Archive for the ‘Hormone Physician’ Category

Testosterone therapy has mixed results, studies find Fort Worth Star Telegram They looked at the impact of testosterone therapy in hundreds of men 65 and older who had measurably low levels of the hormone. (About 20 percent of men over 60 have diagnosable low testosterone.) The findings: One less-than-positive conclusion was ...

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Testosterone therapy has mixed results, studies find - Fort Worth Star Telegram

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Mar 10, 2017

DEAR DR. ROACH: My husband acquired a drug-resistant E. coli infection from a prostate biopsy. His urologist initially treated him with gentamicin injections and cephalexin. Two days after discontinuing the cephalexin, the infection returned (chills, fever, malaise and pain in the urinary tract). He got more gentamicin injections and more cephalexin. Finally, the doctor read the lab results and discontinued the gentamicin, which was shown to not be effective. He had 10 more days of cephalexin, and after a few days off the drug, the infection was back. Finally, the urologist switched him to amoxicillin-clavulanate, and he got better. Its been three weeks since his last pill. Can we be confident that the infection wont return?

I did some reading right after he got sick and learned about the increasing number of men becoming ill after prostate biopsies with drug-resistant E. coli nearly 4 percent. I assumed the urologist had tested him and that it was not this strain. I was wrong. He waited nearly two weeks before ordering a urinalysis and another week to carefully read it. My husband spent two months getting shots and taking oral meds.

On the plus side, the prostate biopsy was negative.

I hope you can print this as a cautionary tale for anyone considering this procedure. Anon.

ANSWER: A prostate biopsy is most commonly done to confirm suspected prostate cancer after an abnormal PSA test or physical exam. Antibiotics commonly are given before the biopsy to prevent urine infections, but that has increased the likelihood of resistance.

There are several lessons to be learned from your letter. The first is that an infection that returns immediately after stopping an antibiotic should raise the possibility of resistance, and a culture should promptly be performed and susceptibilities should guide future antibiotic treatment. Seven to 10 days of an effective antibiotic should be curative in nearly all cases, and in those in which it isnt, another solution should be sought.

Getting many biopsies increases risk of infection. The increasing use of MRI scanning to guide prostate biopsy may decrease the need for so many biopsies, and hopefully decrease infection rates.

DEAR DR. ROACH: I would like to get off levothyroxine 0.05 mg daily. Would that be possible? J.

ANSWER: Levothyroxine, a synthetic form of thyroid hormone, is used in people who are unable to make enough thyroid hormone. There are many reasons why. People who have had complete surgical removal of the thyroid are absolutely dependent on taking the replacement and would be seriously ill and eventually die if they were to stop taking a replacement. People who are taking it after thyroid cancer often are given slightly high amounts, in order to suppress TSH, the regulatory hormone. This, in turn, reduces the likelihood of cancer recurrence. I would never consider stopping replacement.

In people with Hashimotos thyroiditis, an autoimmune thyroid disease, the thyroid often is unable to make hormone but eventually, after months or years, can recover. In the U.S., we usually keep people on replacement hormone for life, but I have seen instances where people have gotten off their medication. This requires your physician to agree (some wont, because not everyones thyroid will recover) and very close management of both lab tests and symptoms for an extended period of time. The low dose you are taking suggests a good chance that you could get off it. I would ask you to think twice, though, as to why you want to stop taking it.

(Roach is a columnist for the North American Press Syndicate. Write to him at 628 Virginia Drive, Orlando, FL 32803.)

D.C. Capitol Switchboard: (202) 224-3121 Ohio House U.S. Rep. Bill Johnson, 6th District, 1710 Longworth House ...

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DEAR DR. ROACH: I have chewed nicotine gum for 15 years with tea or coffee. What are the dangers? ...

TODAYS BIRTHDAY (March 14). Theres sunshine in your mind this year, and the cheerfulness you feel will touch ...

International Womens Day is a once-a-year acknowledgment of what women do every day of the year, which is to ...

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Reader has lingering E. coli post-biopsy - The Steubenville Herald-Star

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Women's Health: Women, Headaches and Migraines myfox8.com When life style changes aren't enough, your doctor may recommend other treatment such as hormone therapy, over the counter medication, doctor prescribed medication or Botox injections. Botox injections have become a popular treatment method for ...

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Women's Health: Women, Headaches and Migraines - myfox8.com

Dr. Charles Mok Releases Innovative New Book on Women's Health Forbes NEW YORK (March 7, 2017) Physician and business leader Dr. Charles Mok today announced the publication of Testosterone: Strong Enough for a Man, Made for a Woman (available now). The book is published with ForbesBooks, the exclusive ... In the book ...

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Dr. Charles Mok Releases Innovative New Book on Women's Health - Forbes

FLORENCE -- The aging process takes a toll on the body, and knowing that helps individuals adjust to the new normal, doctors said.

Dr. Saquib Anjum, a geriatric and palliative care physician, said helping aging patients know what are typical changes to the body can help ease fear when the patient notices those changes.

"I see a lot of anxiety patients go through because of aging," Anjum said. "Aging is broadly predictable."

As life expectancy increases, it's important that the growing number of senior adults understand these body changes, Anjum said.

He said when patients notice changes he describes as typical of someone growing older, the first request is often a medication to reverse the change. However, Anjum said the best thing to do is to identify lifestyle changes to adjust to them.

Typical body changes related to aging include decreased heart rate from thickening of heart walls and slight enlargement of the heart muscle; an increase in blood pressure; a more noticeable decrease in blood pressure from standing or changing position; a less effective immune system; and loss of muscle mass.

Those changes, Anjum said, can manifest themselves like symptoms of a disease, but are typically just related to the normal aging process. A healthy diet and regular exercise are the best ways to stave off such changes, and to control the effects of them when they do occur.

"A lot of older patients are on multiple medications and will go through multiple rounds of medications trying to find one that works," Anjum said. "These are just things that happen as you age."

Anjum noted that as people reach geriatric status, kidney function can decrease. He said that's especially important for patients who are cycling through medications trying to find one that "fixes" their symptoms.

"When kidneys don't functions as well, drugs stay in your system longer," he said. "That increases the risk of side effects."

Dr. Robert Webb said there are several "syndromes" that occur in older patients that people need to be aware of as they age.

Disruption of the sleep cycle is a frequent complaint from senior patients, Webb said. He said older patients often have a harder time falling asleep; wake more often during the night; and experience restlessness during sleep more often.

He said 50 percent of seniors use some sort of prescription medication for sleep, and 30 percent have a chronic problem with sleep.

He recommends lifestyle changes, such as eating large meals earlier, taking medications that can disrupt sleep earlier in the day, and taking melatonin, a hormone that regulates sleep.

"Melatonin is very helpful for seniors," he said. "It helps reset your sleep/wake cycle."

Falling is another common risk for seniors that can be managed to a degree, Webb said. He said certain types of medications, such as antidepressants, benzodiazapines and anti-inflammatory drugs, can increase falls for older patients.

He recommended increased strength exercises, and physical and occupational therapy for better balance and mobility. He said correcting environmental factors can reduce the risk of falls.

"You don't want throw rugs," he said. "What happens when you have throw rugs? That increases the risk of catching your foot on the rug and falling."

It is often medications, Webb said, and the side effects of those medications that cause complaints from older patients.

"All senior symptoms are drug side effects until proven otherwise," Webb said.

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Doctors talk aging: What's normal, how to manage it - Times Daily

The doctors and nurses told Jarrod and Jillian Johnson that their newborns case wasnot that unusual.

Landon Johnson had been trying to breast-feed almost continuously since his birth days earlier and screaming each time his mother pulled him from her chest.Just stick with it, the first-time parents were told; it will take some time to get the hang of breast-feeding.

But hours afterthe Johnsons took their sonhome from the hospital, Jillian found him unresponsive.

