Archive for the ‘Hormone Physician’ Category

Hormone therapy consultations are provided by Dr. Maddie Deutsch, the Medical Director of UCSF Transgender Care, an Associate Professor of Clinical Family & Community Medicine,and aninternationally recognized expert in gender affirming health care, and by Michael Snavely, MD, a Family Physician with special training in gender affirming health care. Patients can be seen only for hormone therapy and consultation, or in conjunction with receiving primary care.In many cases, visits can be conducted using video visits / telemedicine. It is strongly advised that all patients being seen by Dr. Deutsch for hormone therapy consultation only have an outside primary care provider; in the case of co-existing health issues, patients may be required to establish a primary care relationship either with an outside medical provider, or with Dr. Deutsch.

Dr. Deutsch offers the placement of testosterone pellets in the office for her own patients.

Dr. James F. Smith, MD, MS in the UCSF Department of Urology also offers this service for patients who are already on testosterone and have a doctor who is managing their hormone therapy and who is available to collaborate.

Contact us to arrange a consultation.

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Hormone Therapy | Gender Affirming Health Program

Getting older gets a bad rap, especially when it comes to maintaining peak performance at work, in the gym, and even in the bedroom. But even though its normal for your body to experience changes as you age, there are simple, proven steps you can take to stop any negative effects in their tracks.

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Ehormones MD: HGH Therapy | Testosterone Replacement Therapy

If youve been diagnosed with breast cancer, endometrial canceror prostate cancer, your cancer team may recommend hormone therapy as part of your treatment plan. You likely have lots of questions about this type of treatment, its advantages and its potential downsides.

Also referred to as hormonal or endocrine therapy, this cancer treatment is different from menopausal hormone replacement therapy (HRT), which refers to the prescription of supplemental hormones to help relieve the symptoms of menopause.

Certain cancers rely on hormones to grow. In these cases, hormone therapy may slow or stop their spread by blocking the bodys ability to produce these particular hormones or changing how hormone receptors behave in the body.

Breast and prostate cancers are the two types most commonly treated with hormone therapy. Most breast cancers have either estrogen (ER) or progesterone (PR) receptors, or both, which means they need these hormones to grow and spread. By contrast, prostate cancer needs testosterone and other male sex hormones, such as dihydrotestosterone (DHT), to grow and spread. Hormone therapy may help make these hormones less available to growing cancer cells.

Hormone therapy is available via pills, injection or surgery that removes hormone-producing organs, namely the ovaries in women and the testicles in men. Its typically recommended along with other cancer treatments.

If hormone therapy is part of your treatment plan, discuss potential risks or side effects with your care teamso that you know what to expect and can take steps to reduce them. Let doctors know about all your other medications to avoid interactions.

Aromatase inhibitorssuch as anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin)work by inactivating aromatase, which your body uses to make estrogen in the ovaries and other tissues.

When and why theyre used: These medications are used primarily in women who have gone through menopause. Estrogen production declines dramatically after menopause. Premenopausal women produce too much aromatase for the inhibitors to work effectively. (Aromatase inhibitor drugs may be prescribed for younger women if theyre given with a drug to suppress ovarian function.)

Ask your care team whether you may benefit from aromatase inhibitors based on your cancers characteristics. Patients may receive aromatase inhibitors before surgery to shrink tumors for easier removal, or after treatment to prevent breast cancer from returning. These drugs may also play a role in breast cancer prevention for certain people who are at high risk.

Risks: While side effects differ based on the type of hormone therapy, the main ones in women with all types of hormone therapy (including aromatase inhibitors) are:

These are similar to symptoms of menopause, as both hormone therapy and menopause reduce the amount of estrogen in the body. In relatively rare instances, aromatase inhibitors may also increase the risk for heart attack, chest pain (angina), heart failure, high cholesterol, bone loss, joint pain, depression and mood swings.

Selective estrogen receptor modulators (SERMs)including tamoxifen (Nolvadex), raloxifene (Evista) and toremifene (Fareston)selectively block estrogen from certain tissues, namely the breast, while increasing its availability in other areas such as the bones.

When and why theyre used: Doctors may recommend SERMs after surgery for early ER-positive breast cancer in menor women, to reduce the chances that it recurs. Theyre also approved to treat advanced breast cancer, and may be used to prevent breast cancer in high-risk individuals. Toremifene is only approved for advanced stage breast cancer that has spread.

Risks: In addition to more common side effects of hormone therapy such as hot flashes, tamoxifen risks may include blood clots, stroke, bone loss, mood changes, depressionand loss of sex drive. Men who take tamoxifen may experience headaches, nausea, vomiting, rashes, impotence and loss of sex drive. Raloxifene may increase a patients chances of having a stroke or developing potentially fatal blood clots in the lungs or legs. Fortunately, these side effects are considered relatively rare. Have your doctor explain the potential side effects associated with each SERM when discussing the pros and cons of these medications with you.

Fulvestrat binds to estrogen receptors, completely stopping the hormone from attaching to the receptors.

When and why its used: Fulvestrant is approved for women who have advanced ER-positive breast cancer that has spread following treatment with other types of hormone therapy. Its also prescribed for postmenopausal women with ER-positive, HER2-negative cancers(meaning they have normal levels of human epidermal growth factor receptor-2) who have not undergone other hormone therapy.

Risks: Fulvestrant may cause nausea, vomiting, constipation, fatigue, back pain, bone pain, joint pain, headaches, hot flashes and breathing issues.

Ovarian suppression may involve surgery, drugs or radiation therapy.

The surgical procedure, called an oophorectomy, removes the ovaries to stop them from producing estrogen, while drugs prescribed for this purpose include gonadotropin releasing hormone (GnRH) analog and luteinizing hormone-releasing hormone (LHRH) analog.

When and why theyre used: These types of therapies may be recommended with either tamoxifen or an aromatase inhibitor for premenopausal patients.

Risks: Ovarian suppression may cause bone loss, mood swings, depression and loss of libido, along with hot flashes, night sweats, and vaginal dryness or atrophy.

Hormone therapy may be part of prostate cancer treatment if the cancer has spread and cant be cured by surgery or radiation therapyor if the patient isnt a candidate for these other types of treatment. It may also be recommended if cancer remains or returns after surgery or radiation therapy, or to shrink the cancer before radiation therapy.

Additionally, hormone therapy may be combined with radiation therapy initially if theres a high risk of cancer recurrence. It can also be given before radiation therapy to shrink the cancer and make other treatments more effective. Other types of hormone therapy for prostate cancerinclude:

This type of therapy includes LHRH agonists, also called LHRH analogs or GnRH agonists, such as Leuprolide (Lupron, Eligard), Goserelin (Zoladex), Triptorelin (Trelstar) or Histrelin (Vantas).

When and why theyre used: Intended to lower the amount of testosterone produced by the testicles, these drugs are injected or placed as a small implant under the skin. Doctors may refer to this as medical castration. Orchiectomy or surgical castration is the removal of the testicles.

Risks: Side effects may include:

These drugs sometimes cause an initial increase in male sex hormones, which may be dangerous. LHRH antagonists are another type of androgen deprivation therapy that doesnt cause this initial rise or flare. Both LHRH agonists and antagonists may stop the testicles from making androgens but dont control production in other parts of the body, such as the adrenal glands. This means that a tumor may still have access to the hormones it needs to grow. Drugs are available that block androgen madeby cells outside of the testicles.

These pills prevent male sex hormones from promoting tumor growth.

When and why theyre used: Doctors may suggest androgen blockers if an orchiectomy or an LHRH agonist or antagonist is no longer working. (An anti-androgen is also sometimes prescribed for a few weeks when an LHRH agonist is first started to prevent a possible flare.)

Newer anti-androgens, available as daily pills, include enzalutamide (Xtandi), apalutamide (Erleada) and darolutamide (Nubeqa).

Risks: Side effects may include diarrhea, fatigue, rash and worsening hot flashes. Dizziness and seizures are more severe, but less common, side effects.

Estrogens may be tried for prostate cancer if other hormone treatments are no longer working.

Cancer of the uterus or its lining, the endometrium, may respond to hormone therapy with progestins. Other types of hormone therapy for endometrial cancer include:

When and why theyre used: Hormone therapy is typically reserved for advanced uterine or endometrial cancer, or for cancer that has returned after treatment. Its often combined with chemotherapy.

Risks: Side effects are similar to those seen with hormone treatment for other types of cancer.

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Hormone Therapy For Cancer: Benefits, Risks & Reasons

Many women expect hot flushes, dry skin and night sweats when they reach the menopause. But the effect the menopause can have on the brain is rarely mentioned. This is something a recent Channel 4 documentary presented by Davina McCall explored.

The documentary, called Sex, Mind and the Menopause, discussed how the menopause can cause a range of brain-related symptoms, including brain fog, mood changes and memory problems. It also suggested that taking hormone replacement therapy (HRT) some years before the menopause may be the solution to these problems alongside potentially halving a womans risk of developing dementia.

With around 4.4 million women of working age going through the menopause in the UK, its clear that we need solutions to help those suffering from brain-related and other menopause symptoms. But HRT might not live up to what the documentary suggested it to be.

Around 23% of women experience measurable changes in brain function during menopause especially to their memory. These changes typically occur in the early stages, during perimenopause (the transitional period before menopause, typically between 40 and 44 years of age when oestrogen levels begin to drop and the frequency and intensity of periods start changing).

This is something the documentary touched on, with one doctor using brain scans of perimenopausal women to show that brain activity was 25% lower compared with premenopausal women (the time before perimenopause). However, the documentary did not show viewers that these brain changes are usually temporary often reversing a couple of years after reaching the menopause when a woman no longer has periods. This is typically between 45 and 55 years of age.

These temporary brain changes may be caused by other menopause symptoms that can affect sleep, such as night sweats. Since sleep plays an important role in brain function, not sleeping properly could lead to concentration and memory problems. No evidence to date has conclusively shown whether or not the hormonal changes that happen during this period are the cause of brain changes in humans.

While there is good evidence that HRT can help reduce the severity of some menopause symptoms (including hot flushes and night sweats), its less certain whether such treatments have any long-term benefit on memory and brain function.

Another argument the documentary makes is that taking HRT can significantly reduce a womans risk of developing Alzheimers disease the most common form of dementia. They drew on the results of an American study of over 400,000 women that showed those who used HRT had a 50% lower risk of dementia. This was especially true if they were taking natural hormones, such as oestradiol (an oestrogen steroid hormone).

But there is one key issue with this type of observational study. Previous studies have shown that women who decide to take HRT were better educated, exercised regularly, had a healthier weight and lower blood pressure and cholesterol levels compared with women who chose not to take HRT. All of these factors are known to decrease dementia risk.

While the study took these factors into account, having a good education or a healthy lifestyle may still have had a greater influence on reducing dementia risk than taking HRT by itself during the menopause did.

While a large UK study showed that taking HRT during the menopause can lower a womans risk of being diagnosed with dementia, this effect was much smaller (only around 8-12% lower) and was only seen in women taking the hormone oestradiol. It is worth noting that this study looked a both women who had experienced natural menopause as well as those who had early menopause because of surgery. Its believed that premature surgical menopause (before the age of 40) increases dementia risk unless these women take a replacement oestrogen treatment such as oestradiol. So while the study showed lower dementia risk in some women taking this hormone therapy, this might only have been the case for those who had an already elevated risk because of early menopause. Its also worth noting that overall, there was no association between taking hormones during the menopause and dementia in the UK study.

This UK study also showed that taking oestrogen alongside progesterone (the standard hormone treatment for the menopause prescribed to women who still have a womb), either eliminated the beneficial effect of oestrogen treatment alone or even increased the risk of dementia slightly. Previous studies have also shown an increased risk of dementia when taking a combination hormone though this risk was typically seen in women who were over 60 or if they were taking hormones for more than ten years. Giving these older women sex steroids has been associated with negative effects, accelerating damage to the brain cells.

Its also worth noting that taking combined hormone treatments for more than five years is linked to a greater risk of breast cancer though this risk is small, especially when compared with, say, the risk of cancer from being overweight or smoking. As such, most medical guidelines suggest that taking combined hormones for menopause symptoms is safe for up to five years after the menopause.

Hormone replacement therapy can be effective for many women in alleviating a range of menopausal symptoms, particularly hot flushes. Whether HRT can prevent dementia or alleviate brain-related symptoms due to the menopause is still unclear. But fortunately, any brain changes that happen because of the menopause are usually temporary.

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Menopause: HRT's brain-protecting effect may be overstated - The Conversation Indonesia

Cameron Wright, 16, has always seen himself as a dude. As a young child, Cameron didnt have the words to explain the disconnect between how he saw himself and how the world saw him. But he knew that despite being born in a girls body, he was meant to be a boy.

After taking reversible puberty blockers that pause a teenagers body changes, Cameron considered whether he wanted to begin hormone therapy to physically transition more permanently. He did not take the decision lightly. Cameron said his doctor made him spend almost a year mulling over the question, working with his therapist, and thinking through the life-altering implications before the doctor believed he was ready to start taking the medications in 2020.

I thought about if I stayed a girl, life would be so much easier, said Cameron, who uses the pronouns he and him. But this is what I want, and Im not going to let anything stop me from being who I want to be, whether its hard or not.

Then in November 2021, the GENder Education and Care, Interdisciplinary Support clinic in Dallas, known as Genecis, stopped taking new patients for gender dysphoria hormone treatment because of pressure from Republican activists and politicians. Although doctors can continue to see patients like Cameron whom they were already treating, the clinic was dismantled. Cameron and his family now have concerns about what this means for them.

The Texas attorney general, Ken Paxton, also opened investigations into pharmaceutical companies whose products are used by transgender patients, and Republican Gov. Greg Abbott and the state GOP are increasingly focusing legislative and reelection efforts on a record number of bills that target transgender young people, their parents, and their doctors.

