

Some transgender women report a significant reduction in libido, depending on the dosage of antiandrogens. A small number of post-operative transgender women take low doses of testosterone to boost their libido. Many pre-operative transgender women wait until after reassignment surgery to begin an active sex life. Raising the dosage of estrogen or adding a progestogen raises the libido of some transgender women.

Spontaneous and morning erections decrease significantly in frequency, although some patients who have had an orchiectomy still experience morning erections. Voluntary erections may or may not be possible, depending on the amount of hormones and/or antiandrogens being taken.

Recent studies have indicated that hormone therapy in transgender women may reduce brain volume toward female proportions.[65]

All aforementioned physical changes can, and reportedly do, change the experience of sensation compared to prior to HRT. Areas affected include, but aren't limited to, the basic senses, erogenous stimulus, perception of emotion, perception of social interaction, and processing of feelings and experiences.

The most significant cardiovascular risk for transgender women is the pro-thrombotic effect (increased blood clotting) of estrogens. This manifests most significantly as an increased risk for thromboembolic disease: deep vein thrombosis (DVT) and pulmonary embolism, which occurs when blood clots from DVT break off and migrate to the lungs. Symptoms of DVT include pain or swelling of one leg, especially the calf. Symptoms of pulmonary embolism include chest pain, shortness of breath, fainting, and heart palpitations, sometimes without leg pain or swelling.

Deep vein thrombosis occurs more frequently in the first year of treatment with estrogens. The risk is higher with oral estrogens (particularly ethinylestradiol and conjugated estrogens) than with injectable, transdermal, implantable, and nasal formulations.[66] DVT risk also increases with age and in patients who smoke, so many clinicians advise using the safer estrogen formulations in smokers and patients older than 40.

Because the risks of warfarin which is used to treat blood clots in a relatively young and otherwise healthy population are low, while the risk of adverse physical and psychological outcomes for untreated transgender patients is high, pro-thrombotic mutations (such as factor V Leiden, antithrombin III, and protein C or S deficiency) are not absolute contraindications for hormonal therapy.[67]

Estrogens may increase the risk of gallbladder disease, especially in older and obese people.[68] They may also increase transaminase levels, indicating liver toxicity, especially when taken in oral form.[citation needed]

A patient's metabolic rate may change, causing an increase or decrease in weight and energy levels, changes to sleep patterns, and temperature sensitivity.[citation needed] Androgen deprivation leads to slower metabolism and a loss of muscle tone. Building muscle takes more work. The addition of a progestogen may increase energy, although it may increase appetite as well.[citation needed]

Both estrogens and androgens are necessary in all humans for bone health. Young, healthy women produce about 10mg of testosterone monthly,[citation needed] and higher bone mineral density in males is associated with higher serum estrogen. Both estrogen and testosterone help to stimulate bone formation, especially during puberty. Estrogen is the predominant sex hormone that slows bone loss, even in men.

In spite of the induction of breast development, HRT in transgender women does not appear to increase the risk of breast cancer.[69][70][71] Only a handful of cases of breast cancer have ever been described in transgender women.[70][71] This is in accordance with research in cisgender men in which gynecomastia has been found not to be associated with an increased risk of breast cancer.[72] On the other hand, men with Klinefelter's syndrome, who have two X chromosomes (similarly to cisgender women) in addition to hypoandrogenism, hyperestrogenism, and a very high incidence of gynecomastia (80%), show a dramatically (20- to 58-fold) increased risk of breast cancer that is between that of cisgender men and cisgender women (though closer to that of the latter).[72][73][74] The incidences of breast cancer in cisgender men (46,XY karyotype), men with Klinefelter's syndrome (47,XXY karyotype), and cisgender women (46,XX karyotype) are approximately 0.1%,[75] 3%,[73] and 12.5%,[76] respectively. Also of potential relevance is the case of women with complete androgen insensitivity syndrome, who are genetically male (i.e., 46,XY karyotype) and have normal and complete morphological breast development and in fact breast sizes that are on average larger than those of cisgender women[77][78] yet, similarly to cisgender men, appear to have little (or possibly even no) incidence of breast cancer.[79][80] The risk of breast cancer in women with Turner syndrome (45,XO karyotype) also appears to be significantly decreased, though this may be related to ovarian failure/hypogonadism rather necessarily than to genetics.[81]

Similarly to the case of breast cancer, prostate cancer is extremely rare in transgender women who have been treated with HRT for a prolonged period of time.[69][82][83] Whereas as many as 70% of men show prostate cancer by their 80's,[84] only a handful of cases of prostate cancer in transgender women have been reported in the literature.[69][82][83] As such, and in accordance with the fact that androgens are responsible for the development of prostate cancer, HRT appears to be highly protective against prostate cancer in transgender women.[69][82][83]

Migraines can be made worse or unmasked by estrogen therapy.[citation needed]

Estrogens can also cause prolactinomas. Milk discharge from the nipples can be a sign of elevated prolactin levels. If a prolactinoma becomes large enough, it can cause visual changes (especially decreased peripheral vision), headaches, depression or other mood changes, dizziness, nausea, vomiting, and symptoms of pituitary failure, like hypothyroidism.