His skin was blue and, she said, when she picked him up, his body felllimp in her arms.

Jarrod started CPR.

Jillian dialed 911.

Landon was rushed to an emergency room.

But it wasnotuntil days after their newborn had stopped breathing after his medical team wasunable to resuscitatehim and after he was put on life support that Jillian Johnson said she and her husband learned what might have happened to him. A doctor in a neonatal intensive care unit told them he suspected Landon was so severely dehydrated that his heart had stopped beating, she said.

It was really hard for me to comprehend at that point, because I had beenbreast-feeding him What do you mean he was dehydrated? Jillian Johnson said she told the doctor in February 2012. I couldnt wrap my head around it.I was frustrated with myself because, there were these doctors and nurses who kept telling me, Just keep feeding him. Just keep him on the breast. Youve got a great latch. Youre doing fine.

But she had no breast milk to offer him, she said.

Just 19days after Landon was born, his parents made a heart-wrenching decision to remove himfrom the machines that were keeping him alive.

Then they watched their baby die.

Five years later, Jillian Johnson is speaking out about her sons death, warning other mothers about breast-feeding in a blog post that has gone viral.

Althoughbreast-feeding is considered the ideal wayto feed ababy, she said, women should understand the risks such as not being able to produce enough milk and realize that there is nothing wrong with using formula in bottles.

I want people to stop shaming each other, Johnson told The Washington Post. Regardless of how you feed your baby, just make sure theyre fed. Its plain and simple.

I want people to educate themselves, she said. You want to do whats best for your kid? Fine. Breast is best, sure as long as the baby is getting something out of it.

Landon died ofhypoxic-ischemic encephalopathy, or brain injury caused by oxygen deprivation;cardiac arrest; andhypernatremic dehydration, according to records from the Los Angeles County coroner.

Johnson, who lives in the Los Angeles area, declined to name the hospital where he was born or release any records.

[Doctor says: When it comes to breastfeeding, your health and happiness matter as much as your babys]

Christie del Castillo-Hegyi, aphysician and co-founder of Fed is Best Foundation, said she has studied Landonsmedical records. Castillo-Hegyi, whose nonprofit foundation focuses oninfant feeding,noted that the boy was born Feb. 25, 2012, by emergency C-section because he was not getting enough oxygen during labor.

At birth, he weighed 7 poundsand 7 ounces but, by day three, he had lost9.7 percent of his weight, she said.

Johnson described the ordeal late last month in a post on theFed is Best Foundations blog:

Landon cried. And cried. All the time. He cried unless he was on the breast and I began to nurse him continuously. The nurses would come in and swaddle him in warm blankets to help get him to sleep. And when I asked them why he was always on my breast, I was told it was because he was cluster feeding. I recalled learning all about that in the classes I had taken, and being a first time mom, I trusted my doctors and nurses to help me through this even more so since I was pretty heavily medicated from my emergency c-section and this was my first baby. But I was wrong.

Johnson wrote thatalactation consultant told her Landon had a great latch and was doing fine but noted that she may have a problem producing milk because she had been diagnosed with a hormonal disorder calledpolycystic ovarian syndrome.

The consultant told her to take herbal supplements, she said.

The Johnsons took Landon home on Feb. 28, 2012. Early the next morning, on Leap Day, they found him unresponsive.

We were both crying, But to watch your husband he was squeezing me so hard it hurt, but I couldnt pull myself away from him because he was bawling and praying that God would bring his baby back to him,Jillian Johnson said in an interview, sobbing.

No one at the baby-friendly hospital where Landon was born told her this could happen, she said.

In the United States, more than 400 suchhospitals believe that human milk fed through the mothers own breast is the normal way for human infants to be nourished, according to Baby Friendly USA, an organization that implements the Baby-Friendly Hospital Initiativeby theWorld Health Organization and the United Nations Childrens Fund.

Baby Friendly USA Executive Director Trish MacEnroesaid the organizationexpects designatedhospitals tohelpmothers bond with babies and care for them, whichincludes exclusively breast-feeding. When mothers waver,she said, hospitals shouldtry to identify the obstacles and help mothers overcome them.

But, she said, its ultimately the mothers decision.

Regarding the case of Landon Johnson, MacEnroe said it was indeed tragic but added, I think its really important for mothers to know that breast-feeding is safe,and it is the optimal means for infant nutrition.

Because Johnson would not identity the hospital where Landon was born, MacEnroe said she did not know whether it was a baby-friendly hospital.

[Why I breastfed my son until he was 3]

Medical experts say starvation caused by breast-feeding is extremely rare; in fact,theAmerican Academy of Pediatrics recommends that babies exclusively breast-feed for the first six months, for a variety of reasons.

General pediatrician Andy Bernstein,a spokesman for the American Academy of Pediatrics, saidhumans are hard-wired to go several days without fullyfeeding.Typically, experts say, newborns can subsist thosefirst days on their mothers first milk, known ascolostrum, until their mothers mature milk comes in.

Bernstein said most pediatricians agree it is acceptable for newborns to lose up to 10 percent of their birth weight during this transition. But, he added, physicians must also consider any factors that could put mothers and babies at risk, such as being a first-time mother; having a long, complicated delivery or a C-section; or suffering from certain health issues, including some hormone disorders.

Im definitely going to encourage breast-feeding when possible, Bernstein said. We easily get the majority of our patients breast-feeding, but there is still a significant number of patients who, for a variety of issues, breast-feeding just doesnt work out. As gung-ho as we are about breast-feeding in 2017, I think it has to be done carefully.

Still, he said, formula is very acceptable source, both alone or to supplement breast milk.

But much more common is the societal pressure some women say they feel to breast-feed.

In an op-edfor The Post last year, three psychiatrists wrote that although the benefits of breast-feeding are backed by science, the recommendations carry the force of a threat: If I dont breastfeed, my child is more likely to get sick; if I dont breastfeed, my child wont be as smart; if I dont breastfeed, Im not a good mother.

Heres what not enough people talk about: Just as new babies are vulnerable, so are their mothers. And a mothers mental health is crucial not just to her, but also to her baby. A depressed and anxious mother isnt able to provide the nurturing that her baby needs to develop and grow. And if that depression and anxiety is caused or worsened by the breastfeeding experience, breastfeeding isnt worth it.

Then theresthe physical pain some women say they endure to breast-feed their babies.

Johnson, Landons mother, said that during the three days she was constantly nursing her son, her breasts were sore and her nipples were raw and bleeding.

She was also hurting for her newborn; she felt that she was failing him, she said.

Despite the horror she lived through, Johnson said she is not against breast-feeding. She has given birth to two girls since Landons death and has breast-fed them both supplementing with formula.

I am not against breast-feeding; I am pro-breastfeeding, she said. Thats the one thing I dont appreciate is everyone saying I need to stop being anti-breastfeeding. I am not. Honestly, if I was anti-breastfeeding, my kid would probably be alive.

I had no idea he was starving, she added. Oh my God if Id known that, I would have given him a bottle.

Read more:

We had no hope: The amazing story of the baby born with his brain outside his skull

The incredible story of how a newborns cry may have helped save her mothers life

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She listened to her doctors and her baby died. Now she's warning others about breast-feeding. - Washington Post

If youre preparing for the United States Medical Licensing Examination (USMLE) Step 1 exam, you might want to know which questions are most often missed by test takers. Check out this example from Kaplan Medical, and view an expert video explanation of the answer. Also check out all posts in this series.

A 32-year-old woman comes to the physician because of amenorrhea for the past 15 months after delivering a baby. She says that she has also had fatigue, facial swelling, cold intolerance and has gained an additional 4.5 kg (10 pounds) since her baby was born. A review of her records shows that the delivery was complicated by severe hemorrhage. Laboratory studies of serum show:

Injection of 500 g of thyrotropin-releasing hormone fails to produce an increase in either serum TSH or prolactin. Assay of other hormones is most likely to show normal levels of which of the following hormones?