Since then, Texas Childrens Hospital in Houston announced it would stop offering hormone therapy. The Texas Tribune reported that Legacy Community Health, also in Houston, quietly paused hormone therapy for teens as well. And doctors throughout the state are telling patients they will no longer prescribe the medications under pressure from insurance companies.

Transgender young people and their families across Texas are now scrambling to find providers and maintain access to their medications, with some exploring options outside the state. An estimated 17,000 transgender people ages 13-17 live in Texas, according to Equality Texas, an LGBTQ+ education and advocacy organization.

For Chloe Ross, 15, who uses the pronouns she and her, the crackdown on her care has been distressing. Im just as human as everyone else, she said.

Chloes doctor is still seeing her and prescribing her hormones. But her mother, Kathryn Ross, has started researching options for out-of-state care. The family has been saving money in case they need to move, Ross said, but they hope it doesnt come to that.

Having just moved, and Chloe making good friends, the last thing we want to do is uproot her, said Ross. Moving would be the last option.

During the pandemic, the family relocated to a larger city within Texas, leaving behind bullies, and the teen found acceptance from new schoolmates who know her only as Chloe, someone who loves theater and wants to study genetics. But Abbotts orders to investigate parents who allow their children to receive gender-affirming care, and legislative threats to criminalize such care, weigh heavily on Chloe.

Im just trying to get through high school and stuff, Chloe said through tears. Having Gov. Abbott make me worry about that kind of stuff is terrible because I dont get a normal life anymore, you know? Right now, Im having to go to my teachers to ask them to please not turn me in for being trans. I shouldnt have to worry about something like that.

For as long as she can remember, Chloe said, she has favored wearing jewelry, playing volleyball, and participating in theater. She did not know how to express what she was feeling and thought she was gay. Chloe and her mom said strangers regularly assumed Chloe was a girl even as she presented as a boy and had not yet come out as transgender.

Echoing other parents, Chloes mother said that even though she was already deeply involved in LGBTQ+ support and advocacy, Chloes coming out as transgender was a gut punch. Never once did she disbelieve Chloe, but she feared for her daughters future. She feared for what is happening now.

Young people receiving gender-affirming care include those who are socially transitioning for example, wearing clothing that reflects their gender identity and those taking puberty blockers or hormones.

Not all young people who identify as transgender, however, move beyond social transitioning or experience the condition known as gender dysphoria, which means that they experience psychological stress when their body doesnt match their identity. And people who take puberty blockers dont necessarily decide to take gender hormones. Surgery is not recommended for people younger than 18.

Although gender-affirming care for trans young people remains politically controversial in many parts of the U.S., a study published by JAMA Network Open showed a reduction in suicidal ideation in trans youths who received such care. Health care organizations that include the Endocrine Society, the American Academy of Pediatrics, and the American Medical Association endorse gender-affirming health care.

Despite the changes to Genecis, Cameron is scheduled for a May appointment with Dr. Ximena Lopez, the doctor overseeing his care. His mom, Myriam Reynolds, however, worries it wont take place. Lopez has filed a lawsuit against UT Southwestern Medical Center, which jointly operated Genecis with Childrens Medical Center Dallas, alleging that the facility discriminated against some patients by preventing them from receiving gender-affirming care based on their gender identity.

In the meantime, Reynolds picks up Camerons hormone refills as soon as they are available to maintain a constant supply. She also said the family is considering all options to ensure Cameron can continue receiving care despite the state crackdown.

They dont care at all about trying to help my kid, Reynolds said. Its all political theater.

Its especially hard because access to Genecis was a consideration when the family decided to relocate from Colorado to Texas in 2017. Cameron had already come out as transgender, and, after researching the clinic, his mother believed he would receive compassionate, thoughtful care as he transitioned. Now the family is concerned about what kind of care Cameron will be able to get in Texas.

Cameron, who hopes to study music production or become a firefighter, tries to be optimistic that politicians will stop cracking down on medical care for people like him.

I cant control the way I am, said Cameron. This is not my moms doing or my doctors doing. This is just me trying to be myself.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

This story can be republished for free (details).

By Sandy WestKaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

Original post:
The Families of Trans Kids in Texas Consider Their Options Amid Crackdown on Care - Physician's Weekly

Diabetes is a chronic health condition that affects how your body turns food into energy. If you have diabetes, your body either doesn't make enough insulin or can't use the insulin it makes as well as it should. Over time this can cause serious health problems such as heart, vascular, Alzheimer's disease, or cancer, vision loss, neuropathy and kidney disease. To-date, there are three traditional types of diabetes: type 1, type 2, and gestational diabetes.

According to the CDC, diabetes is one of the nation's leading causes of death and disability. In 2019, diabetes was the seventh-leading cause of death in America and claimed more than 87,000 lives. Diabetes-related deaths surged by 17% in 2020 and 15% in 2021 compared to the pre-pandemic level in 2019. And many more who are living with diabetes suffer from disease-related cardiovascular damage, and other chronic diseases of aging, vision loss, and lower-limb amputation.

There isn't a cure for diabetes, so self-management and a healthy lifestyle regimen are necessary to reduce the impacts of diabetes on the human body. As a medical practitioner, specializing in endocrinology, diabetes and metabolism, I help my patients understand and manage their diabetes. Read on to find out moreand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

It's believed that Type 1 diabetes is caused by an autoimmune reaction that attacks the body by mistake. If you have Type 1 diabetes, your pancreas is unable to make the hormone insulin, which normally regulates the level of sugar (glucose) in your blood stream. Without insulin to clear out the excess glucose, levels rise, wreaking havoc on the blood vessels. This is what causes all the vascular damage throughout the body.

Type 1 diabetes can be autoimmune-related or non-autoimmune-related. The autoimmune forms of diabetes may manifest in childhood, adolescence, or adulthood. Adult-onset autoimmune diabetes accounts for about 20% of adult-onset cases (which means that 80% of cases are not autoimmune-related).

The presence of certain antibodies in the blood are considered markers of diabetes. These include glutamic acid decarboxylase (GAD) and pancreatic insulin-producing islet cell antibodies (ICA). When GAD-positive antibodies are seen in adult-onset diabetes, it's a form of disease called latent autoimmune diabetes in adults ("LADA," or "type 1.5 diabetes"). This type of diabetes is often misdiagnosed as Type 2 diabetes, because it's adult-onset. This misdiagnosis unfortunately leads to poor therapeutic choices, worsening of glycemic (blood sugar) control, and may speed up progression to fulminant insulin-deficient Type 1 disease (a condition where the insulin-producing beta cells of the pancreas are swiftly and completely destroyed). Most early childhood onset Type 1 diabetes involves autoimmune dysfunction, where antibodies attack and destroy the insulin-producing cells

Some in the medical community now suspect that non-autoimmune forms of insulin-deficient (Type 1) diabetes are, in fact, autoimmune in nature, but they involve antibodies that have not yet been identified.

The main cause of Type 2 diabetes is obesity. Type 2 diabetes is also called "insulin resistance," because it's not a lack of insulin that causes blood sugar to rise, but an inability of the body's cells particular muscle and fat cells to utilize it. The pancreas still makes insulin as it should, but the insulin is rendered nonfunctional because the cells "resist" it. This has the same negative effect as having no insulin. Sugar levels rise, leading to vascular damage throughout the body. Moreover, the compensatory hyperinsulinemia itself plays an important pathogenic role in the chronic diseases of aging, including heart, vascular, Alzheimer's disease and cancers.

Type 2 diabetes used to be known as adult-onset diabetes, but both Type 1 and Type 2 diabetes can begin during childhood and adulthood. Type 2 is more common in older adults, but the increase in the number of children with obesity has led to more cases of Type 2 diabetes in younger people.

On the other hand, 20% of adult-onset diabetes is an autoimmune form (positive GAD antibody) of type 1 diabetes, so called latent onset diabetes of the adult, or LADA.

A variant of type 2 diabetes is ketosis-prone diabetes type 2. These individuals are typically older than adolescents, or childhood-onset type 1 diabetics, and are typically obese. This group is commonly racially identified as black, Hispanic, Asian, or Indian. Ketosis or ketoacidosis is characteristically an initial onset disease presentation, requiring insulin treatment that subsequently is manageable with oral agents. The pathogenic cause of ketosis-prone type 2 diabetes is not clear.

Another factor contributing to the development of Type 2 diabetes is the consumption of "non-food" dietary additives (for example, artificial sweeteners). These substances cause oxidative stress in the liver and subsequently the pancreas, resulting in excessive secretion of insulin and resistance to that insulin in the muscle, liver and fat cells. As mentioned above, insulin-antibody-mediated diabetes in childhood is often considered Type 1 disease, although the presence or absence of insulin deficiency independent of autoimmunity, also differentiates Type 1 versus Type 2 diabetes.

Long-standing Type 2 diabetes eventually leads to exhaustion destruction of the pancreas's insulin-producing beta cells with declining insulin levels. When this happens, the disease evolves into a non-autoimmune form of Type 1 (insulin-deficient) diabetes, sometimes referred to as diabetes type 1 1/2. When this happens, the person will need to start taking insulin shots, because their body no longer produces its own insulin.

Another insulin-resistant or Type 2 form of diabetes is known as steroid-induced diabetesan unexpected increase in blood sugar that's related to the use of steroids.

This can occur with prolonged steroid use and is one reason prescribed courses of steroid medications are generally short and taper off quickly. Such marked rises in blood glucose levels may occur in people with or without a history of diabetes. The most characteristic feature is skeletal-muscle insulin resistance with blood-sugar spikes that occur after meals. The muscles do not take up the sugar as they should. Steroid-induced diabetes is more similar to Type 2 diabetes than Type 1. In both steroid-induced diabetes and Type 2 diabetes, your cells do not respond appropriately to insulin. In Type 1 diabetes, your pancreas does not create insulin.

Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don't already have diabetes. Gestational diabetes occurs when your body becomes resistant to the actions of insulin during your pregnancy. Insulin is a hormone made by your pancreas that lets blood sugar into the cells in your body for use as energy.

Both hormones produced by the placenta (progesterone and human placental lactogen) promote resistance to the actions of insulin. The placenta also produces a hormone called corticotrophin releasing hormone (CRH) which increases cortisol production during pregnancy. This also antagonizes the actions of insulin. In addition, excessive weight gain and poor dietary choices during pregnancy promote insulin resistance.

Having gestational diabetes can also increase your risk of high blood pressure during pregnancy, due to insulin resistance induced compensatory hyperinsulinemia, promoting arterial vasoconstriction and kidney mediated salt retention.

The term Type 3 diabetes has recently been coined in reference to the insulin-resistance component of the pathogenesis (course of development) of Alzheimer's disease. Type 3 diabetes occurs when neurons in the brain become unable to respond to insulin, which is essential for basic tasks, including memory and learning. Some researchers believe insulin deficiency is central to the cognitive decline of Alzheimer's disease.

Maturity-onset diabetes of the young (MODY) are a group of inherited diabetes subtypes that are passed from parent to child through the genes. Symptoms typically begin in older childhood or young adulthood, before age 30. This group is characterized by having abnormally high blood sugar levelsblood sugar arises from reduced production of insulin. Severity depends on the particular genetic variety, and can range from symptomless to severe. MODY in contrast to types 1 and 2 diabetes, only accounts for 1-2 % of the prevalence of diabetes.

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Anyone experiencing ongoing dry mouth, excessive thirst, frequent excessive urination, lightheadedness, unintended weight loss, or blurred vision should have their blood glucose level checked immediately. A doctor should do bloodwork that includes an endogenous insulin level (the best test is a C-peptide level). If this level is low or mid-range, a GAD antibody test should be done.

If pre-diabetes or insulin-resistant type 2 diabetes is diagnosed, the best course of action is to lose weight, develop an exercise plan that includes at least 30 minutes of walking or other movements most days of the week, quit smoking (if applicable), limit alcohol, follow a Mediterranean diet (there are many forms of it that can be adapted to any ethnic preference) and find ways to reduce stress. Learning what constitutes a healthy, balanced diet (that included not only the Mediterranean but a low glycemic ndex-based diet and limiting the processed and "nonfood" additives to the diet) is a great first step to better health, and may help prevent the onset or progression of type 2 diabetes. And to protect your life and the lives of others, don't visit any of these 35 Places You're Most Likely to Catch COVID.

Dr. Brian Fertig, M.D., F.A.C.E., is the Founder and President of the Diabetes & Osteoporosis Center in Piscataway, NJ, serves as an Associate Professor at Robert Wood Johnson Medical School and as the Chair of the Department of Diabetes and Endocrinology at Hackensack Meridian Health, JFK University Medical Center. He is also the author of "Metabolism & Medicine," a two-volume series detailing a scientific approach for predicting and preventing disease.

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This is the #1 Cause of Diabetes, Says Physician Eat This Not That - Eat This, Not That

WASHINGTONFemale rats exposed to a scream sound may have diminished ovarian reserve and reduced fertility, according to a small animal study published in the Endocrine Societys journal, Endocrinology.

Ovarian reserve is the reproductive potential left within a woman's two ovaries based on the number and quality of eggs. A woman is born with a finite number of eggs and her body cannot create any more. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs.

We examined the effect of stress on ovarian reserve using a scream sound model in rats, said Wenyan Xi, Ph.D., of the Second Affiliation Hospital of Xian Jiao Tong University in Xian, China. We found that female rats exposed to the scream sound had diminished ovarian reserve and decreased fertility.

The researchers used a scream sound model to investigate the effect of stress on ovarian reserve in female rats. They exposed female rats to a scream sound for 3 weeks and analyzed the effect on their sex hormones, the number and quality of their eggs and their ability to get pregnant and have babies after mating.