Especially in the early stages of hormone replacement therapy, blood work is done frequently to assess hormone levels and liver function. The Endocrine Society recommends that patients have blood tests every three months in the first year of HRT for estradiol and testosterone, and that spironolactone, if used, be monitored every 23 months in the first year.[85] The optimal ranges for estradiol and testosterone are:

The optimal ranges for estrogen apply only to individuals taking estradiol (or an ester of estradiol), and not to those taking synthetic or other non-bioidentical preparations (e.g., CEEs or ethinylestradiol).[88]

Physicians also recommend broader medical monitoring, including complete blood counts; tests of renal function, liver function, and lipid and glucose metabolism; and monitoring of prolactin levels, body weight, and blood pressure.[89]

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Hormone replacement therapy (male-to-female) - Wikipedia

Stroke is the fifth leading cause of death for men. But for women, it is third. In this region, more women have strokes than men.

Stroke and blood pressure

Age is the No. 1 risk factor for stroke. High blood pressure is No. 2. Therefore, it is important that blood pressure is monitored.

Blood pressure is a risk factor that can be easily treated. No one can stop from getting older, but everyone can work with their physician to maintain their cholesterol and blood pressure. Keeping both of these within healthy limits will make a big difference.

A stroke also can occur during pregnancy. In fact, 5 to 10 percent of pregnant women will suffer from preeclampsia or some other hypertensive disorder. Preeclampsia is a condition where a pregnant woman has high blood pressure and significant amounts of protein in her urine.

Medical studies now indicate that anyone with a history of pregnancy and preeclampsia is at an increased risk of stroke later in life. And what has been discovered is that the issues the increased stroke risk are 30 or 40 years later in life.

The belief is that the combination of high blood pressure and pregnancy causes an injury to the lining of the blood vessels. This damage to the lining increases the stroke risk.

The take-home point here is to be sure to have your blood pressure checked during physician visits. Hormone therapy or oral contraceptives will also increase the risk of stroke for those with high blood pressure.

Migraine headaches are more common in women than men. Migraines can often be crippling, sending a woman to a quiet, darkened room to alleviate the pain.

Migraines are believed to put a woman at greater risk of stroke than even family history of heart problems or high cholesterol. Add smoking and oral contraceptives to the migraine mix and you have a potentially destructive combination.

A migraine by definition means one side of your head hurts, or pounds this is considered the "migraine" part of it. It is associated with nausea and head pain.

When there is an aura, it indicates one has a focal neurologic symptom that occurs prior to the headache. For instance, the arm goes weak, vision is lost on one side or the other and flashy lights might be seen.

These symptoms occur 15 to 20 minutes before the headache generally appears. So, for all women who suffer migraines (and remember, more women than men have migraines) and are on oral contraceptives and smoke cigarettes, there is an increased risk of having a stroke.

Disability is another huge issue with stroke. For people who have suffered a stroke, many are most likely living with a significant amount of disability. They may be unable to talk, see or work. Stroke also is the leading cause of serious long-term disability.

Fortunately, the overall incidence of stroke in the United States has decreased. We believe this is due to a focus on the treatment of blood pressure.

It is essential, if at all possible, to prevent a stroke from occurring, or at best, seek medical treatment quickly at the first onset of symptoms. Everyone should be able to recognize stroke symptoms and act quickly.

In both men and women, common symptoms include:

>> Sudden numbness or weakness of face, arm or leg especially on one side of the body.

>> Sudden confusion, trouble speaking or understanding.

>> Sudden trouble seeing in one or both eyes.

>> Sudden trouble walking, dizziness, loss of balance or coordination.

>> Sudden severe headache with no known cause.

Call 911 immediately if you have any of these symptoms.

Dr. Timothy Hagen is the medical director of stroke and neurology services at McLeod Regional Medical Center. He is board certified in neurology and sleep medicine. He received his medical degree from Western University in Pomona, California. Hagen completed an internal medicine residency at Good Samaritan Hospital in Cincinnati, Ohio, and a neurology residency at the University of Cincinnati.

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A woman's risk of stroke: Get to know the factors and the symptoms - SCNow

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At least 20 million Americans, 80 percent of them women, suffer from low levels of thyroid hormones, which can have major consequences. The thyroid gland regulates metabolism, heart, muscle and brain functions. An old, but rarely-used therapy may be a making a comeback among patients looking for a natural solution.

Cheryl Williams, 61, has a lot of energy these days for walking the dog and practicing yoga, but for years she had none and doctors had no idea why.

She said, "They'll say 'oh, everything looks great. All your levels are just great.' I'm going, 'well how come I need a wheelchair to get out of here?'"

Jane Sadler, M.D., a family physician at Baylor Scott and White Medical Center did tests which showed that Cheryl has a thyroid deficiency, hypothyroidism.

"Their body is going to run into problems with heart failure, osteoporosis, low heart rate," said Dr. Sadler.

Hypothyroidism is often treated with synthetic human thyroid hormone, but that didn't improve Cheryl's energy level so Dr. Sadler tried a seldom used remedy: pig thyroid extract. Doctors rarely prescribe the pig hormone because unlike the synthetic hormone, the concentration can vary. But it worked for Cheryl.

"It's rewarding, but I will emphasize that I have to monitor Cheryl's levels of thyroid much more closely than I would somebody on a synthetic thyroid hormone replacement," Dr. Sadler said.

"When I think back now, it's like wow, I can do these things without it being such a challenge and struggle," Cheryl said.

The American Thyroid Association said the number of Americans with thyroid deficiency could be as high as 60 million, with 60 percent undiagnosed. A simple blood test to measure TSH, thyroid stimulating hormone- will provide the answer.

Excerpt from:
New "old" remedy for thyroid disease - WTAJ