A. Aldosterone

B. Cortisol

C. Follicle-stimulating hormone (FSH)

D. Gonadotropin-releasing hormone (GnRH)

E. Growth hormone

The correct answer is A.

Sheehan syndrome is hypopituitarism caused by ischemic damage to the pituitary resulting from excessive hemorrhage during parturition. The pituitary is enlarged during pregnancy; it is more metabolically active and more susceptible to hypoxemia. The blood vessels in the pituitary may be more susceptible to vasospasm because of high estrogen levels.

In about 30 percent of women who have excessive hemorrhage during parturition, some degree of hypopituitarism eventually manifests. The symptoms depend on how much of the pituitary is damaged and what cell types are destroyed. Although some pituitary hormones may be unaffected even in severe hypopituitarism, pituitary hormones and the hormones controlled by them are more likely to be reduced than hormones that are not primarily controlled by anterior pituitary function.

Our patient has amenorrhea (decreased LH) and symptoms of hypothryoidism (decreased TSH). Aldosterone secretion is relatively independent of adrenocorticotropic hormone (ACTH); it is controlled mainly by angiotensin II and plasma potassium concentration. Aldosterone is least likely to be reduced by hypopituitarism. Treatment is replacement of thyroid hormone and cortisol.

Read these explanations to understand the important rationale for why each answer is incorrect.

Choice B: Cortisol is controlled by pituitary production of ACTH; because ACTH is often impaired in Sheehan syndrome, reduced secretion of cortisol is likely.

Choice C: The pituitary necrosis that is the root cause of Sheehan syndrome is highly likely to reduce secretion of FSH. The observation of reduced estradiol in this patient strongly suggests that FSH is low because estradiol increases as follicular development occurs.

Choice D: The presence of the depressed levels of estradiol and LH in this patient releases hypothalamic secretion of GnRH from its normal feedback control. GnRH levels are likely to increase above normal.

Choice E: Growth hormone is very likely to be reduced by the pituitary necrosis.

For more prep questions on USMLE Steps 1 and 2, view other posts in this series.

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USMLE Step 1: Postpartum amenorrhea and hormone levels - American Medical Association (blog)

Keith Roach, To Your Health 5:40 p.m. ET March 2, 2017

Dear Dr. Roach: My daughter has just been diagnosed with polycystic ovary syndrome. She is in her mid-20s, exercises regularly and watches what she eats, but still puts on weight. She does not want to go on birth control. Where do we start? I know there is no cure.

B.M.

Dear B.M.: Polycystic ovary syndrome is very prevalent, affecting 6 to 8 percent of women, but it is variable in terms of both the types of symptoms and their severity. The most common symptoms are menstrual irregularities and consequences of high male hormones (such as excess body hair and acne). Being overweight or experiencing weight gain is important, as is the metabolic risk from diabetes and abnormal cholesterol levels. Lesser-known symptoms that are seen regularly in women with PCOS include depression, anxiety and eating disorders. The polycystic appearance of the ovaries themselves is demonstrated in women with PCOS, but also can be seen in normal women and therefore is not needed for diagnosis. Diagnosis is made after a careful history and physical exam, and by laboratory testing ( also necessary to exclude some other causes.)

Treatment of PCOS is intended to reduce symptoms, to reduce the risk of heart disease and diabetes, to manage fertility (including contraception, if needed, and helping women get pregnant, if desired) and to reduce risk of abnormal growth of the lining of the uterus (the endometrium) associated with abnormal hormone levels. The primary treatment is with lifestyle changes, so I agree with getting regular exercise and a prudent diet. If these are inadequate, it is reasonable to consider medication treatment.

For women with symptoms of high androgen (male hormone) levels, birth-control pills are the most prescribed treatment, and your daughters doctors should discuss your daughters concerns about taking them. They provide many benefits in women with PCOS, especially by reducing male hormone effects (acne, excess body hair) and reducing risk of abnormal endometrial growth (and possibly cancer). Of course, they have side effects, including risk of blood clots.

For women who cannot take birth control pills, metformin, which reduces insulin levels, has some benefits. It helps with weight gain and menstrual irregularities, and it probably reduces diabetes risk. It does not help with the body hair.

PCOS is a large topic that I cant cover fully. I recommend starting with the information on the American Congress of Obstetricians and Gynecologists FAQ page at tinyurl.com/z7we7er.

Dear Dr. Roach: My primary-care physician and gynecologist are recommending I take Fosamax. What is the alternative to taking Fosamax?

K.J.

Dear K.J.: If there are no other treatable causes, such as low vitamin D or high parathyroid hormone levels, then I think Fosamax or another bisphosphonate is a good choice. There are others, but Fosamax has been well-studied.

Email questions to ToYourGoodHealth@med.cornell.edu.

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Doc: Pill's hormone regulation benefits women with PCOS - The Detroit News

By Alan Mozes

HealthDay Reporter

MONDAY, March 6, 2017 (HealthDay News) -- Obese girls may face a significantly higher risk for developing allergies, a new study suggests.

But the researchers found the opposite was true for obese boys: They may actually face a slightly diminished risk for asthma, food allergies and eczema when compared to normal-weight boys.

"We found a direct increase in the number of atopic [allergic] diseases associated with obesity in urban female children and teenagers, but not in males," said study co-author Dr. Sairaman Nagarajan. He's a resident physician in the department of pediatrics at SUNY Downstate Medical Center in New York City.

"These results were highly significant, even after adjusting for the effects of age and race," he said.

Nagarajan and his colleagues were scheduled to present their findings Monday at the annual meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI), in Atlanta.

Their investigation focused on 113 children (45 percent girls, 55 percent boys), about a quarter of whom were obese.

All the children lived in Brooklyn, N.Y., and were on average between the ages of 8 and 9. Allergies aside, all were deemed to be relatively healthy.

Medical histories were taken to assess for a range of allergic conditions, including asthma, food allergies, hay fever and/or eczema. The children were then given allergy scores, with those struggling with more allergic conditions getting higher scores.

The researchers found that obese girls had allergy scores higher than normal-weight girls: 4 vs. 2.6.

In contrast, obese boys were found to have slightly lower allergy scores than normal-weight boys: 3 vs. 3.4.

The upshot, said Nagarajan, is the possibility "that lifestyle modification therapies and exercise and diet programs may be specifically beneficial to urban obese girls."

But why?

"We hypothesize that there are hormonal differences causing girls to have higher atopy [allergies]," said Nagarajan.

For example, he pointed to the possibility that higher adrenal sex hormone levels found among girls may predispose them to a higher risk for both becoming obese and also for having a stronger overall inflammatory response.

This, Nagarajan said, may "[cause] them to react to things non-obese females wouldn't have."

Still, the study wasn't designed to prove that obesity caused the allergies, and the research team acknowledged that more study is needed.

That point was echoed by Dr. James Baker Jr., CEO and chief medical officer Food Allergy Research & Education (FARE), an allergy information organization.

"These appear to be preliminary findings," Baker said, "and really need to be validated in a larger, prospective study to understand their significance."

Dr. Jay Lieberman, an assistant professor of pediatrics with the University of Tennessee Health Science Center, and LeBonheur Children's Hospital in Memphis, agreed.

"Overall, I am not too surprised by these findings," he said, adding that many studies have suggested "that the obesity effect on allergic diseases may be more pronounced in females rather than males."

"There are many theories as to why," Lieberman added. "The main theory is the role that hormones -- estrogen, estradiol, progesterone, etcetera -- may play [a role] in driving allergies, and that hormonal levels may be imbalanced in obese patients. And, thus, females with obesity are more prone to allergies than obese males, who do not produce these hormones at levels that females do."

Still, Lieberman cautioned that "one must take into account that this was a retrospective study on a relatively small sample of children." Thus, the results must be taken with a grain of salt, meaning the findings could very well be due to chance, he said.