They found the scream sound decreased the rats estrogen and Anti-Mullerian hormone levels. Estrogen is a group of hormones that play an important role in growth and reproductive development, and Anti-Mullerian hormone is a hormone made by the ovaries which helps form reproductive organs. The scream sound also lowered the number and quality of the women's eggs and resulted in smaller litters.

Based on these findings, we suggest stress may be associated with diminished ovarian reserve, Xi said. It is important to determine an association between chronic stress and ovarian reserve because doing so may expand our appreciation of the limitations of current clinical interventions and provide valuable insight into the cause of diminished ovarian reserve.

Other authors of this study include: Hui Mao, Haoyan Yao and Ruiting Shi of the Second Affiliation Hospital of Xian Jiao Tong University; and Zhiwei Cui of the First Affiliation Hospital of Xian Jiao Tong University in Xian, China.

The study received funding from the Natural Science Foundation of Shaanxi Provincial Department of Education.

The manuscript, Scream Sound Induced Chronic Psychological Stress Results in Diminished Ovarian Reserve in Adult Female Rat, was published online, ahead of print.

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Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the worlds oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at http://www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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Stress may be associated with fertility issues in women - EurekAlert

Menopause brings about a number of physical changes. Ovaries stop releasing eggs, periods cease, hot flashes begin, and vaginal dryness becomes more common. Along with the dryness, vaginal pain may also increase during and after menopause.

Most pain after menopause can be traced to one issue: A drop in estrogen. This hormone is responsible for lubricating the skin in and around the vagina, making the tissues more flexible, and maintaining the vaginas pH balance. (This helps keep infections at bay.)

The greater the drop in estrogen, the higher the likelihood of issues like vaginal dryness, tightness, and pain.

Learn more about what causes vaginal pain after menopause and what can help relieve the pain. This article will also look at other issues not related to menopause that could be responsible for vaginal pain or discomfort.

In most cases, vaginal discomfort and pain after menopause are related to sex. In fact, according to the North American Menopause Society, 17 to 45 percent of postmenopausal women say they find sex painful.

As estrogen levels drop, the vagina makes less of its own natural lubrication and moisture. The tissues become thinner and more fragile.

As a result, penetrative sex may cause tearing and irritation. Discomfort and pain after sex are more likely, too. In fact, its not uncommon for postmenopausal people to experience soreness, burning, and irritation in the vagina or vulva after sex.

Pain after menopause may also be the result of vaginal tightness during sex. Without estrogen, your vagina can shorten and narrow at the opening. Penetration may be painful.

This dry, thin vaginal tissue and the resulting inflammation and irritation is a condition called vaginal atrophy or atrophic vaginitis. Other symptoms can include:

Without treatment, people may experience tearing and bleeding after sex. People may be less inclined to have sex because they fear post-sex discomfort and pain.

Vaginal atrophy can also lead to chronic vaginal infections like yeast infections after menopause. Because of the changes in the vaginas pH, bacteria, yeast, and other organisms can grow and thrive more easily. These issues can lead to pain and discomfort, among other symptoms.

Urinary function issues are common in people with vaginal atrophy, too. This includes urinary tract infections (UTIs) and bladder infections. These conditions cause pain and discomfort.

Vaginal pain after menopause is often easily treated. Your doctor will want to pinpoint the underlying cause of any pain or discomfort. This will help ensure youre receiving the proper treatment. Some of these treatments include:

Hormonal changes arent the only reason for vaginal pain after menopause. The following issues may also cause vaginal pain and discomfort:

You dont have to live with vaginal pain after menopause. Lower estrogen levels do cause many changes to the body, including vaginal pain and discomfort. However, most of the underlying causes of this pain can be treated and corrected with your doctors help.

Pain during sex after menopause is a common issue. Many of the other issues that can cause vaginal pain after menopause are common, too. Despite that, many people simply do not talk about it with their doctors or clinicians.

It may be a fear of embarrassment. It could also be simply not knowing how to bring up the topic. But if you dont discuss this issue, you wont have the opportunity to get help and treatment.

After menopause, vaginal pain is typically the result of changes to the vagina caused by low estrogen levels. Less estrogen in the body leads to thinner, drier, and less elastic vaginal tissues. Penetrative sex may be more painful as a result of these changes, especially if you do not use lubrication.

Typically, vaginal pain after menopause is easily treatable. Over-the-counter lubrication or moisturizers can help during sex. Sometimes, people need a prescription from their doctor for estrogen supplements or creams. These treatments can help boost your estrogen levels and restore the vaginas natural moisture and flexibility.

If youre experiencing vaginal pain after menopause, talk with your doctor, who will be able to help you find the right treatment.

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Menopause and Vaginal Pain: Causes and Treatment - Healthline

Ten percent of women in the United States between the ages of 15 and 49 currently use some form of long-acting reversible contraception, a category that includes intrauterine devices, or IUDs.

Research has found the vast majority of people with IUDs are satisfied with their contraceptive method, but some women find the insertion process much more painful than they expected.

It was, I would say, the most painful thing Ive ever had done, said Amy Halldin, 40, who had an IUD inserted last week. I broke out into a sweat. I threw up.

She is not alone. In recent months, many women and some womens health care providers have used social media platforms like TikTok to draw attention to the broad range of patients experiences during IUD placement and to advocate for better pain management options.

IUDs have also made headlines recently as the leak of a draft Supreme Court opinion on Roe v. Wade has raised questions about whether states might be able to increase their regulation of contraceptives.

In light of the attention on IUDs right now, The New York Times spoke to several obstetrician-gynecologists about how women who are considering an IUD can prepare themselves beforehand.

An IUD is a type of long-acting, reversible contraceptive. The small, T-shaped device is placed in the uterus and left in place to prevent pregnancy for between three and 12 years, depending on the type. It is one of the more effective forms of birth control available, in part because it decreases opportunities for human error unlike, for instance, the birth control pill, which must be taken daily.

IUDs are really safe and theyre highly effective, said Dr. Sarita Sonalkar, an assistant professor of obstetrics and gynecology at the Perelman School of Medicine at the University of Pennsylvania. There are both hormonal and non-hormonal types, because people want different types of options in pregnancy prevention.

Hormonal IUDs (Mirena, Kyleena, Liletta and Skyla are the brands available in the United States) use the hormone progestin to prevent pregnancy, and work by thickening mucus in the cervix to keep sperm from reaching an egg. They can also suppress ovulation. The copper IUD (Paragard), which does not rely on hormones, is wrapped with a small piece of copper that is toxic to both sperm and eggs.

Research also shows that IUDs can be an effective form of emergency contraception if the device is placed within five days of unprotected sex.

To insert an IUD, a health care provider which might be an OB-GYN, a midwife, a nurse practitioner or another practitioner trained to do the procedure puts a speculum into the vagina, then uses a special insertion tube to pass the IUD through the opening of the cervix and into the uterus. This process typically takes a few minutes.

Some pain is expected. Most women tolerate insertion very well, although it can be associated with moderate cramping, so taking either Ibuprofen or Tylenol within the hour before insertion can certainly help, said Dr. Margaret Boozer, associate professor in the department of obstetrics and gynecology at the Heersink School of Medicine at the University of Alabama at Birmingham.

Women considering an IUD should have an in-depth conversation with a trusted health care provider about the basics, including potential benefits and side effects, as well as their personal history and family-planning goals.

But it is also important to have a conversation about the procedure itself.

An IUD insertion can be painful for some people, but there are interventions, Dr. Sonalkar said. I think its really important to know providers can offer local numbing medication at the time of insertion. And that has been shown to significantly decrease pain at the time of insertion.

Ask your provider what pain management options they offer. There is no way to predict with certainty what your personal experience will be, but there are factors health care providers can use to make an educated guess. For example, Dr. Maria Rodriguez, an associate professor of obstetrics and gynecology at the Oregon Health and Science University School of Medicine, said she generally asks her patients what their monthly periods are like and how they cope with strong menstrual cramps.

She also considers whether they have given birth vaginally before. Some providers believe IUD insertions are easier and less painful among women who have, because their cervix has been dilated. Some providers prescribe a medication taken orally before an IUD placement, which can help dilate the cervix, but research looking at its safety and efficacy has been mixed.

Women who are nervous about the procedure or who have a history of trauma may be particularly good candidates for pain relief options that go beyond taking an over-the-counter medication ahead of time.

For women whove had a history of trauma, I like to talk to them about what they need to feel comfortable and safe while Im doing any kind of exam, and that would include an IUD placement, Dr. Rodriguez said. She added that it is important for women to know they can always ask their providers to stop.

Dr. Jonas Swartz, an assistant professor of obstetrics and gynecology with the Duke University of School of Medicine in North Carolina, said he will sometimes offer patients who are really anxious about IUD placement oral medicine that can help with anxiety, but only if they have someone who can drive them to and from the appointment.

We also see patients who really are uncomfortable with the idea, or the pain, or who have a history of trauma and really dont want a clinic procedure. We can offer them a procedure either with moderate sedation or in the operating room where theyre asleep, he added.

There isnt a magic number of IUD placements a health care professional must perform before they become particularly skilled or sensitive. But Dr. Rodriguez said women should feel empowered to ask their providers if it is something they do regularly.

In my experience, if you see a provider who has placed a lot of IUDs, it tends to go quicker and more smoothly, she said.

It may be useful to ask your provider about their availability for IUD removal. Research shows that the majority of women who get them are satisfied with their choice a year later, but they arent a good fit for everyone, Dr. Sonalkar said.

People have a lot of trouble these days making an appointment for any type of care, and if theres a point where they really dont like their method they feel its not the right one for them, or they want to become pregnant it is really frustrating if they cant have access to removal, she said. So I think thats an important thing to ask your provider.

Continued here:
IUD Insertion: What to Know and Expect - The New York Times

Endometriosis is a chronic condition that affects women of childbearing age and causes severe pelvic pain, painful sexual intercourse, abdominal bloating and sometimes infertility. According to the World Health Organization, as estimated 190 million women worldwide live with endometriosis and comedian and actress Amy Schumer is one of them. The mother of one documented her health journey with the disease and shared that she had her appendix and uterus removed after struggling with endometriosis, a condition where the tissue that usually lines the uterus grows outside of it., for years. Schumer posted on Instagram, "I feel good. Finally. It's been a journey thanks for helping me get my strength back @seckinmd(endo) @jordanternermd (lipo)," she began. "Never thought i would do anything but talk to me after your uterus doesn't contract for 2.5 years and you turn 40. @paulvincent22 vickie Lee (acupuncture) my girl Nicole from the tox my friends and fam. Let's go!" Eat This, Not That! Health spoke with Dr. Tomi Mitchell, a Board-Certified Family Physician with Holistic Wellness Strategies who explained what to know about endometriosis and signs that indicate you could have it, As always, please consult with your physician for medical advice. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Mitchell says, "Endometriosis is a chronic and progressive condition that affects women of reproductive age. The main symptom of endometriosis is pelvic pain, ranging from mild to severe. Other symptoms include painful periods, pain during sex, and difficulty conceiving. Endometriosis occurs when the tissue lining the uterus (the endometrium) grows outside the uterus. This displaced tissue continues to act as it would inside the uterus, thickening and shedding each month in response to hormonal cues. However, because this tissue cannot exit the body, it becomes trapped, leading to inflammation and pain. Endometriosis most commonly affects the ovaries, fallopian tubes, and tissue lining the pelvis; however, it may also occur in other parts of the body in rare cases. There is no cure for endometriosis, but symptoms can be managed with medication or surgery," Dr. Mitchell emphasizes. "Some women also find relief from complementary and alternative therapies such as acupuncture or massage. If you think you may have endometriosis, talk to your doctor about your symptoms and treatment options."

According to Dr. Mitchell, "Endometriosis is a condition that can be difficult to diagnose due to its varied symptoms. Common symptoms include painful cramping, heavy bleeding during menstruation, and discomfort or pain during sex or bowel movements. To determine if a woman has endometriosis, her doctor will typically perform a pelvic exam to look for potential lesions and tissue growths in the reproductive organs. They may also order an ultrasound, CT scan, MRI scan, or laparoscopy to take a closer look at the reproductive organs. Once a woman has been diagnosed with endometriosis, several treatment options are available. Treatment may involve over-the-counter medications such as painkillers or hormonal medicines like birth control pills for mild cases. More severe cases of endometriosis require surgery to remove any tissue growths and lesions from the affected areas of the body. Additionally, lifestyle changes such as stopping smoking and maintaining a healthy weight can help alleviate some of the symptoms associated with this condition. Ultimately, by speaking with your doctor about your unique situation and taking all of your symptoms and treatment preferences into account, you can find the right approach for managing endometriosis and feeling better again."

"Endometriosis occurs when tissue that usually lines the inside of the uterus grows outside the uterus," says Dr. Mitchell. "This tissue can attach to the ovaries, fallopian tubes, or other parts of the pelvis. When this happens, it can cause inflammation, pain, and scarring. The exact cause of endometriosis is unknown, but there are several theories about what might contribute to the development of the condition. One theory suggests that some of the uterine linings back up through the Fallopian tubes and into the pelvis during menstruation. This tissue then implants itself on organs in the pelvis and begins to grow. Another theory suggests that endometrial cells may be present at birth and migrate to other parts of the body during puberty. There is also evidence that endometriosis may run in families. If you have endometriosis, you may be at higher risk of developing ovarian cancer or cancer of the uterus lining. However, most women with endometriosis do not develop cancer."

Dr. Mitchell explains, "Endometriosis is a condition that can affect fertility by causing tissue growth outside of the uterus. This tissue growth, also known as lesions or implants, can affect the ovaries and fallopian tubes, vital for fertility and carrying a pregnancy to term. In addition to these physical changes, endometriosis can also cause painful symptoms such as severe cramping and heavy bleeding. These disruptions in normal functioning make it difficult for the body to carry out essential biological processes that allow for conception and fetal development. Despite these challenges, however, treatment options are available that can help women suffering from endometriosis conceive successfully. For example, certain hormone-based medications or surgery may be able to help reduce or eliminate pain and restore normal functioning of the ovaries and Fallopian tubes. Ultimately, though fertility is sometimes affected by endometriosis, many treatment options are available that can help women with this condition achieve their goal of welcoming a healthy baby into their family."

"Endometriosis is a common condition that affects millions of women across the globe," Dr. Mitchell states. "However, despite its prevalence, many people know very little about this condition or how to treat it properly. That's why it's so crucial for people to learn more about endometriosis and what they can do to manage their symptoms and seek appropriate treatment if necessary. At its most basic level, Endometriosis occurs when tissue from the uterus lining grows in other parts of the body, such as the fallopian tubes, bladder, or even on other organs. The most apparent symptom of Endometriosis is painful menstruation, with some women also experiencing pelvic pain, heavy bleeding, painful intercourse, or difficulty conceiving. Fortunately, many treatments are available for managing these symptoms and reducing the flare-ups that characterize this condition. For example, medications such as NSAIDs can help to reduce pain, while hormonal therapies like birth control pills can help balance hormones to prevent endometrial tissue growth. Additionally, lifestyle changes like getting plenty of exercises and maintaining a healthy diet can also help manage Endometriosis and lessen its impact on one's life. With increased awareness and proper management strategies, women can live a more comfortable life."6254a4d1642c605c54bf1cab17d50f1e

"This is often the most common symptom of endometriosis," says Dr. Mitchell. "For women with endometriosis, pelvic pain is often one of the first signs of something wrong. This pain can manifest in several different ways, ranging from a dull ache to sharp cramps. In some cases, the pain may be so severe that it interferes with a woman's ability to work or walk. Pelvic pain is caused by the growth of endometrial tissue outside the uterus. This tissue can attach to the ovaries, fallopian tubes, or other organs in the pelvis. It responds to the hormonal changes of the menstrual cycle in the same way that the tissue lining the uterus does. This tissue builds up and breaks down every month, causing inflammation and pain. This pain is the only symptom of endometriosis for many women, but others may also experience heavy bleeding, pain during sex, or difficulty getting pregnant. If you are experiencing pelvic pain, it is essential to talk to your doctor to make a diagnosis and treatment can begin."

Dr. Michtell shares, "Endometriosis is a condition in which the tissue that usually lines the inside of the uterus, called endometrium, grows outside of the uterus. Since this tissue is shed each month during menstruation, wherever it exists out of the uterus will be subjected to this same shedding. This can result in severe pain and discomfort with sex, including burning sensations, pain during penetration, and overall tenderness in the pelvic area. Unfortunately, endometriosis is often misdiagnosed or overlooked as a cause of such pain. However, identifying and treating this condition early can prevent more severe complications from developing over time. For example, if you experience pain with sex and suspect that you may have endometriosis, it is essential to see your doctor for an evaluation. With proper diagnosis and treatment, patients can achieve relief from their symptoms and go on to enjoy healthy and satisfying sexual relationships."

According to Dr Mitchell, "Painful bowel movements or urination are the most common symptoms associated with endometriosis. This devastating condition occurs when tissue that usually grows inside the uterus instead starts to grow outside of it. As a result, these growths may exert pressure on surrounding organs, leading to discomfort and pain in the pelvic region. Symptoms like painful bowel movements and urinary frequency can thus be important indicators that one has endometriosis. Beyond this general association, however, the exact mechanisms that underlie these painful symptoms are still not fully understood. Some researchers have speculated that it might be related to changes in nerve signals originating from affected organs. Still, others believe that inflammation may be involved, as inflammation has been linked with pain sensation in other bodily areas. Whatever the cause, it is clear that painful bowel movements and urinary frequency should never be ignored and should always be discussed with a healthcare professional if they persist for more than a few days. Doing so may help serve as an early warning sign indicating that one's body is under stress due to this condition and perhaps more severe complications down the line. So remember: pain doesn't have to mean something serious, but only speaking up about it could help save your health!"

Dr. Mitchell explains, "Endometriosis is a chronic, often painful condition in which the tissue that usually lines the inside of the uterus grows outside of it. This displacement can cause the misplaced tissue to attach to organs in the pelvic region, including the ovaries, Fallopian tubes, and bowel. Endometriosis can cause fertility problems in several ways. One is by inhibiting ovulation or disrupting the Fallopian tubes' normal function. The misplaced tissue may also attach to the ovaries, causing them to twist or distort. This can lead to inflammation and scarring, which can interfere with fertility. In addition, endometriosis is often associated with an imbalance of hormones that can adversely affect fertility. Infertility is often one of the first signs of endometriosis for all these reasons. If you are struggling to conceive, it is essential to consult with your doctor to rule out this condition."

Dr. Mitchell says, "Heavy periods, or menorrhagia, are a common symptom of endometriosis. According to the Endometriosis Foundation of America, as many as 80 percent of women with endometriosis experience heavy bleeding during their period. While heavy periods can be a nuisance, they can also signify a more severe condition. For women with endometriosis, heavy bleeding can be caused by the buildup of tissue outside the uterus. This tissue can grow on the ovaries, fallopian tubes, and even the abdominal cavity lining. When this tissue sheds during menstruation, it can cause severe cramping and heavy bleeding.In some cases, the bleeding can be so heavy that it leads to anemia. If you are experiencing heavy periods, it is essential to talk to your doctor. Heavy bleeding can signify endometriosis, and early diagnosis and treatment are necessary for managing this condition."

Excerpt from:
Sure Signs You Have Endometriosis Like Amy Schumer Eat This Not That - Eat This, Not That

Back in 2017, Lady Gaga shared on Twitter she has fibromyalgia and "wished to raise awareness," for the debilitating condition. Since then she's rescheduled tours due to the severe nerve pain she suffers from fibromyalgia and revealed to Vogue, "I get so irritated with people who don't believe fibromyalgia is real," the singer said. "For me, and I think for many others, it's really a cyclone of anxiety, depression, PTSD, trauma, and panic disorder, all of which sends the nervous system into overdrive, and then you have nerve pain as a result." And she's not alone. According to the Centers for Disease Control and Prevention, fibromyalgia affects roughly four million American adultsan estimated 2 percent of the U.S. population and at times it can be hard to diagnose because its symptoms mimic other diseases. Fibromyalgia is a chronic condition that causes sleep problems and widespread pain throughout the body that can severely interrupt a person's daily activities and lifestyle and Eat This, Not That! Health spoke with experts who explained what to know about it and signs that indicate you could have it. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Jacob Hascalovici, the Chief Medical Officer with Clearing, a telehealth platform for chronic pain patients says, "Some people who develop fibromyalgia may have experienced a physically or emotionally traumatic event. For others, fibromyalgia may appear without any discernible 'trigger' event. Previous infections appear to increase the risk of developing fibromyalgia, and the risk may also be higher when the body becomes very sensitized to pain and to having to deal with pain triggers and memories of pain."

Board certified internist Dr. Jacob Teitelbaum, MD, bestselling author of From Fatigued to Fantastic! says, "CFS, and it's painful cousin fibromyalgia (CFS/FMS), represent an energy crisis that trips a key circuit breaker in the brain called the hypothalamus. This controls sleep, hormones, and autonomic function, so the circuit breaker going off-line causes widespread dysfunction and is often crippling. Anything that causes people to spend more energy than they can make (including viral and other infections, including COVID) can trip the hypothalamic circuit breaker and trigger CFS/FMS."

Dr. Andrew Neville, ND, one of the top experts in fibromyalgia and Adrenal Fatigue explains, "Ultimately, it's a dysfunction of the Stress Response System, and it starts in the adrenals. Cortisol, your main stress hormone, serves as your body's primary anti-inflammatory function. Your adrenal glands produce that cortisol. If the adrenals are taxed, and you cannot produce adequate anti-inflammatory cortisol, you will be overly inflamed. Inflammation causes pain. Chronic inflammation also acts as an additional biochemical stress, which perpetuates the entire body's dysfunction and causes it to over-perceive its environment. This is called 'Central Sensitization.' If this continues to occur over time, it develops into chronic pain and/or chronic fatigue for others. This is often diagnosed as Fibromyalgia."

Megan Anderson, APN Nurse Practitioner at The California Center for Functional Medicine says, "A lot of newer research has shown that many of the symptoms in fibromyalgia syndrome (FMS) are caused by antibodies that increase the activity of pain-sensing nerves throughout the body. The results show that fibromyalgia is a disease of the immune system, rather than the currently held view that it originates in the brain. One study published in the Journal of Clinical Investigation, demonstrated that the increased pain sensitivity, muscle weakness, reduced movement, and reduced number of small nerve-fibers in the skin that are typical of FMS, are all a consequence of patient antibodies. From a functional medicine lens, we tend to view it as a syndrome that falls somewhere along the autoimmune spectrum and likely has multiple triggers, and therefore multiple ways to potentially address it."

"Fibromyalgia is characterized by widespread musculoskeletal pain, so you might have fibromyalgia if you're suffering from widespread muscular pain," says Dr. Hascalovici.

Dr. Teitelbaum says, "Most of you have likely noticed that after a workout, when energy levels in the muscles are low, your muscles go tight rather than loose and limp. This is because it takes more energy to relax a muscle than to contract it. The energy crisis in fibromyalgia causes chronic muscle shortening and secondary widespread pain. When the muscle pain becomes long-term, it triggers secondary brain pain (called central sensitization and nerve pain."

Gita Castallian, MPH Public Health Analyst at The California Center for Functional Medicine states, "The main sign of fibromyalgia is pain and tenderness in muscles and joints throughout the body, often ranging and roaming over time. This is an indicator of fibromyalgia when the pain lasts for three months or longer and typically becomes chronic. It is often described as a constant, dull and widespread ache and often worsens after too much activity, poor sleep, not enough exercise, stress and weather changes. Some people with fibromyalgia describe the pain as stabbing, shooting, throbbing or aching."

Dr. Hascalovici shares, "You may have fibromyalgia if the pain makes it difficult to concentrate. This symptom is known as 'fibro-fog.'"

Dr. Teitelbaum adds, "Difficulty with short-term memory and word finding and substitution can be quite severe. This has been labeled the brain fog, and is caused by numerous factors. These include inadequate energy in the brain cells, decreased blood flow to the parts of the brain responsible for speech (temporal lobe), chronic infections because of the immune dysfunction CFS and fibromyalgia (people have experienced brain fog when they have the flu), and numerous other contributing factors."

Castallian says, "Brain fog, sometimes called 'fibrofog' in this context, is common for people with fibromyalgia, making it hard to focus and concentrate on mental tasks, a lack of mental clarity and affects memory. They particularly have issues with memory when dealing with complex tasks while multitasking or having divided attention. One study showed that fibromyalgia patients have memory impairments mimicking about 20 years of aging. Since there are many causes for brain fog, it is important to rule out other causes (like B12 deficiency or iron-deficiency anemia) before pinning it on fibromyalgia."

Dr. Teitelbaum says, "Normally with severe fatigue, people can sleep all weekend. But because the hypothalamic circuit breaker which controls sleep malfunctions in CFS/FMS, severe insomnia accompanies the fatigue. When both of these are present for over three months, I would presume a CFS/FMS -related process is present until proven otherwise. Even if other conditions are present."

Castallian adds, "A common sign of fibromyalgia is waking up tired, even after a full night's sleep. There is often severe and chronic fatigue. Other sleep issues are also associated with fibromyalgia, including restless leg syndrome, insomnia and sleep apnea. Additionally, because lack of sleep can decrease your ability to process pain, insomnia and other sleep issues can aggravate and intensify fibromyalgia symptoms. Therapies that are targeted toward managing the pain can help with sleep and vice versa working to improve sleep can help to make the pain more manageable. Chronic pain can be exhausting in many ways."

"Pain from fibromyalgia may shift locations or have an erratic pattern, so it could be affecting different areas of your body at different times," states Dr. Hascalovici.

Dr. Neville states, "With an unregulated nervous system and a trigger-happy limbic system, sensory nerves connected to smell are always on high alert."6254a4d1642c605c54bf1cab17d50f1e

"Stress tolerance bottoms out with fibromyalgia, making even simple decision-making stressful and sometimes even impossible," says Dr. Neville.

According to Dr. Neville, "The heightening of senses that results from Fibromyalgia tends to put patients on high-alert. The slamming of a door may feel like an earthquake. The phone ringing makes the heart race."

According to Dr. Hascalovici. "Fibromyalgia can cause widespread and often disruptive pain throughout the body, often in your muscles and soft tissues. Difficulty sleeping, pronounced fatigue, and memory issues like trouble concentrating frequently characterize fibromyalgia as well. It's not uncommon for people with a challenging or traumatic background to develop fibromyalgia, and the condition is often also accompanied by depression, anxiety, TMJ, and IBS."

Dr. Teitelbaum says, "Although some people are able to continue working, they are usually able to do little else. More severe cases often leave the person crippled and even bedbound."

Castallian explains, "Fibromyalgia is a complex, chronic and painful syndrome affecting the musculoskeletal system that can result in widespread pain throughout the body, extreme fatigue, brain fog, sleep disorders and other physical and cognitive issues. These symptoms can be debilitating, keeping some with FMS from maintaining their ability to work or do normal daily functions of life. Additionally, it is considered an invisible illness because it is not readily visible from the outside. It is not easily recognized that someone may be suffering or in pain just by looking at them. Because of this, there is an added layer of stress to the impact that fibromyalgia already has on the quality of day to day life. Invisible illnesses often do not receive the empathy or credibility that readily visible illnesses do, often fueled by doubt, denial, stigma and feelings of isolation. Additionally, because the symptoms of fibromyalgia are common in many other conditions, receiving an accurate diagnosis can be a challenging and frustrating process, taking many years of searching for answers for most people with this chronic illness."