Research presented at meetings should be considered preliminary until published in a peer-reviewed journal.

WebMD News from HealthDay

SOURCES: Sairaman Nagarajan, M.D., MPH, resident physician, department of pediatrics, SUNY Downstate Medical Center, New York City; Jay Lieberman, M.D., assistant professor, pediatrics, University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis; James Baker Jr., M.D., CEO and chief medical officer, Food Allergy Research & Education; March 6, 2017, presentation, American Academy of Allergy, Asthma & Immunology meeting, Atlanta

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Obesity May Raise Girls' Risk of Asthma, Allergies - WebMD

For decades, doctors have assumed that symptoms of menopause, such as hot flashes, sweating and reduced sex drive, are caused by a reduction in the amount of estrogen that the body is producing. Dr. Charles Mok, a former emergency room physician who is board certified in Anti-Aging Medicine and the founder of Allure Medical Spa and Allure Vein Center of Southgate, has evidence that doctors have focused too much on estrogen for menopause and science has found low testosterone levels are also responsible for many symptoms. In his new book Testosterone: Strong Enough for a Man, Made for a Woman (Forbes Hardcover $25.99, ISBN 978-0998365503), Dr. Mok provides peer-reviewed studies which support this view, translating scientific literature into an easy to understand manual for hormone replacement therapy. The book launch is scheduled for March 2 at a Macomb County Allure Medical Spa location.

The evidence for testosterone therapy is overwhelming, and we want to get the message to doctors and, importantly, to their patients, says Dr. Mok. Clinical research shows that testosterone reduces the risk of breast cancer by 50 to 75 percent, which has enormous health implications, and natural estrogen cuts the risk of heart attacks by over 70 percent if used long term. For women suffering from debilitating symptoms such as mood swings, anxiety, hot flashes and reduced libido, the treatment can really improve overall quality of life.

Dr. Moks book takes readers on a journey that chronicles the start of hormone replacement therapy in the 1940s through to the flawed 2002 Womens Health Initiative which suggested women taking a combination of synthetic estrogen drugs and synthetic progesterone had an increased risk of heart disease and breast cancer, which ultimately dissuaded millions of women from seeking hormonal help. It is important to note that further research into the Womens Health Initiative data showed that when women took even the synthetic hormones around the time of menopause and stayed on them, there was a 40 percent reduction in their risk heart attacks and premature mortality.

Dr. Moks book provides compelling evidence about the important role of testosterone in shaping womens health. The hormone is 10-20 times more abundant than estrogen in young women, but then falls as women age. Dr. Mok provides myriad long term studies showing that modern testosterone therapy (normally delivered in the form of a tiny pellet, about the size of a grain of rice, inserted underneath the skin) keeps women healthier, with no adverse side-effects.

Benefits can include weight loss, better sex life, improved mood, fewer sleep problems, reduced hot flashes and night sweats, thicker hair, lower risk of breast cancer and lower risk of heart disease.

Dr. Mok became interested in preventive medicine while working as an emergency room doctor, recognizing that many of his patients conditions could have been avoided. His medical career has now taken him on a path to help patients live their best lives, and for many this approach has been life-changing.

Dr. Mok will launch his book with a lecture, followed by a party, at 6 p.m. March 2 at Allure Medical Spa, 8180 26 Mile Road, Shelby Township.

The event is free to the public and all attendees will receive a copy of the book. RSVP by calling 586-992-8300 or emailing info@alluremedicalspa.com.

Source: CKC Agency

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Area doctor to launch book on women's health during menopause - Southgate News Herald

Montgomery County and the Lehigh Valley, PA (PRWEB) February 28, 2017

Dr. Thomas E. Young, Owner and Medical Director of Young Medical Spa, is excited to announce the addition of a new service: Bio-Identical Hormone Replacement Therapy for restoring hormonal balance and improving overall health and vitality.

Suitable for both men and women, Bio-Identical Hormone Replacement Therapy may help correct hormonal imbalances that can result from aging, relieving such symptoms as depression, fatigue, migraines, low libido, urinary incontinence, lack of mental clarity, trouble sleeping, and more.

A customizable treatment that is tailored to each patients exact needs, Bio-Identical Hormone Replacement Therapy at Young Medical Spa involves inserting tiny pellets beneath the skin that gradually release a steady stream of natural hormones over time. Patients can receive therapy for low testosterone, estrogen, or a combination of both hormones, as needed.

In concert with Bio-Identical Hormone Replacement Therapy, Young Medical Spa clients have access to a complete line of nutraceuticals that promote thyroid, heart, liver, and brain health. The combination of nutraceuticals and Bio-Identical Hormone Replacement Therapy provides a natural approach for long-lasting results without the potential negative side effects of prescription medications and traditional synthetic hormone replacement therapy methods.

Young Medical Spa offers Bio-Identical Hormone Replacement Therapy at both of its locations in Lansdale and Center Valley, convenient to patients in the greater Philadelphia and Lehigh Valley areas. Please visit youngmedicalspa.com to learn more about these treatments at Young Medical Spa. Center Valley patients can also call 610-816-0077; Lansdale residents can learn more about this new service by calling 215-660-4121.

About Young Medical Spa in Center Valley and Lansdale Pennsylvania

Dr. Thomas E. Young founded Young Medical Spa with the mission to provide the highest quality aesthetic treatments and services within the comfort of a relaxing, spa-like environment. At Young Medical Spa in the Lehigh Valley region, all patients are treated under the supervision of medical aesthetic experts to ensure that results match the teams passion for aesthetic medicine.

Dr. Young is a leader within the medical aesthetic industry, and shares his expertise by training other physicians with his advanced techniques and wealth of experience. At Young Medical Spa, Dr. Young works diligently to ensure that each patient is able to achieve their desired results within a state-of-the-art location and in the company of a friendly and welcoming staff.

Services offered include Bio-identical hormone replacement therapy (BHRT), hand rejuvenation, intimate rejuvenation with ThermiVa, P-Shot, and O-Shot. Patients can undergo facelifts, neck lifts, eyelid surgery, thread lifts, Kybella, and PrecisionTX for facial contouring. Body sculpting and shaping treatments include SmartLipo Triplex, CoolSculpting, SculpSure, Brazilian butt lift, natural breast augmentation, cellulite reduction, and the Young Diet Program. Botox, Dysport, and dermal fillers (Juvderm, Restylane, Radiesse, Belotero Balance, and Voluma are administered with clinical and aesthetic expertise. Young Medical Spa is a Brilliant Distinctions participant and a Cynosure Center of Excellence. Additional services include Laser Hair Removal and skin rejuvenation (IPL photofacials, microneedling, skin tightening, laser skin resurfacing, stretch marks & scar revision, laser leg vein therapy, chemical peels, microdermabrasion, and clinical facials. Clients can also purchase from a suite of professional medical-grade skin care products.

Young Medical Spa has two locations serving the Lehigh Valley and greater Philadelphia areas. Their Center Valley medical spa is convenient to Allentown, Bethlehem, and Easton. The Lansdale medical spa is located in Montgomery County outside of Philadelphia, serving King of Prussia and Lower Bucks County. Every patient is given the time and attention necessary to develop a unique treatment plan and foster a valuable relationship with the staff. Young Medical Spa is dedicated to patient care and comfort, maximizing results while ensuring the utmost safety.

Young Medical Spa is conveniently located at 4025 West Hopewell Road in Center Valley, PA, and at 635 North Broad Street, Lansdale, PA.

About Dr. Thomas Young Thomas E. Young, M.D. is the owner and medical director of Young Medical Spa located in the Lehigh Valley and Lansdale, PA. Double board-certified by the American Board of Internal Medicine, he is a native of the Lehigh Valley, and has been practicing medicine in the Lehigh Valley and surrounding areas since completing his residency at the Harrisburg Hospital. He is double-board certified by the American Board of Internal Medicine in Internal Medicine and Geriatrics.