Dr. Neville explains, "There are many ways a chronically active stress response, such as occurs in Adrenal Fatigue, can cause pain. The main stress hormone, cortisol, is also our main anti-inflammatory molecule in the body. When this hormone is out of balance, a variety of inflammatoryhence painfulphysiologic conditions can arise. Excess cortisol and adrenaline also "hyper-sensitize" peripheral nerves, which basically turns up the volume on the nervous system, creating a situation where patients 'feel' all bodily sensations at a higher level. This is a process called introception. Last but certainly not least, the excess stress hormone 'sensitizes' the brain, including the limbic system (the CEO of the stress response system). This phenomenon is called Central Sensitization. This also occurs in the sensory nerves, so that many of my patients with Adrenal Fatigue are also overly sensitive to bright lights, loud sounds, and harsh chemicals and smells. Even touch sensation has its volume cranked up; someone could simply touch one of my patients, and the patient's brain registers that as pain. We know from functional MRI studies that the PTSD notably originates in the amygdala, which is part of one's limbic system. As I mentioned earlier, the limbic system is the CEO of the stress response system.

As we only have one stress response system dealing with any and all stress, I compare it to a bucket. All stress in our livespast and presentis in the bucket, including past trauma and abuse. It is well documented that past trauma and abuse of any kind predisposes someone to stress-related diseases in adulthood, such as anxiety, depression, insomnia, and even fibromyalgia and Chronic Fatigue Syndrome.

When we take this into context, Lady Gaga is absolutely correct in that her fibromyalgia was triggered by her PTSD. (The singer told TODAY she has PTSD from being sexually assulated by a producer when she was 19.)

Adrenal Fatigue, as well as fibromyalgia, can be effectively treated when we look at it in terms of an overactive stress response system. Comprehensive holistic treatment can desensitize the system, creating space in one's stress bucket so that the system becomes less and less trigger-happy. As that happens, we turn off the chronic stress responseor fight or flightwhich perpetuates chronic wear and tear in the body. During treatment, we're also turning on the healing and repair mechanisms in our bodies. As this occurs, the symptoms of an overactive stress response (such as fatigue, pain, anxiety, depression, and insomnia) gradually decrease over time in intensity, frequency, and duration, until they finally fade away completely."

Dr. Hascalovici states, "Fibromyalgia doesn't necessarily shorten your life expectancy. With treatment, you can maintain your mobility, manage your symptoms and practice healthy ways to change the way your body perceives pain. People with fibromyalgia can experience the best of what life has to offer, with the proper treatment and support. Having a strong support system is important and may be one of the biggest indicators of how successful your treatment could be. You can take control of your pain by educating yourself and by building a team of friends and medical professionals who can support you."

Dr. Neville says, "Fibromyalgia is medical jargon for chronic transient pain of unknown cause with no known effective treatment. Doctors recommend general health advice and pain killers. You'll have good days and bad, and you're told that you need to learn to live with it. After years of research and treating patients with fibromyalgia, and dealing with it myself, I've found that the cause of chronic pain is a dysfunction of your stress response system, commonly known as Adrenal Fatigue. Adrenal Fatigue can be properly treated, effectively ridding your body of fibromyalgia.,"

Dr. Teitelbaum reveals, "I had CFS/FMS myself back in 1975 which knocked me out of medical school and left me homeless for a year. I have dedicated the last 45 years to researching and teaching about effective treatments. Anything that triggers an energy crisis in the body can cause fibromyalgia. For example, about 11 30% of people with lupus, rheumatoid arthritis, and multiple sclerosis will have a secondary fibromyalgia."

Dr. Teitelbaum also shared his additional thoughts about fibromyalgia.

"Lady Gaga has been blessed with finding excellent physicians familiar with the illness, which is part (along with being so determined) of what allows her to continue. But as I mentioned, fibromyalgia occurs along a wide spectrum of severity. Some, like Lady Gaga, are among the "walking wounded" that are still able to function. Where others are house or bed bound. But having treated thousands of people with these conditions successfully, the vast majority of people can benefit with proper treatment and support. Often dramatically. The problem is that the treatments tend to be low cost (relative to patentable medications), and therefore nobody is teaching physicians about them. There are literally dozens of treatments that are very effective. Most fall under the SHINE acronym as discussed earlier. It is important to start by addressing sleep. This can be done with a host of natural and prescription therapies, usually in low-dose and in combination, until the person is getting their eight hours of sleep nightly.

Nutritional support is critical for optimizing energy. This begins by eliminating sugar and increasing salt and water intake. Then adding a high dose B complex vitamin along with magnesium 200 mg a day. Our published research has shown that Ribose 5 g 2 to 3 times a day, red ginseng, Ashwagandha, Rhodiola, and other herbal support can be very helpful as well.

If the person is getting hangry (irritable when hungry) then adrenal support is helpful. Cold intolerance and weight gain suggestive thyroid support may be needed despite normal testing. Worsening of fatigue and insomnia around the menses suggested bioidentical estrogen and progesterone may be needed. It is helpful to remember that the hypothalamic circuit breaker that goes off-line controls virtually the entire hormonal system. Resulting in hormonal deficiencies despite normal blood tests. There are countless other treatments that need to be considered, but the above gives a good start."

Read the original here:
Sure Signs You Have Fibromyalgia Like Lady Gaga Eat This Not That - Eat This, Not That

Eric Liu, MD, FACS, reviews treatment options, pitfalls of diagnoses, andthe importance of involving specialists and advocates early in neuroendocrine tumors.

Complex in their development, diagnosis, and treatment, neuroendocrine tumors (NETs) present a challenge to clinicians who may only see a few cases during their career. NETs are slow growing with a symptom burden that may be attributable to other disease states. Delayed diagnoses result in patients presenting with late-stage disease.

NETs are what I call an unusual disease, Eric Liu, MD, FACS, said in an interview with OncologyLive. NETs used to be considered quite rare [and] its one of those diseases where we do not receive that much education on it in medical school or in our training process. So, its kind of an unusual, unknown disease, but it affects a lot of [individuals]. Liu is surgical director of the Neuroendocrine Institute at Rocky Mountain Cancer Centers in Denver, Colorado.

As a community oncologist with a specialty in NETs, Liu highlighted the most important aspect of the disease: awareness. The neuroendocrine system is [one] that no one ever talks about. We talk about the respiratory tract and the digestive tract and the central nervous system and even the endocrine system. But the neuroendocrine system is more like what we call the diffuse endocrine system that controls a lot of things in the background. There are tiny little cells scattered all throughout the bodyin the lungs, through the digestive tract called neuroendocrine cells, and they can turn into cancers, he said.

In a discussion of the disease state, Liu reviewed treatment options chronic [disease]; some of my colleagues call it cancer in slow motion. (Figure1-4), pitfalls of diagnoses, and the importance of involving specialists and advocates early. NETs are a disease for which, luckily, we have many clinicians who are experts in and really specialize in them, he said. Unfortunately, it is not a well-known disease that [all practitioners] can take care of. I always encourage [colleagues], if they see this unusual diagnosis, to seek expert opinions.

The diagnosis of neuroendocrine cancer is very complicated, and the reason is because the symptoms can be extremely mild. Neuroendocrine cancers tend to be more of a chronic [disease]; some of my colleagues call it cancer in slow motion.

Because it can linger for a long time, the diagnosis can be tough to make [and] in lots of cases [individuals] have mild symptoms [including] abdominal pain, a little flushing here and there, maybe some diarrhea, and [they] come and go in some cases. For example, a patient will present with abdominal pain in the emergency department and an x-ray will look normal, and [a clinician] wont see [any sign of NETs]. This pain will come again [and] eventually, the patient may get a CT scan, and [receive a] diagnosis of NETs. [Other times], there are no symptoms at all, and the patient can present all out of the blue with sudden abdominal pain or NETs can even be found incidentally on a CT scan for another reason, or possibly even [during] an endoscopy or a colonoscopy.

It is a tough diagnosis to make. [Lets take an example of] a 50-year-old woman who presents with flushing, a very common symptom for NETs. If that is the situation, a gynecologist may present a diagnosis of menopause. [What if a] patient has persistent diarrhea? A gastroenterologist may prescribe a colonoscopy and results may not show anything but the symptom persists. The gastroenterologist may give a diagnosis of irritable bowel syndrome. You can see how these mild symptoms can very easily be misinterpreted, and the diagnosis of NETs is not made for a long time.

Unfortunately, the treatments for irritable bowel syndrome and menopause do not treat cancer and so as the symptoms persist, the disease persists. Thankfully, its a slow growing disease in general and individuals can live with it for a long time. It is a very challenging diagnostic dilemma. But once the diagnosis is made, thankfully there is a lot we can do to help patients.

Luckily, we do have good diagnostic techniques to [confirm NETs]. The easiest one is a CT scan, [which is] quick, standard, lots of [individuals] can get it, its not very expensive, and it provides a survey of the lungs, stomach, and pelvis. That is frequently how we make the diagnosis of NETs by seeing a mass either in the intestines, the pancreas, or the liver.

We also have different blood tests as well; however, they are not quite as good. Unfortunately, [because] NETs are slow growing, and individuals can have them for many years without any symptoms, [they] frequently [are] diagnosed very late, usually stage IV. Stage III [disease] tends to include spread to the local lymph nodes, but stage IV is when it spreads far, for example to the liver, bones, or lungs.

NETs typically start in the lungs, pancreas, or small intestine, which are the 3 most common points of origin [and] even though it has a reputation for being a very slow disease, it is aggressive in the way that it spreads. Neuroendocrine disease is not benign; it is a highly metastatic disease that can be life threatening.

We must consider comorbidities and age [at the time of diagnosis], which is usually 60 years, but can be seen in a patient who is age 40 or 50 years. Treatments can be quite varied and include medicines, surgery, special kinds of radiation, and different kinds of therapies for the liver. [We must] take into consideration the overall general health of the patient.

For example, if the patient has many comorbidities, such as diabetes, or a history of stroke, and they are elderly and very frail, maybe the treatment for the neuroendocrine disease needs to take a back seat to something else, because if a patient is going to die, for example due to a stroke or a heart attack, NETs may not be the most life-threatening aspect of their health. But if a patient is quite healthy, they dont smoke, and are doing well, my goal is always to keep the patient healthy. And our goal, as it should be for everything, is to heal the patient so that they can live a high quality of life. If I can help improve quality of life, thats always my No. 1 priority.

Despite neuroendocrine [disease] being a relatively unusual and rare, we have many different types of therapies. And the reason that I encourage patients to see specialists is because choosing the tools in the toolbox can be very challenging. We need to decide what is best for the patient and one tool clinicians forget is surveillance. Then we have other types of medicines, because neuroendocrine [cancer] is a hormonal disease, and one of the unusual things is that NETs may affect blood sugar [and] they may cause pain. And so, getting those hormones under control is very important.

But theres no question that up front one of the most powerful therapies that we have for neuroendocrine disease is surgery. If we can remove a lot of the bulk of the tumor, we can remove a fair amount of the hormone burden, which is not usually the case for other cancers.

However, a lot of the times the disease goes to the liver, and we can use embolization. Additionally, one of the most exciting therapies we have is called PRRT, or peptide receptor radionuclide therapy, which combines hormonal therapy with radiation that goes straight to the tumor and the radiation treatment [is delivered] from the inside out. Its very effective in helping to control the disease. It is not a cure, but it can help patients with symptoms and can help slow down the growth of their tumors.

I always say, have a buddy. Have a friend who specializes in neuroendocrine disease who you can talk to. I should stress that I am community physician, so I understand what it is to be out there working with patients in their community. Ive seen 2000 cases of NETs and Ive learned how vastly complicated the disease really is. What I always tell clinicians is, dont be shy, order all the tests, gather all the information up front so you can have all the correct data and can make the best decision.

One of the problems I see frequently as a specialist who receives referrals is that sometimes the patient did not have a complete workup. [In some cases] the clinicians jumped to [one type of] surgery, when in fact maybe you could have done a little better surgery if you had more information. Or in other cases, the wrong therapy was administered because the pathology was misinterpreted. There are lots of different ways that the devil is in the details.

I always encourage my colleagues across the United States [to see this as] a team effort. I am happy that the patient always has their [primary oncologist] at home because they get their treatments, shots, and their scans [locally] and they dont have to fly to Denver, Colorado to see me every single month; that would be ridiculous. If we can work together, and I can share some of my experience with you, we can come up with the best plan for the patient. That is always the best that we can do.

I dont know everything about brain cancer, bone cancer, or bladder cancer but I know a lot about neuroendocrine cancer. And so, I am happy to rely on my colleagues who really specialize in those other things.

There is one other thing I do want to share, neuroendocrine disease really isnt that rare, and there is a lot we can do to help patients. Unfortunately, the information is not readily and easily available, which means that individuals need to advocate for themselveseither the patient needs to advocate, or the physician needs to advocateget the right tests, seek second opinions, dont worry about having to travel because you might have to do that.

Luckily, if anything has come from the COVID-19 pandemic, it is that we do a lot more telemedicine now. Reach out and see [whether] some of the experts in the United States would be willing to see you through telemedicine and review your case. A lot of the time, a physician at home can conduct the physical exam and with the advanced scans that we have, I can see right into their bodies. So, most of the time, they just need me to think about the case.

Think about getting a second opinion, think about working with a specialist, make sure you get a comfortable team around you. If they say something is impossible, that might not always be true.

See more here:
Unmasking NETs Requires a Multifaceted Approach to Care - OncLive

Emergency contraception methods, like Plan B, help prevent pregnancy up to five days after having unprotected sex. (Photo: Getty Images)

Although emergency contraception has been around for years the FDA approved it as a prescription pill in 1998, followed by an over-the-counter option in 2006 there are still some people who either dont understand how it works or confuse it with abortion pills. But they are not the same thing.

Emergency contraceptive pills prevent pregnancy up to five days after having unprotected sex, according to Planned Parenthood. They do not induce abortion, Dr. Emily Godfrey, associate professor of ob-gyn at the University of Washington Medical Center, tells Yahoo Life, adding that if youre already pregnant, it does not harm a pregnancy if you use it.

Heres what you need to know about emergency contraception.

Dr. Melissa Myo, clinical instructor of obstetrics and gynecology with the Keck School of Medicine of USC, tells Yahoo Life, In broad terms, emergency contraception refers to any method that can be used shortly after unprotected intercourse to prevent pregnancy.

The most commonly known method is in pill form, of which there are two types on the market.

The first type contains levonorgestrel, such as over-the-counter Plan B One-Step, My Way, Take Action and generic versions. Levonorgestrel is a type of progestin thats found in other oral contraceptive pills, but for emergency contraception its at a higher, one-time dose to delay ovulation, explains Myo.

The second type contains ulipristal acetate and is sold under the brand name Ella, which requires a prescription, and it also comes in generic form. Ella acts on progestin receptors and also inhibits ovulation, says Myo.

Essentially, both pills work by delaying the presence of an egg, explains Myo, so that a sperm cant find one and fertilize it.

Both types of pills can be taken up to five days after having unprotected sex to prevent pregnancy. But Planned Parenthood notes that they work much better if you take them during the first three days.

Story continues

But pills arent the only form of emergency contraception. Theres another type that people sometimes do not know about, says Myo and thats a copper IUD. She explains that copper IUDs, which are inserted by a health care practitioner, primarily work by interfering with sperm function and can be a good option for someone who is interested in not only preventing this pregnancy but also in starting a longer term contraceptive method.

Experts recommend that the copper IUD be inserted within five days of unprotected intercourse, but is found effective up to 10 days in some studies, points out Myo.

Theres also a hormonal type of IUD with the same levonorgestrel hormone as Plan B, which was recently found to be just as effective as the copper IUD for the purposes of emergency contraception when placed within five days after intercourse, she says.

According to the World Health Organization (WHO), when a copper IUD is inserted within five days of unprotected sex, its more than 99% effective in preventing pregnancy.

Emergency contraceptive pills can prevent up to over 95% of pregnancies if taken within five days of unprotected sex, according to WHO.

Weight appears to be a factor, though, when it comes to the effectiveness of emergency contraceptive pills. According to Planned Parenthood, emergency contraceptives that contain levonorgestrel may not work well in people who weigh 155 pounds or more in that case, prescription Ella would be a better option.

However, Planned Parenthood says that Ella may not work in people weighing 195 pounds or more. IUDs, on the other hand, work regardless of a persons weight.

Godfrey says that, when it comes to emergency contraception, the best and most effective type is an IUD. Its been proven over and over again that it will absolutely prevent an unplanned pregnancy, she says.

According to Cleveland Clinic, the copper IUD is the most effective of all, working 99% of the time, no matter your weight. Thats followed by the prescription pill Ella, which Cleveland Clinic states is more effective than over-the-counter methods because it works closer to the time of ovulation.

However, over-the-counter emergency contraceptive pills have an advantage since theyre easier for most people to access (and have no age restrictions), while Ella and IUDs require getting an appointment to see a health care practitioner.

Above all, the best method to use is the most effective method you have available, notes Cleveland Clinic.

Common side effects that people might experience include headache and nausea. Some people experience changes to their menstrual bleeding during that month, and most changes resolve without any other treatment, says Myo, who points out that no serious complications have been linked to the use of emergency contraceptive pills in scientific research.

Also, because emergency contraceptive pills are taken as a one-time dose, even people who have medical issues that might prevent them from being able to safely take oral contraceptive pills long-term can take emergency contraceptive pills, she says. But its always smart to check with your health care provider first.

Experts, like Myo, say that its incredibly important to have access not only to emergency contraception, but also to all forms of contraception. No one form of contraception is perfect for everyone, and every individual has their own goals for their life and their wishes for how they live in their body, Myo says.

This is particularly important as reproductive rights are being restricted in certain parts of the country. The threat of reducing or eliminating contraception is a direct threat to peoples abilities to live the life they want, says Myo. The logic espoused by Justice Alito in the [Supreme Court] draft opinion also hints at future attempts to restricting our access to contraception. In clinical practice, we often will ask our patients their reproductive goals: Do you plan to be pregnant in the next year? When do you plan to be pregnant? How many children, if any, would you want in your lifetime? These questions help us tailor our recommendations for contraceptive methods that will hopefully help our patients reach their goals.

In light of the threats to Roe v. Wade, Myo says that its now more important than ever to discuss issues such as contraception, including emergency contraception, with your doctor. You can fill a prescription or purchase pill-form emergency contraceptives, she says. You can ask your doctor for a prescription of a years worth of oral contraceptive pills so that you dont risk missing doses.

But, Myo adds, even with all the preparations, all methods have risk of failure, and it is not a replacement for access to safe abortion. Even if contraception remains available to us, we will still have to continue to push for abortion access for everyone.

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What is emergency contraception and how does it work? Experts explain. - Yahoo Life

By Dr. Amy Tan, M.D.

"Justice demands integrity. It's to have a moral universenot only know what is right or wrong but to put things in perspective, weigh things. Justice is different from violence and retribution; it requires complex accounting."

- bell hooks

Two toxic workplaces, almost a decade apart. Same person affecteda racialized woman physician but at different stages of her career. Two different provinces, two different institutions, two different chains of command, two different policies and procedures to navigate. Two different decisions about whether to submit a formal complaint for gendered racism (and ageism) for harmful behaviourby different white male physicians. Two different decisions and experiences once initial informal complaints made. Same outcome: no justice, no acknowledgement of the harm endured, no accountability. While I may have made the decisions to leave both of these workplaces, they were not actual choices I had due to the great harm that I endured. I still suffer from the trauma, and physical and psychological ramifications of ongoing injustice that I endured in both of these workplaces. My family has also endured the effects alongside me.

The most recent ordeal dragged on over the last 12 months until I excised myself from the horrendously toxic situation. As Im left picking up the pieces again, doing everything I can to bring down my blood pressure and stress hormone levels, and healing from what was a traumatizing formal complaint process, I cant help but ask, if I truly feel that both experiences have left me with the same outcome of feeling unheard, unseen, unacknowledged, and without justice with regards to my harmful experiences in the workplace with other physicians, then what real options do racialized (Black, Indigenous, Asian, and other Persons of Colour) women and nonbinary persons in medicine have when disrespect, gendered racism and other mistreatment occurs in the workplace? My two complaints were specific to certain male physicians and incidences that crossed the line for me. There have beencountlesscovert and overt racist aggressions Ive endured over the 23 years of training and my career in medicine. I could fill pages with stories of unwanted touching, or of being told to my face that I was a diversity hire, that Asians dont experience racism, so be quiet, that my English is so good, and that my people are responsible for the pandemic because of our disgusting eating habits by colleagues and patients. I have been mistaken innumerable times by patients and staff members to be a member of the housekeeping or food services staff in to collect dinner trays over my entire career. I know that Im not alone in suffering persistent racism throughout my years in medicine. A survey of physicians in Alberta (one of the provinces Ive trained and worked in for many years) that was published last month, showed thatover 75% of cisgender BIPOC women physicians surveyedhad experienced harassment and discrimination. 74% of the small number of physicians who reported such workplace harassment and discrimination were unsatisfied with the outcome due to retaliation or lack of satisfactory outcome. While I didnt complete this survey, these statistics completely resonate with my experiences. Theovertly violent and racist commentspublished in the report by white physicians, our colleagues, shows beyond any possible shadow of a doubt, the truly toxic and racist culture that people like me must endure in our careers.

With over50% of Canadian physiciansreporting burnout two years into the pandemic, I am stating clearly that without addressing the rampant racism experienced by Black, Indigenous, and racialized physicians (most especially women and nonbinary), along with all healthcare workers and patients, there will be no improved wellness for us.Wellness is more than the burnoutthat racialized women and nonbinary physicians are at increased risk for; it includesunderstanding and addressingthe fact that there arephysiological impacts on racialized physicians healthfrom being subjected to ongoing racial injustice in the healthcare system.

****************************************************

The first time I tried to put in a formal complaint for two white male physicians, who I will call Jeff and Bob, I was told by the Department Chair that I should be warned of how hard a formal complaint process would be for me and my young family. Is this really what you want or need right now, Amy? You know it will simply become a he said, she said situation.

When I pushed back that I had a paper trail for Jeffs years-long mistreatment of me, and that the egregious way in which Bob treated me was witnessed by several other department members, the Chair responded, No, thats not how it works. Then he went on to say, Amy, you have to understand that they feel threatened by you. They see you as a young whippersnapper, 20-30 years younger than them and you make them look bad with how productive you are. What was alluded to in that conversation was that as anAsian woman leader, I was just expected to work so hard but not do it in a way that threatened anyone else. I wasnt to make any waves. I was to just do the work demanded of me and be quiet. I was supposed to know there was an unspoken societal agreement in that my age, identity and productivity would be seen by others as tacit justification of their bullying of me. The Chair would not support my request for a formal complaint; he would sit it out if it came to that.

I resigned and left that position six months after that conversation. I gave up my hard-earned tenure achieved at age 35 at that university after years of enduring this toxicity upheld by so many complicit colleagues, and for which there was no end in sight. It took me several years to process, unpack and undo the belief that I was the problem, as they had made me feel. Truthfully, it wasnt until Jeff had a very public run-in with the law that exposed his true lack of a moral compass, could I even start to believe that maybe I wasnt at fault for having to leave that institution.

Fast forward several years and another leadership position in another province within another institution. My past experiences had taught me a tremendous amount, and put me on the alert for any disrespect. In feminist scholarSara Ahmeds book,Complaint!,she writes, You cant go back to the person you were before the complaint, you cant unsee what you come to see through complaintbeing able to see what is going on, to see more, is also to see what you did not see before (Pg 29). In addition to not being able to unsee gendered racism and disrespect, I now had even more years of experience and expertise under my belt. I was not going to tolerate ongoing gendered racist undermining of my work and leadership 17 years into my career. As part of my ongoing anti-racist and anti-oppressive praxis, I actively call out power differentials and the elephants in the room when I perceive conflict and tensions between groups that must work together in an effort to actively address them and find workable solutions. At this new workplace, I was told at first that they appreciated my ability to call out power dynamics that were affecting working relationships and people's work (which was ultimately the care of patients and families). But they became more resistant to address these concerns as I kept bringing it up. It only took six months of subtle othering and subversion as the only racialized physician (and leader) in this group for a more overt gendered racist attack to occur that challenged my leadership in a public manner. Lets call this white male physician, Bill. It was immediately apparent as the only racialized physician in this group, that no one understood the gendered racist impact Bills comments had had on me, or that I was being punished by him for not conforming to the racist stereotypes of the subservient Asian woman who is not to take a stand. The people who could have intervened on my behalf were immobilized by their own white fragility. When I expressed my harm that had been witnessed and unconfronted by the other white physicians, I got the Oh, Im sure he didnt mean that, and No, were not racist, were (colour-blind) nice physicians types of reactions, including from the leaders who would receive the complaint. I had no choice but to proceed with the formal complaint process against Bill to be seen and heard; this process was horrendous and traumatized me even more.

There were so many points in this formal process where I endured even more harm and that exacerbated the threat I felt in my workplace: a) the notion that both the complainant (me) and the respondent were seen as onequalfooting as colleagues, completely disregarding the societal power differential of a white male physician with that of an Asian woman physician, in a virtual face-to-face alternative dispute resolution attempt where he could be allowed to exert his power and privilege over me without any restraint, b) the stance of neutrality by the institution in adjudicating this complaint of gendered racist harm, and c) the eight months of silencing during the investigation that fostered the ostracizing of me in my workplace with the whispers of my being difficult and unwell by my other (white) colleagues, while all the benefit of the doubt was given to Bill. The worst part was that my complaint was only handled by various white people, none of whom had eitheranyunderstanding or lived expertise to understand racism. The institution used a colonial legal framework and lawyers to determine whether I was treated differently than a white man, which is missing the point entirely. In making my complaint, I was not seeking to be treated the same as a white man (equality not yet achieved in society); I was seeking to be heard and seen as an individual with an incredibly different lived experience for which my psychological safety isnever assurednot only in spaces of vast whiteness, but also within the colonial healthcare system and society in Canada. Recognition that I would havedifferentneeds for how to be treated is, in fact, theequityI was seeking as a person who has less societal and systemic power and privilege than my white colleagues. We have not yet achieved equality in society and must stop deluding ourselves that treating everyone the same is appropriate. I was morally injured and mentally exhausted throughout the complaint process. I have come to recognize that the entire complaint process itself, and subsequent ostracization I endured for putting in a complaint were an extension of the harassment for which I complained. This in it of itself is the goal of harassment: to tire out and inflict weariness through the repetition of trying experiences (Ahmed 2021).

So to answer my own question that I had at the outset of this piece, I can honestly saythat neither option was helpful to me as a racialized woman physician leader.Neither option gave me any validation, acknowledgement, or any accountability for bad behaviour. Both options caused further trauma and harm that has affected my well-being and that of my family over the years. My well-being is affected not only by the psychological ramifications and burnout I suffered through this mistreatment, but the physical effects that coping with oppression at work have due toincreased stress and inflammatory responses(Marya and Patel 2021). There has been absolutelynojustice for what I endured.