Dr. Young is an experienced cosmetic injector and specializes in multiple awake tumescent procedures and techniques, and began performing SmartLipo Laser Body Sculpting soon after approval by the FDA. Dr. Young has performed well over 6,000 procedures to date, identifying him as the most experienced awake tumescent liposuction physician in the region.

Dr. Young is consistently the first physician to introduce many advanced aesthetic procedures and technologies to the region including awake tumescent laser liposuction, natural breast augmentation, Brazilian butt lift, Cellulaze cellulite reduction, CoolSculpting, SculpSure and stem cell procedures. He also trains other physicians across the country in awake tumescent liposuction & liposculpture procedures.

Dr. Young received an International Award in the category of Best Overall Body Make-Over (a combination of procedures) at the inaugural THE Aesthetic Awards at THE Aesthetic Show in Las Vegas, NV. He also has been voted Leading Aesthetic Physician Botox, Laser & Cosmetic Enhancements in the 2011, 2012, 2013, 2014, 2015, and 2017 Whos Who in Business for the Lehigh Valley, and was twice voted Best Aesthetic Physician by Lehigh Valley Magazines Best of the Valley Readers Poll. Additionally, Young Medical Spa was voted Best Medical Spa in The Morning Calls Readers Choice Awards in 2011, 2012, 2013, 2014 and 2015.

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Introducing Bio-Identical Hormone Replacement Therapy at Young Medical Spa in Center Valley and Lansdale ... - PR Web (press release)

Men's Fitness

Is testosterone-replacement therapy good or bad? One man suffering from low levels searches for answers. Men's Fitness But, leading experts agree, first you need to visit a urologist or an endocrinologistspecialists more adept at diagnosing and treating hormone deficiencies than the average family doctor or low-T clinicto have your blood-testosterone level checked. and more »

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Is testosterone-replacement therapy good or bad? One man suffering from low levels searches for answers. - Men's Fitness

Updated February 23, 2017 15:53:59

A Perth doctor with 25 years' experience has been found guilty of professional misconduct for prescribing large amounts of steroids and other drugs to patients for weight loss and bodybuilding.

Amish Dwarka Singh was found by the State Administrative Tribunal (SAT) to have "acted carelessly, incompetently and improperly" for prescribing the drugs for "no proper therapeutic reason" between 2008 and 2014.

Singh also ordered iron and fresh frozen plasma infusions for patients when they were not necessary for any treatment.

He also was found to have "engaged in a general practice of prescribing Human Growth Hormone".

The SAT found that in some cases, there were adverse effects from the drugs one male patient who was prescribed steroids over two years required surgery to remove enlarged breast tissue.

In the case of another patient, Singh prescribed steroids after diagnosing them with "body dysmorphia with an overlap of binge eating disorder", but the tribunal found that "was simply a cover" to prescribe drugs for bodybuilding.

He also was found to have acted unprofessionally towards another doctor, who treated one of his supposed bodybuilding patients in hospital after they had suffered a seizure, believed to be related to drug withdrawal.

Singh was found to have kept "inadequate" medical records, but he told the hearing he did not take notes on some of his patients because they were high-profile people and they did not want him to.

Singh denied the allegations against him, but the SAT found much of his evidence to be "deliberately untrue".

"The ultimate findings of this tribunal reflect a tragic fall from grace of a very well educated and experienced physician," it said.

Singh's penalty is yet to be determined.

Topics: courts-and-trials, doctors-and-medical-professionals, perth-6000, wa

First posted February 23, 2017 15:16:57

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Perth doctor Amish Dwarka Singh guilty over weight loss, bodybuilding prescriptions - ABC Online

Testosterone supplements have grown into a $2 billion market, with millions of men of a certain age taking it for low energy, low libido, low mood what marketers call "low T" even though that's not an approved use.

Now, the first study to rigorously test whether the quintessential male hormone can fight the toll of aging shows it isn't much of a youth elixir.

A year of testosterone treatment was no better than a placebo for memory and thinking, and it increased fatty plaque in coronary arteries, a risk factor for heart disease. The hormone helped anemia and low bone density in the minority of men with those conditions, which can be treated with other, proven therapies.

The results, published Tuesday in the Journal of the American Medical Association and JAMA Internal Medicine, add to findings from a year ago: Testosterone did not improve fatigue or walking speed, and its modest benefits on sexual function faded by the end of the study.

"The hopes for testosterone-led rejuvenation for older men are dimmed and disappointed if not yet finally dashed," University of Sydney professor of medicine David J. Handelsman concluded in an editorial accompanying the latest results.

University of Pennsylvania endocrinologist Peter Snyder, who led the complicated, government-funded clinical trials involving 788 senior men at 12 medical centers, disagreed.

"It shows for the first time that treatment of older men with low testosterone has certain benefits, including bone density and anemia," Snyder said. "I would say the effects on bone and anemia were striking."

He added a caveat. Even though the $50 million "T Trials" are the most conclusive studies ever done on the hormone, researchers didn't follow enough men long enough to tell whether testosterone increases risks such as heart attacks, stroke, or prostate cancer.

AbbVie, which donated its leading brand, Androgel, to the trials, said in a statement that the company is "committed to our patients and is proud of our continuous support of research that advances science for the benefit of hypogonadism patients."

Actually, hypogonadism occurs when the body doesn't produce enough of the hormone due to disease, injury, or chemotherapy.It's the condition for which testosterone-replacement therapy is approved.

Prescribing testosterone for age-related deficiency which is only vaguely defined took off in 2000. The trend was driven not by solid scientific evidence, but by the introduction of convenient, rub-on testosterone products, the first being Androgel. Many men are put on testosterone with no tests of their levels or despite tests showing normal levels, a study of Medicare claims found.

Two years ago, the U.S. Food and Drug Administration cracked down on this overprescribing. It ordered drugmakers to revise product labeling to stress the approved use, and to warn that the drug may increase the risk of heart attacks and stroke. Another order that manufacturers conduct a clinical trial to clarify the heart risks is "under discussion," the FDA said Friday.

Concerns about testosterone use also led the National Institute on Aging to fund the T Trials, which began enrolling men over age 64 in 2009.

T Trials researchers had to screen more than 50,000 men to find 788 with confirmed abnormally low testosterone levels along with one or more age-related symptom that the hormone might help. More than 60 percent of the men were also obese, a condition that can depress testosterone levels.

Now, with a clearer scorecard on benefits, Snyder would like to see the government fund a study to tease out the risks an effort that would take 5,000 men, five years of treatment, and $500 million.

Other experts see no point in defining the downsides of a therapy with weak upsides.

"The improvements in outcomes in the T Trials were minimal," said Deborah Grady, a professor of medicine at the University of California, San Francisco, and an editor of JAMA Internal Medicine.

Grady was a leader of the Women's Health Initiative, the mammoth government study that in 2002 shattered the deeply held belief that menopausal hormone therapy protected women's hearts. The National Institutes of Health agreed to fund the initiative because estrogen, unlike testosterone, had decades of circumstantial evidence of cardiac benefits.

Testosterone's cardiac effects are still unsettled. Some studies that mine medical records including one in Tuesday's JAMA Internal Medicine have found men taking it have fewer heart problems.

The T Trials' anemia findings add to the complexity.

Testosterone is known to increase production of red blood cells, which carry hemoglobin, a protein that ferries oxygen. In 126 men with mild anemia a deficiency of red blood cells or hemoglobin that can cause fatigue testosterone was better than a placebo at boosting hemoglobin. The hormone corrected anemia that had no apparent cause, as well as anemia caused by iron deficiency or inflammation.

However, in six men, the hormone triggered an oversupply of red blood cells. Testosterone labeling warns about this because the blood can become too thick, a risk for dangerous blood clots or stroke.