The sad truth is that there arenogood choices to seek acknowledgement of harm, receive any accountability for harm, or have any systemic changes made that would make institutions less harmful for racialized women and nonbinary persons in healthcare to navigate. This is the despairing reality of the patriarchal, colonial, and racist medical culture in North America, and that of the Western world. I also live and work with disabilities due to ongoing neurological effects from surviving a near-death rollover motor vehicle collision that punctured my lung, broke several ribs, and crushed my backbone (vertebrae) in four places when I was a resident physician. I havent, however, even touched how the unwillingness of call groups to accommodate such disabilities in call schedules has resulted in even more oppression for me.

How is this acceptable?The ongoing pervasive nature of systemic racism means that the medical profession is not adequately supporting racialized women and nonbinary persons within the profession. This also elucidates that if colleagueswithinthe medical profession are subjected to ongoing racism, the racist harm that our profession causes the patients and families we serve to suffer is immense. The racialized physicians who are harmed within the profession are arguably those who would be most acutely aware of the need for cultural safety for patients and families. But, if we are not supported and holistically healthy as professionals, how can we work to ensure safety for our patients in a sustainable manner?

Another quote from the book,Complaint!, resonates with me, What I learned about institutions froma complaint led me to leave; at the time it did not feel like a choice but like what I had to do. If complaints are more likely to be received well when they are made by those with more power (Ahmed 2021 Pg 38), then how do we compel complaint systems (both informal and formal) to rectify this ongoing power imbalance that only serves to further harm racialized women/nonbinary people, and others from intersectional oppressed backgrounds who have the courage to make a complaint?

We must overhaul the colonial complaint system to better support and protect racialized women/nonbinary people in medicine. Physician wellness will be the most critical priority we have going forward as we continue through this pandemic to a post-pandemic recovery of the physician workforce for years to come. For racialized women and nonbinary physicians, addressing gendered racism in medicine will bethewellness issue that must be tackled if theres any hope to curb the burnout amongst us. We must have systems workforthose with less societal and institutional power by virtue of their social location and oppression. The system must workforthose who must fight daily to be seen, heard, and respected. We do not have the privilege of having existed as a white male in society who has always been afforded the benefit of the doubt. We continue in our careers to be denied the same privileges bestowed to white male physicians and to some degree, white women physicians, in our profession. We must acknowledge this hard truth. While white male physicians have been emboldened to take up space by being praised and rewarded for it, racialized women physicians are punished for daring to take up space, even when they have the expertise and job title with responsibilities that requires speaking up and making decisions. We must acknowledge that medicine is not immune to the systemic systems of oppression pervasive in society. To better support racialized women and nonbinary physicians, we must have a safe and effective accountability system to submit complaints that has the principles of equity as its foundation.

The systemmuststart out withbelieving victimsand those with intersectional identities that are oppressed who have the courage to submit a complaint about racism or oppression. The system currently treats the person who has been oppressively harmed and dares to file a complaint (to try to seek help), as the wrongdoer. Any complaint about racism (and/or any other oppressive harm) must be immediately directed to a specific pathway where only racialized people and actual experts in anti-racism and anti-oppression deal with the complaint. The people tasked with managing racism complaintsmust havelived expertise on having to navigate the world with racism on an ongoing basis.

Every complaint must have a power and privilege and power differential analysis at the outset. As Archbishop Desmond Tutu has said, the system cannot be neutral in the face of oppressive harm complaints.There is no neutral.The inordinate amount of effort in protecting the innocence until proven guilty and confidentiality of the (white)respondent of a racism complaint (who already is afforded the benefit of the doubt over the racialized complainant, societally) means continued harm to the complainant through the inequity in the colonial processes and policies. Clear boundaries and safety measures must be immediately put in place for the complainant, and monitored. While I had called the Canadian Medical Protective Association (CMPA) for legal advice on how to navigate this complaint process, I was informed, to my incredulity, that they were not positioned to advise or support me, as the complainant, despite being a physician member who pays my medical-legal protection dues as required to practice. The respondent, however, would have been supported by the CMPA in this complaint. Talk about the system upholding systemic racism, power and privilege within the profession.

Existing in this society with its dehumanizing messages about racialized and Indigenous people creates internalized racism within racialized people that take decades to unpack, understand and actively resist. The fact that a racialized person would have concluded that making a complaint was required would have only resulted after much internal torture, self-gaslighting, and introspection. We would have already tried to obtain informal help because we know that the system is not set up to protect and support us. In my two cases where I needed to proceed with complaints, I had sought help repeatedly from people who had the power and jurisdiction within the institution to help me. I had had several informal complaint meetings with my Chair, and his predecessor, regarding Jeff over six years to no avail. This was despite having a thick file full of documentation of the various incidents over the years and many belligerent emails from him. One very high level white male superior advised me that I just had to put more effort into making nice with them (in a patriarchal, condescending tone akin to being patted on the head), but that I was just to carry on as I was supported by leadership in my work. Another white male superior said that I just had to get some white hair, some wrinkles, and not look like I was twelve to command respect. No one in a position of power to help me deal with these bullies was willing to step in because they didnt want to upset the faculty members who had been at the institution for such a long time. In the situation regarding Bill, as detailed earlier, I was met with white fragility byeveryonedirectly involved who could have used their white privilege to help me. Be it the silence, staying out of it, remaining neutral, protecting oneself, outright dismissal of the impact on me, not seeing the racism, or defending Bill, these were all forms of furthercovert racisminflicted on me by these colleagues. While two people within the physician group acknowledged in private that they could see that I had been attacked by Bill, when it came to actually putting their privilege on the line to speak up for me, they choose not to. They actively chose, instead, to harm me further by upholding the status quo at a critical time. It is near impossible to recover from such disappointment and betrayal from your colleagues.

Oppressive harm requiresrestorative justiceto occur so that there is acknowledgement that violation of a person (and relationship) has occurred, not a violation of a law. Restorative justice focuses on healing of the individual harmed while requiring accountability from the respondent that also includes their own personal learning and growth. This process involves receiving an acknowledgement of harmful impact (regardless of intention), accountability for future incidents, and sending a clear message that lashing out at people in a gendered racist way is never acceptable, but especially in a workplace. The complaint process for racist and/or oppressive harm should be focused on the institution recognizing the complainants pain as ahuman being,not shielding those who cause harm and are already protected by the status quo of society and the institution. The person harmed should not be the person tasked with teaching everyone in the complaint process about racism and oppression, including racist gendered stereotypes, as I had to do ongoing over months to the several people who (mis)handled my complaint. This included, ironically, having to explain how covert racism exists to the third party white lawyers hired to investigate whether gendered racism had occurred. Leaders ateverylevel in medicine must be competent to not only support those on their teams who have been harmed, but more importantly, to not further perpetuate harm through their defensive responses.

Complaints about racism and other intersectional oppressive harm must be acted upon as urgent, and concluded quicklywithin 8 to 12 weeks. At the conclusion of the complaint process, there must be a wrap-up meeting that not only discusses actions or outcomes, but determines what ongoing needs, changes and system feedback is required to help complainants who have experienced oppressive harm going forward. Institutions must understand that regardless of a complaint investigation being concluded, the complainant will be forever changed for having gone through the original harmful event, and the complaint process that dehumanizes them.

I resigned from my position last fall before the conclusion of the investigation for my complaint. That was how untenable my situation became over the eight months of the complaint process. The last straw was receiving yet another harmful email. After several requests that I not be present in regular administrative meetings with the respondent of my complaint, I was told that it had been decided that I was to meet with the whole physician group, or none of the group. This email was from a white woman physician colleague who had heard through my tears and anguish in the preceding months, the immense toll and impact that this whole ordeal was having on me and my family. If I had broken my leg and the elevator to an upper floor was out of service, would they have denied my reasonable accomodation if I had requested a meeting in the lobby so that I wouldnt have to crawl up the stairs? If they did, this would be so disgustingly and overtly dehumanizing to make someone crawl up the stairs. My insistence that I not be in the presence of the person who was causing meongoingharm, and the respondent of an ongoing complaint (itself a harmful process) was treated as unreasonable. I was essentially barred from being able to do my job while trying to advocate for my own safety. As Sara Ahmed writes, You can be exhausted by not being accommodated; you can be exhausted by the work you have to do in order to [try to be] accomodated (Ahmed 2021).

I was demoralized, exhausted and dehumanized. I had to end that pain for myself, and my family by resigning.

As youre reading this, you might be thinking, what expertise do I have to demand such system changes? I have lived expertise as a racialized woman physician with disabilities working in Canadian healthcare institutions for 18 years, a medical educator who has supportedcountlessracialized and otherwise oppressed learners who have experienced hardship due to oppression in their training, and a physician who has gone through and been failed by both the informal and formal complaint process at different stages of my medical career. Do not perpetuateepistemic injusticeby thinking that my testimony, and my blood, sweat and tears in 18 years of experiences (23 years if you count my training years) do not carry any weight or expertise.

***********************************************

In attempting to make sense of the injustices I have faced, I have read and researched this topic in the social psychology, sociology, psychology, medicine, social justice and anti-racism literature for years. As a qualitative medical researcher, I have attempted to make meaning from these injustices to enact institutional change to improve things for the next generation in medicine.

Epistemic injusticeprops up systemic racism within the policies and procedures in Canadian healthcare institutions. Epistemic racism plays out every day in Canadian society, in the silencing, exclusionary, and disbelieving responses to discussions of racism, be it in the national news, or within organizations and workplaces. The dominant narrative has been formed by white people in society over time and continues to this day. This means that the lived experiences of racialized people are not only undisclosed or unheard, they arenotbelieved and/or dismissed if heard because they dont fit the dominant narrative (ie: the dominant group doesnt suffer racism so does not see or understand racial harm). These exemplify the two ways in which epistemic racism exists:testimonial injustice(the person not being believed due to racism, subconscious or not) andhermeneutical injustice(not understanding or believing the interpretations of lived experiences by racialized persons because it doesnt fit the dominant narrative). Harm is perpetuated through the stories of only the dominant group who then make the rules and direct the narratives upon which racist and oppressive harm is adjudicated. This is why all the white physicians with whom I worked in the second complaint were so quick to confidently dismiss and punish me for daring to utter the word racism in relation to a colleague and their group, when they have zero understanding of racism. It is also why I was overtly denied any accommodation when asking for protection from the respondent in not being in his virtual or physical presence, despite my clear articulation of the threat he posed to me. As a result, I was forced to give up clinical shifts (and income) because I was so fearful that being in his (to me, threatening) presence on the wards would adversely distract me in caring for patients safely. It is also why when asking for help, that other leaders could dare to say, Well, none of the other physicians (all of whom are white) have stood up and supported you, so who are we to believe that racism occurred. I did not need an investigation to confirm what I knew to be gendered racism.

This is why white men (and women) are defended so quickly in media stories about oppressive harm. This is why many racialized people who aspire to the seductive power and privilege in society that centres whiteness will give white people the benefit of the doubt over racialized people, especially women and nonbinary people, even when they themselves are racialized. This occurred in my first complaint experience. Lateral violence from racialized colleagues in many ways, is more violent than racism from white people or institutions. How do we move past asking the question of does systemic and other forms of racism exist within our healthcare organization or institution to what can we do to minimize the harm to racialized people within our organization and the healthcare system? How can we support them better within the organization to strive towards achieving equity?

Ultimately, the question I have for all healthcare leaders across Canada is do our voices, perspectives, and our lived expertise in having a lifetime of navigating colonial society as racialized individuals not matter within healthcare? Why must we endure racist harm in the workplace in silence and isolation?

Every workplace policy must consider restorative justice principles to achieve what is earnestly being sought by complainants of oppressive harm; help to be seen and heard as a person with different needs, that impact matters more than intent, and that it is not punishment but accountability being sought. The complainant is simply trying to lessen their chances of such a harmful incident occurring again. We know it will occur again, especially if unchecked. This is our reality. We must not continue to exacerbate the harm of inequities in the workplace through complaint policies that only aggravate oppression by virtue of how they are written. More importantly, the process harms by being disconnected from the problem the policy is intended to address (Ahmed 2021). These policies themselves serve to only avoid the person harmed and the oppressive problems within the institution.

Since my most recent ordeal, some of my healing has been fostered through my work with the newly formedAnti-Racism Support Groupin UBCs Family Practice Residency Program. The decolonized approach to achieving restorative justice that our group strives for, led by an inspiring Indigenous Elder, gives me hope that colonial institutions can change and actively work towards safety and authentic support of racialized physicians in medicine. It is past due thatallinstitutions concretely address the problems that complaints bring forth to those who have less institutional and societal power within medicine. It is past time thatallinstitutions create explicit safety for racialized women and others who experience intersectional oppression, rather than continuing to burden those with less power and privilege, as the most affected, to fight to be seen and heard in these institutions. Only then, can physicians who are racialized women and other intersectional identities, and those who are coming after us, haveanyhope of surviving our careers in medicine.

Excerpt from:
Why must Black, Indigenous, or otherwise racialized women and nonbinary physicians endure racist harm in the workplace in silence and isolation? - The...

The first thing to know is that not all sleep medications are the same. The myth is, It doesnt matter which one you choose, they all work the same way, they all do the same thing. They dont, said Dr. Andrew D. Krystal, a psychiatrist at the University of California, San Francisco, who specializes in sleep disorders. Some drugs, like zaleplon (Sonata), decrease the amount of time it takes to fall asleep, he said; while others, such as suvorexant (Belsomra), block signals in the brain that cause you to wake up. The hormone melatonin, as well as prescription drugs like ramelteon (Rozerem) that act on melatonin receptors, help regulate the bodys internal clock but dont necessarily help you stay asleep.

The best drug for you will largely depend on what causes your insomnia. It really is about choosing the right medication for the patient, said Dr. Aruna S. Rao, a neurologist at Johns Hopkins Medicine. If your problem is that you cant fall asleep at bedtime, then a drug that prevents you from waking in the middle of the night may not help. If you fall asleep easily but cant sleep toward the end of the night, then drugs that wear off within a few hours, like zaleplon (Sonata), arent going to do you much good, either.