Like all participants in the trials, the six men were closely monitored, so the problem was detected, their testosterone dose was reduced, and their red blood cell counts returned to normal, Snyder said.

"The results illustrate that decisions about testosterone treatment need to be individualized," said Evan Hadley , director of the National Institute on Aging's geriatrics division.

Physician Michael Carome, director of health research at the consumer advocacy organization Public Citizen, drew a different bottom line: "This body of research indicates that testosterone is not the fountain of youth that some patients, doctors, and industry have hoped, or represented it as being."

Published: February 21, 2017 11:03 AM EST The Philadelphia Inquirer

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Major study finds testosterone therapy is no fountain of youth - Philly.com

Currently only a school nurse can administer a shot to a student in the condition, but a bill in the state legislature would allow other school employees to be trained so they could also intervene.

Grant Robinson , WBIR 11:57 PM. EST February 19, 2017

KNOXVILLE - On Wednesday a couple from Knoxville will address the senate education committee in support of a bill that would expand access for training and administering a life-saving drug.

Adrenal insufficiency is a condition where a body doesn't produce cortisol - a hormone essential for managing stressors.

People with the disease may go into adrenal crisis, a medical state marked by severe pain, low blood pressure and loss of consciousness that if untreated can lead to death.

Adrenal crisis can be treated, but under the current state law school nurses are the only employees at schools who can administer the shot.

Senate Bill 117 amends that law by allowing other school employees to be trained to administer the injection.

Landon Adzima is a junior at Gibbs High School and lives with adrenal insufficiency. During last year's wresting state tournment, Landon suffered an adrenal crisis.

"There's nothing I could really compare it to," Adzima said. "It just felt like my body was shutting down and that I was helpless and there was nothing I could do about it.'

Adzima's parents were in attendance and were able to administer the drug. They worry that if a student is at school and the nurse is off campus, an adrenal crisis could cause lasting damage.

"We think it's important that school employees could be properly trained to give this injection in the absence of a school nurse," Andy Adzima said. "They're always the nearest person to the student in an emergency that might happen at the school and the time they might have to wait for someone who's legally allowed to give this injection could make a huge difference."

The bill would only require schools to train personnel if a parent or guardian notified the school that a student is diagnosed with adrenal insufficiency.

The bill is sponsored by Senator Richard Briggs (R - Knoxville), who is also a physician.

( 2017 WBIR)

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Family pushes bill expanding medical training in schools - WBIR.com

ROME Turnarounds dont get much quicker than this.

Three days after he was hired, Zdenek Zeman coached last-place Pescara to its first outright win of the season by a score of 5-0 the first time the Abruzzo club has won with a five-goal margin in Serie A history.

All I can do is thank the lads because we only had three training sessions together but they showed that if we dedicate ourselves and if we stay focused we can do well, Zeman said after the victory over Genoa on Sunday. We broke the spell.

For its only other victory this season, Pescara was awarded a 3-0 win over Sassuolo in August because Sassuolo used an ineligible player. Sassuolo had won 2-1.

Previous coach Massimo Oddo was fired last week after six consecutive losses in the last two of which Pescara had conceded a total of 11 goals.

So on Thursday, Pescara rehired the 69-year-old Zeman, a chain-smoking Czech coach known as the Bohemian who had guided the club to the Serie B title five years earlier with a record number of goals.

Known for his all-out attacking style and 4-3-3 formation, Zemans impact was immediate.

After an own-goal five minutes in, Gianluca Caprari the only holdout from Zemans first spell at Pescara scored two, English-born Libya international Ahmad Benali added another and 20-year-old Alberto Cerri got his first Serie A goal.

The result prompted the firing of Genoa coach Ivan Juric.

Zeman doesnt say much but when he does speak hes very clear, Cerri said. He told us to clear our heads and give our all.

Pescara is still 11 points from safety with 13 matches to go but its only one point behind penultimate Crotone and two points behind Palermo. The goal is to catch Empoli, which is 10 points ahead.

It doesnt depend only on us, it depends on how the others do, too, Zeman said. We would need the three squads ahead of us to stall and us to leap forward. Plus, we still have to face (Serie A leader) Juventus so we already have one less match available even though well try to win that one.

Zeman, who will turn 70 before the end of the season, has a long history with Juventus. He accused the Turin power of drug abuse nearly 20 years ago when he coached Roma, sparking a years-long trial.

In 2004, Juventus physician Riccardo Agricola was convicted of administering banned substances, including the hormone EPO, to Juventus players from 1994-98, and was handed a suspended sentence of 22 months. He was cleared on appeal a year later.

Zeman left Pescara in 2012 to return to Roma, which was an offer he said he couldnt refuse. But memories of his first spell at Pescara, when the club scored a Serie B-record 90 goals in 42 games with a team that featured current Italy internationals Ciro Immobile, Lorenzo Insigne and Marco Verratti made it easy for him to come back.

Zeman said he inherited a squad in poor physical condition.

Were going to have to work on that aspect a lot, Zeman said. The important thing is that the lads dont think the season is over.

Pescaras hard-core ultra fans stayed away from the Genoa match in protest at the squads poor results.

I would have liked for them to have come out and given us a hand, Zeman said. I hope we can convince them to return.

Andrew Dampf on Twitter: http://www.twitter.com/asdampf

Continue reading here:
Quick fix: Zeman turns last-place Pescara around in 3 days - The Republic

Whether you like the President or not, its hard not to like his full head of hair. As Trump himself said As everybody knows, I do not wear a wig. My hair may not be perfect but its mine. The Presidents hair has been a topic of jokes, intrigue and even magazine covers. Some have even suggested that he has grown more hair over the past few years. When most men his age are going bald, what is Mr. Trumps secret?

According to Trumps personal physician, Bornstein, he credited the drug finasteride for Trumps hair growth and said that Trump has all his hair. Finasteride is better known by the name Propecia.

But what is finasteride, and how does it work? This is an oral drug approved by the Food and Drug Administration (FDA) to treat and reverse male pattern baldness. This type of baldness usually begins at the temples and leaves a bald top with some hair around the sides of the head.

Finasteride blocks the action of an enzyme called 5-alpha-reductase. This enzyme changes testosterone to another hormone (DHT) that causes hair loss in males. Finasteride increases hair growth on the scalp by inhibiting this enzyme and also fuels new hair cell growth ( journal Expert Opinion in Drug Discovery) . The effect of finasteride on the scalp will only last as long as the medicine is taken. When it is stopped, the hair will be lost.

Finasteride is also used to treat BPH (benign prostate enlargement) which is common as men age. Men with BPH usually have difficulty urinating and a need to get up at night to urinate. Finasteride helps make these symptoms less severe and reduces the chance that prostate surgery will be needed. It may be used alone or in combination with other medicines.

Finasteride works by increasing the level of testosterone which in turn decreases prostate size and reduces hair loss. If one were to speculate, it is possible that the President has a low PSA and a relatively high testosterone level due to the effect of finasteride.

According to the Journal of Investigative Dermatology, Finasteride has gone through three placebo-controlled trials to assess its effects on male pattern baldness. Men who had taken finasteride had 107 more hairs per square inch after one year of use and 277 more hairs per square inch after five years of use. It should be noted that the average person may have anywhere from 1,050 to 1,935 hairs per square inch according to the journal. No wonder, Mr. Trumps head of hair looks fuller!

The drug has relatively few side effects. Rarely, men reported erectile dysfunction and decreased libido, and there was a slight association with depression, but it is considered a safe drug.

Irrespective of your political leanings, or whether you personally like the President or not, or whether you think he is going to win a lot, Mr. Trump has certainly won the battle of hair. He has managed to avoid baldness and maybe even grow hair. Whether he has done this with the help of Finasteride, remains a matter of speculation until we know for sure. But finasteride remains an option for those men who are starting to lose hair, and would like to hang on for a little bit longer.

This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtras The Doctor is In column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He can be reached at 9037850031, or Sucharu.prakash@usoncology.com

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The Secret Behind Trump's Flowing Locks - eParisExtra.com (blog)

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Fifth-grader Sophia Yastrebov craned her neck Thursday to reach the microphone and ask Texas Supreme Court justices a question they probably ask themselves from time to time.

Do you ever have trouble separating your personal preferences from a persons legal rights? the Longview home-school student asked during a question-and-answer session after the courts Longview session in the Belcher Center at LeTourneau University.

Eleven-year court veteran Justice Phil Johnson fielded that one.

The answer to that is, sometimes, he told Sophia and the audience of more than 1,000 high school and college students, hundreds of lawyers, scores of judges and others from across the region who came to see the states highest civil court hear two cases.

In all, some 1,400 people saw a scene Thursday they would have had to travel to Austin to see before 1997, when voters changed the Texas Constitution to allow off-site sessions.

In answering Sophias on-point question, Johnson confessed he might enter a case thinking one way.

But you research the law, he said. You just come out differently than you would prefer to come out. The answer is, we have a system of laws that has to be predictable. And people have to depend on them.

That was just one lesson but a major one that the nine justices said they wanted to leave behind. The judges acknowledged their job is an obscure one to most Texans, hopefully less so after each of their roughly twice-yearly out-of-town sessions.

Theyve been in mystery for too long, retired Longview plumber Peter Saccoccio said after watching the two cases be heard either of which could set legal precedent.

Making all Texas courts transparent is not merely a campaign promise for the justices, all of whom are Republicans.

Weve gone to high schools and universities across the state, Chief Justice Nathan Hecht told a lunch audience after the morning session. But the best I can remember is, this is the best off-site meeting we have held.

Hecht credited Longviews John and Susan Coppedge, whom he met in 1987, the year he campaigned for his first election to the Texas Supreme Court, for sharing his love of making Texans more aware of their judiciary.

Coppedge is recognized statewide as an expert on the Texas judiciary, often shepherding hopefuls for the Supreme Court, Court of Criminal Appeals and local appellate venues through their political campaigns.

Thursdays events, which included all nine justices teaching afternoon continuing education classes for lawyers in the Gregg County Courthouse, climaxed a two-year effort by the retired surgeon.

Hecht and the court are mandating that all Texas courts go online, with electronic filing implemented in stages. Civil courts are wrapping up that change now, and criminal courts are to be added beginning July 1.

By 2019, all of the court records in all of the trial courts other than justices of the peace and municipal courts will be electronic, Hecht said, adding the next step after that will be opening that portal to all residents.

We need to open up the court records, so people can see the cases that are being filed, he said.

The court will issue rulings from the morning sessions by the end of its term this summer. At roughly one hour apiece, the hearings brought a reunion of sorts for the justices.

Former Supreme Court Justice Craig Enoch and former Chief Justice Wallace Jefferson were squaring off in an inheritance dispute that had wended its way up through the trial and appellate courts in Fort Worth, Waco and Austin.

And now were in Longview, Enoch noted as he began his 20-minute allotment to speak.

Enoch represents a family claiming the woman who was married to their grandfather had been unduly influenced to alter her will by a niece and nephew to whom she is related by blood. The Kinsel family is claiming their stepgrandmother, Lesey Kinsel, was unduly influenced by her nephew and niece, Bob Oliver and Jane Lindsey, while living with dementia.

Justice Eva Guzman stopped Enoch at one point, asking whether someone who has lost competence can regain it.

Enoch replied that medical testimony in the trial record says incompetence is incurable despite good days and bad days.

Enoch said the stepgrandmother had amended her will three times through the years.

All of a sudden, she makes a significant change to the trust, he said, adding the woman dropped the Kinsels from her will and sold her ownership in their grandfathers ranch under direction of the niece and nephew and a law firm that also is being sued by the Kinsels. Once you have undue influence, then any change is improper.

Jefferson represents that law firm, Jackson Walker.

He said the niece and nephew brought their aunt, the Kinsels stepgrandmother, to his clients office in 2007.

The first thing he did was separate Lesey from Jane and Bob, Jefferson said. And he brought in a second lawyer, as witness, while he asked questions to see if she was competent.

The Kinsels won a $3 million jury verdict at the trial court level, but it was reversed on appeal because that court ruled a claim of interference with inheritance rights doesnt exist.

A ruling for the Kinsel family would establish such a right.

The second case involves a doctor who asked to be dismissed from a wrongful death suit under a claim of governmental immunity.

Dr. Leah Anne Gonski Marino was in a residency program in 2015 at a University of Texas Physicians Clinic in Houston, but she was paid by the nonprofit UT Health Systems Foundation.

Her claim of governmental immunity led to her dismissal by the trial court, but an appeals court rejected that dismissal on grounds the nonprofit foundation is not a governmental entity and doesnt control the doctors work.

The lawsuit arose from a hormone injection Marino gave the plaintiffs pregnant daughter, when the daughters regular physician was not available.

The pregnant woman later developed breathing problems and died, along with her unborn twins, en route to a hospital.

Liability typically follows control, attorney Joseph Gourrier argued for the mother and grandmother suing the doctor.

The justices peppered Gourrier, and defense counsel John Strawn Jr., with questions trying to pin down whether the UT medical foundation is a governmental entity. Court members drew multiple citations by the attorneys of the bylaws, policies and other documents governing the assignment of residencies to young doctors under the arrangement of the two UT entities.

The case has implications statewide, including in Longview where Christus Good Shepherd Medical Center offers a medical residency program for doctors in partnership with UT Health Northeast near Tyler.

Justices eager to meet students, public Thursday

Texas Supreme Court will gavel-in at Longview's Belcher Center Thursday

Texas Supreme Court to hear weighty issues in Longview

Security tight for visit by state's highest court

Texas Supreme Court needed voters' permission to travel

Texas Supreme Court Longview stop expected to draw thousands

Originally posted here:
Chief justice cheers turnout at Longview off-site session - Longview News-Journal

Kansas City Star

With health care repeal looming, women turn to IUDs and other long-term birth control Kansas City Star The IUD has become the go-to option for women like Sowle who are looking for safe and effective contraception that doesn't involve the hassle or specific hormones associated with daily pills and can last for years at a time. Because the ... While the ...

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With health care repeal looming, women turn to IUDs and other long-term birth control - Kansas City Star

Postmenopausal women who intentionally lost weight over the course of three years had a much lower risk of endometrial cancer up to 11 years later compared to women whose weight didn't change, a U.S. study finds.

Overall, women who intentionally lost 5 percent or more of their body weight had 29 percent lower risk of developing endometrial cancer during the study period, and the effect was most pronounced for obese women, whose risk dropped by 66 percent with weight loss.

"We decided to do the study because we realized that, although obesity increases the risk of endometrial cancer, research couldn't say if intentional weight loss, especially among older persons, could reduce that risk," lead author Juhua Luo, of the School of Public Health at Indiana University in Bloomington, told Reuters health in an email.

Endometrial cancer is the most common gynecologic cancer in the U.S. and the fourth most common cancer among women. About 2.8 percent of American women will be diagnosed with endometrial cancer at some point during their lifetime, according to the National Cancer Institute.

Body fat is thought to increase risk of this hormone-sensitive cancer by increasing the amount of estrogen a woman produces, the researchers write in Journal of Clinical Oncology.

For their study, Luo and her colleagues analyzed data on more than 36,000 women between the ages of 50 and 79 who participated in the larger, long-term Women's Health Initiative study.

All the women were weighed at the beginning of the study period and again three years later when they were also asked if they had intentionally tried to lose weight in the previous few years. The study team followed the women for an average of 11 more years and found that 566 women were diagnosed with endometrial cancer during that time.

With women whose weight remained stable as the reference point, researchers found that women who dropped pounds were significantly less likely to develop endometrial cancer, and those who gained weight saw an 8 percent to 23 percent increase in risk. For women who had not used hormone replacement therapy for menopausal symptoms and gained weight, risk rose by 30 percent.

"It is not too late to lose weight to reduce cancer risk, even if you are older," Luo said.

The study only looked at older women, but Luo said she thinks it is reasonable to think the effects might apply to younger women too, and more research is indicated.

"The majority of women with endometrial cancer are diagnosed with early-stage tumors that are associated with a high cure rate. However, despite this paradigm, not only is the incidence of endometrial cancer increasing, but the number of women who die as a result of the disease also is increasing," Dr. Jason Wright, chief of gynecologic oncology at Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, writes in an editorial accompanying the study.

In 2016, the number of deaths from endometrial cancer in the United States reached 10,170, which is a 25 percent increase compared with just five years earlier, he writes.

Luo's findings suggest that weight loss, even by a modest amount, can lower a woman's risk of endometrial cancer, Wright told Reuters Health by email.

"Fatty tissue releases estrogen which can stimulate the endometrium and increase a woman's risk of endometrial cancer," Wright said.

At present, the only women for whom screening is recommended are those with Lynch syndrome, a genetic abnormality that predisposes women to the development of endometrial and colorectal cancer among other cancer types, Wright noted.

"Most endometrial cancers will have symptoms early such as vaginal bleeding. Women with vaginal bleeding should consult with their physician for evaluation," he said.

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Older women reduce their endometrial cancer risk with weight loss - Fox News

Verily

5 Reasons Real Women Chart Their Menstrual Cycle Verily The term for observing and tracking one's basal body temperature, cervical mucus, hormone levels, or some combination of these is fertility awareness based methods, or FABMs. Dr. Marguerite Duane, family physician and executive director of Fertility ...

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BioViveMD Your True Wellness Partner Serving Westminster, Centennial, Cherry Creek, Longmont, Lone Tree, Parker, Littleton, and all of Denver Biovive Medicine Colorados Leading Bioidentical Hormone Therapy Clinic

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A half billion dollars at least gets spent each year on blood tests to see which hospital patients have a genetic quirk that makes their blood more likely to form dangerous clots.

And most of that spending probably isnt necessary, according to a new paper by a University of Michigan Medical School team.

Writing in the Journal of Hospital Medicine, they review whats known about testing for the trait called inherited thrombophilia, and call for a drastic cut in the tests use by doctors across America.

After all, they write, hospitalized people who have already had such dangerous clots, called venous thromboembolisms or VTEs, dont need a positive genetic test to justify taking medication and making other changes to prevent future ones.

And theres no evidence that medication to prevent clots will help hospital patients who havent yet had a VTE. Testing their DNA for inherited thrombophilia wont change that.

In other words, the authors say, ordering inherited thromboembolism testing on inpatients is something doctors do for little or no reason.

And according to the teams analysis of data pulled from medical records, they do it hundreds of thousands of times a year in Medicare patients alone.

Often, it appears, the test gets ordered to satisfy curiosity about why a patient had a VTE, to see if theyre among the seven percent of Americans with a genetic mutation that makes blood more prone to clot.

There are several tests for several traits, so patients often get them in combination whats called a hypercoagulable workup.

But if doctors are following guidelines grounded in evidence, the test result should rarely change a patients care.

So, except in very specific cases where such clots are highly likely such as women with a family history of clots who are pregnant or getting hormone replacement therapy theres probably not much reason to do the test at all.

Resisting temptation

More testing is not always better, says Christopher Petrilli, M.D., an assistant professor of internal medicine at U-M and co-first author of the new paper.

Testing for this disorder is almost never beneficial, and in fact can even be harmful because it can cause undue psychological distress for the patient, and unnecessary expense for the healthcare system, he adds.

Physicians and patients should resist the temptation to perform costly search for an underlying genetic cause of venous thrombosis, says co-first author Lauren Heidemann, M.D., also an assistant professor of medicine.

Petrilli and Heidemann both hospitalists who specialize in treating patients in the U-M Health Systems University Hospital have set out to address such no reason testing at UMHS and beyond.

Theyve co-founded a local chapter of the group Providers for Responsible Ordering, which aims to help physicians, nurse practitioners and physician assistants reduce over-testing and use health care resources appropriately.

Theyve also led the effort to make UMHS one of more than 40 founding members of the High Value Practice Academic Research Alliance, which is working to bring institutions together to help one another implement strategies that make better use of resources.

The current climate of public attention on new genetic testing options and personalized medicine could make this difficult in some cases, they note in the paper.

Ideally, genetic tests to find out whether someone carries a certain genetic trait should be used when theres clear information about the risks, benefits and costs of that test.

With national health care spending reaching an unsustainable level, we as physicians need to be vigilant about becoming stewards of health care resources, says Heidemann.

For the paper, Petrilli, Heidemann and their colleagues reviewed the full scope of literature and established guidelines on inherited thrombophilia testing.

They illustrated the situation by applying this information to a hypothetical case of a young patient with a VTE but no family history who suffers a pulmonary embolism a dangerous health emergency where clots form in the lower extremities and travel to the lungs, potentially cutting off oxygen to the body unless treatment starts quickly.

They note the conclusions about VTE prevention and treatment that have been reached by several medical bodies including an American College of Chest Physicians guideline recommending against giving clot-prevention medication to people with the genetic trait but no VTE history.

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News source: University of Michigan. The content is edited for length and style purposes. Figure legend: This Knowridge.com image is for illustrative purposes only.

Excerpt from:
A lot of blood, for no reason? Common, costly clot test has few benefits - Knowridge Science Report

Doctor Rob Riley joins us from Memorial Family Medicine every Tuesday to answer viewer questions.

Here are the questions he addressed during NewsCenter 16 at Noon on February 14, 2017:

"My daughter plays travel softball and practices all year round. The last two practices she has gotten sick. She gets light-headed and dizzy. She also gets nauseous, has trouble breathing, and her chest hurts. Any idea what this could be?"

Dr. Riley: That group of symptoms -- dizziness, nausea, shortness of breath, and chest discomfort -- makes me think of anxiety attack as one possibility. With acute anxiety, people can hyperventilate, and that can cause all of those symptoms. Other possibilities include just one of these common viruses we're seeing right now where the symptoms may not be all that apparent unless the person is exerting themselves, like at softball practice. Rarely, this can be something more serious like a heart issue, so I think it's worth having your daughter checked out by her physician to make sure everything's OK and to get proper treatment if that's needed.

"Are there any natural alternatives for treating Graves' disease?"

Dr. Riley: Graves' disease is a disease of the thyroid gland where the gland gets confused and produces too much thyroid hormone. For reasons that aren't well understood, the immune system produces a substance that stimulates the gland. Symptoms include racing heart, sweating, high blood pressure. We usually treat this either with medications that shut down the thyroid gland's ability to make thyroid hormone, or by destroying the overactive gland with radiation. There's really no so-called natural treatment that will shut down the thyroid gland's production, so one of these options is the way to go in most cases.

"What's your take on essential oils and herbal remedies?"

Dr. Riley: There's a certain appeal to the idea of using substances found in nature to treat our illnesses rather than things cooked up in a laboratory. It feels safer. But natural doesn't always mean safe -- there are plenty of poisons in nature. In terms of effectiveness for various conditions, scientists started studying herbal remedies in earnest in the 1980's and 90's. Unfortunately, the results have been mostly disappointing, though studies have shown mixed results for some products. In general, the most commonly used products appear to be generally safe, though there are some risks of interacting with medications. So, in general, I don't object to people trying an herbal remedy for a non-life threatening condition. If they feel they benefit, that's great. But I don't think the science is solid enough to recommend herbal treatments as first-line for any particular medical condition at this time.

Dr. Riley joins us from Memorial Family Medicine.

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Ask the Doctor: Dizziness, Graves' disease, herbal remedies - WNDU-TV