Many people, too, have sleeping problems that wont be resolved with any sleeping pill. One such condition is sleep apnea, which afflicts 22 million people in the United States and causes frequent wake-ups, said Dr. Grace Pien, a pulmonary, critical care and sleep medicine physician at Johns Hopkins Medicine. Sleep apnea is best managed with a machine that provides continuous positive airway pressure (CPAP), not with medication.

Another issue is that many sleep aids dont have convincing data behind them. The over-the-counter antihistamines I used to take, which contain diphenhydramine, were never really systematically studied for their effects on sleep, Dr. Krystal said. Theyre recognized for their allergy benefits but are often used as a sleep aid because they cause drowsiness, he added. The few studies that have been done on diphenhydramine suggest that it doesnt help much at all: Clinical practice guidelines from the American Academy of Sleep Medicine say the antihistimines benefits, in terms of extra sleep, are below the level of clinically significant improvement.

Sleep aids can also have side effects, some of them serious. A 2017 study found that, when compared with older adults who did not take sleeping medications, those who took sleep aids of any kind recommended by their doctor were 34 percent more likely to suffer a fall, perhaps because the drugs affected their balance or incited clumsiness. Another study found that people who had recently, for the first time, been prescribed sleep medications such as temazepam, trazodone or zolpidem (Ambien) were 90 percent more likely to be involved in car crashes, and that their increased risk was on par with that of driving drunk. Some research even suggests that the long-term use of hypnotic drugs such as nordazepam, clonazepam (Klonopin), flurazepam (Dalmane) and zolpidem (Ambien) can more than double the risk of dementia.

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Using Melatonin or Benadryl to Sleep? Read this. - The New York Times

AstraZeneca SVP of Early Oncology Matthew Ellis/Courtesy AstraZeneca

With an eye on becoming a leading oncology company, AstraZeneca made a splash at the American Association for Cancer Research meeting in New Orleans with 60 different presentations highlighting the cancer programs that will bolster its three biggest assets: Enhertu, Lynparza and Tagrisso.

At the annual oncology conference, AstraZenecas team, led by Susan Galbraith, executive vice president of oncology research and development, highlighted several of its developmental programs. Prior to the start of AACR, Galbraith said the company is serious about pioneering new approaches to cancer treatment through the development of therapies that can target cancer at earlier stages and with greater precision. The first efforts of that goal were on display at the oncology conference where the company focused on MEDI5752, a novel bispecific antibody, and AZD5305, a next-generation PARP1-selective inhibitor.

AstraZeneca highlighted those two assets as well as AZD8205, a novel ADC that targets B7-H4, a protein that is overexpressed in multiple solid tumors. AZD8205 is the first ADC that uses the companys proprietary linker technology.

The U.K.-based pharma company has high hopes for these three assets. MEDI5752 is designed to simultaneously target the immune checkpoint proteins PD-1 and CTLA-4. AstraZeneca believes that the use of a bispecific antibody-like MEDI5752 is a promising immuno-oncology approach precisely because of the way it was engineered to block both proteins. MEDI5752 is designed to bind to CTLA-4 only in the presence of PD-1.

With that specific bit of engineering, it reduces the chances of off-target toxicities. The drug will bind only to those activated T-cells and broaden the therapeutic window for the medication. MEDI5752 is currently being assessed in a Phase I study, and the company presented data from the first 86 patients who were dosed with different levels in order to find the right level of efficacy and durability.

With its next-generation PARP1 inhibitor, AstraZeneca believes it has a new approach to killing cancer cells by targeting their DNA repair mechanisms. Not only that, but AstraZeneca also has early evidence that one of its experimental PARP1 inhibitors is capable of crossing the blood-brain barrier, which will potentially allow for new approaches to treating malignancies of the brain.

Galbraith is now supported by Matthew Ellis, senior vice president of early oncology. Ellis joined the big pharma in March after spending a year in academic research. He told BioSpace from AACR that after years of academic research focused on the tumor profiles of patients, he wants to close out his career by helping AstraZeneca develop new therapies for multiple cancer types.

I want to put together cures for AstraZeneca and patients, he said in an interview.

Ellis joined AstraZeneca from the Lester and Sue Smith Breast Center at Baylor College of Medicine, where he was the director who oversaw efforts to better understand the molecular profile of breast cancer in order to improve treatment. He was also the co-lead ofThe Cancer Genome Atlas Breast Cancer project, which revealed that the loss of the NF1 gene is an important driver of breast cancer resistance to hormone therapy.

As AstraZenecas assets were on display at AACR, he said he was excited about the potential of these therapies and how they can potentially improve patient care and, one day, help lead to an eradication of cancer. As a cancer survivor himself, Ellis said hes well aware of the needs of patients and keeps them at the forefront of what he intends to do at the pharma giant.

As a breast cancer physician, Ellis said hes prescribed PARP inhibitors on multiple occasions and expressed particular excitement about AZD5305, the next-generation PARP1 inhibitor. He noted that this particular asset has been designed to target PARP1, while engineering out PARP2. Current PARP inhibitors that include PARP2 have some off-target issues, he said.

This has improved the off-target profile, Ellis said, referring to AZD5305. The preclinical profile of it is remarkable the hematological toxicity is gone.

Ellis added that without the toxicity concerns from PARP2, there is a potential for using higher doses in patients. That could ultimately lead to its use as a medication that could prevent breast cancer patients from having to have a mastectomy and prevent prostate cancer patients from having invasive procedures.

Were still in early days with this molecule with early data, but its captured everyones imagination. This is something we intend to take advantage of, Ellis said.

He also expressed excitement about the ADC AZD8205, saying that early data suggests the therapy is a remarkable opportunity to replace chemotherapy. As an oncologist, Ellis said chemotherapy is a double-edged sword of treatment.

Replacing that with an ADC approach could be transformative. AZD8205 targets B7-H4, a protein overexpressed in a range of solid tumors. He said B7-H4 was carefully selected because of its overexpression and the current understanding of its role in the tumor. AstraZeneca plans to drive this into human testing next year, coming to a patient near you, soon, Ellis quipped.

As Ellis looked ahead at his future with AstraZeneca, he said he is excited about exploring new hypotheses in oncology drug research, and will also conduct a top-to-bottom review of the companys compounds in order to prioritize and accelerate development.

Ellis also said he intends to promote equity in clinical trials. He said ethnic minorities have been overlooked as participants in trials, and that is something that has to change. He expressed hope that some barriers to trials will be addressed in order to open them up to more people from all races.

The one thing Ive learned is the value of diversity. It creates an amazing environment, but we have to honor that diversity to make sure that everyone can get a drug and they wont be overlooked, Ellis said.

He added that he also hopes to become a champion for trial participation, pointing out that participation levels in the United States are at about 5% of patients. He would like to see that increase to 25%, which would help achieve those higher levels of minority participation.

Theres a societal responsibility to mitigate cancer in our different populations, he said.

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AstraZeneca Rolls into AACR with 60 Presentations, New SVP of Early Oncology - BioSpace

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Data Highlights In Vivo Research and the Potential Mechanism of Action in Pancreatic and Prostate Cancers

CARLSBAD, Calif., April 12, 2022 (GLOBE NEWSWIRE) -- Qualigen Therapeutics, Inc. (Nasdaq: QLGN), a diversified life sciences company focused on developing treatments for adult and pediatric cancers with potential for Orphan Drug Designation, while also commercializing diagnostics, today highlights three posters presented during the American Association of Cancer Research (AACR) held in New Orleans from April 8-13, 2022.

Qualigen Chairman and CEO Michael Poirier commented, Our lead therapeutic program QN-302 may have the potential to ultimately treat multiple tumor types that are characterized by genomic quadruplexes (G4) which are overrepresented in numerous cancer-related genes. The findings reported in these posters illustrate promising in vivo anti-proliferative activity against pancreatic cancer and metastatic prostate cancer. We are encouraged by the results of these studies as we progress toward our goal to benefit the lives of cancer patients, and are on-track to initiate IND-enabling studies.

Pancreatic cancer remains a high unmet medical need with limited treatment options. According to the American Cancer Society, about 62,210 will be diagnosed with pancreatic cancer in the United States. in 2022, and more than 49,830 patients will die from the disease -- the highest mortality rate of all major cancers. For advanced disease, chemotherapy (sometimes along with a targeted drug therapy) may lengthen survival.1

Poster 2926, Structure-based design of quadruplex-binding small molecule compounds: The essential role of water molecules (Dr. Stephen Neidle) Crystal structures and computer modelling were utilized to characterize the details of the interactions of substituted naphthalene diimides targeted against human DNA quadruplexes, and in particular the role of water molecules in the binding site. It is concluded that information on conserved water molecules is important for drug design and has been used in the design of a current lead compound QN-302.

1 https://pancreatic.org/pancreatic-cancer/pancreatic-cancer-facts/

VIEW AACR POSTER

Session Category: ChemistrySession Title: Structural and Chemical BiologySession Date and Time: Tuesday Apr 12, 2022 9:00 AM - 12:30 PMLocation: New Orleans Convention Center, Exhibit Halls D-H, Poster Section 40

Poster 4068, The potent quadruplex-binding compound QN-302 shows potent anti-proliferative activity in a prostate cancer cell panel and anti-tumor activity in anin vivomodel of metastatic prostate cancer (Dr. Stephen Neidle) demonstrated bioavailability and toleration at therapeutic doses in a prostate cancer cell line, PC3, which is derived from castration-resistant prostate cancer and is therefore relevant to the situation when hormone therapies are no longer effective. The in vivo study, which included the commonly used drug abiraterone, showed that QN-302 had statistically significant anti-tumor activity in this model (p=0.0008) relative to the controls, and was superior to abiraterone.VIEW AACR POSTER

Session Category: Experimental and Molecular TherapeuticsSession Title: New Chemotherapy AgentsSession Date and Time: Wednesday Apr 13, 2022 9:00 AM - 12:30 PMLocation: New Orleans Convention Center, Exhibit Halls D-H, Poster Section 27

Poster 4069, The potent quadruplex-binding compound QN-302 shows anti-tumor activity in patient-derived in vivo models of pancreatic cancer (Dr. Stephen Neidle) outlined a study in which QN-302 displayed substantial anti-tumor activity in three patient-derived xenograft (PDX) models for pancreatic ductal adenocarcinoma (PDAC). Immunocompromised mice were subcutaneously implanted with PDX tumor fragments. Mice intravenously received either QN-302, a vehicle, or in some models, gemcitabine. In three of these models, significant changes in tumor growth were observed in those that received QN-302, together with good tolerance and bioavailability at therapeutic doses.

VIEW AACR POSTER

Session Category: Experimental and Molecular TherapeuticsSession Title: New Chemotherapy AgentsSession Date and Time: Wednesday Apr 13, 2022 9:00 AM - 12:30 PMLocation: New Orleans Convention Center, Exhibit Halls D-H, Poster Section 27

QN-302 is the Companys genomic quadruplex (G4)-selective transcription inhibitor being developed as a potential treatment for PDAC, in addition to other tumors of high unmet clinical need. The abstracts accepted by AACR outline the potential binding to a quadruplex target for the compound, as well as significant anti-tumor activity in relevant animal models.

The AACR Conference, being held in New Orleans from April 8-13, 2022, is a focal point of the scientific cancer community where scientists, clinicians, other health care professionals, survivors, and patients review the latest advances in cancer science and medicine.

About Qualigen Therapeutics, Inc.

Qualigen Therapeutics, Inc. is a diversified life sciences company focused on developing treatments for adult and pediatric cancer, as well as maintaining and expanding its core FDA-cleared FastPack System, which has been used successfully in diagnostics for over 20 years. Our investigational QN-302 compound is a small molecule selective transcription inhibitor with strong binding affinity to G4s prevalent in cancer cells; such binding could, by stabilizing the G4s against unwinding, help inhibit cancer cell proliferation. Our investigational QN-247 compound inhibits nucleolin, a key multi-functional regulatory protein that is overexpressed in cancer cells; QN-247 may thereby be able to inhibit the cells proliferation. QN-247 has shown promise in preclinical studies for the treatment of acute myeloid leukemia (AML). The investigational compounds within Qualigens RAS-F family of RAS oncogene protein-protein interaction inhibitor small molecules are believed to inhibit or block the binding of mutated RAS genes proteins to their effector proteins, thereby leaving the proteins from the mutated RAS unable to cause further harm. In theory, such mechanism of action may be effective in the treatment of about one quarter of all cancers, including certain forms of pancreatic, colorectal, and lung cancers. In addition to its oncology drug pipeline, Qualigen has an established diagnostics business which manufactures and distributes proprietary and highly accurate rapid blood testing systems to physician offices and small hospitals for the management of prostate cancer and other diseases and health conditions.

For more information about Qualigen Therapeutics, Inc., please visit http://www.qualigeninc.com.

Forward-Looking Statements

This news release contains forward-looking statements by Qualigen that involve risks and uncertainties and reflect the Company's judgment as of the date of this release. These statements include those related to the Company's prospects and strategy for the development of therapeutic drug candidates. Actual events or results may differ from the Company's expectations. For example, there can be no assurance that the Company will successfully develop any drugs (including QN-302, QN-247 and RAS-F); that preclinical development of the Company's drugs (including QN-302, QN-247 and RAS-F, and the deprioritized infectious-disease drug candidate QN-165) will be completed on any projected timeline or will be successful; that any clinical trials will be approved to begin by or will proceed as contemplated by any projected timeline, or at all; that any future clinical trial data will be favorable or that such trials will confirm any improvements over other products or lack negative impacts; that any drugs will receive required regulatory approvals (or Fast Track designation or Orphan Drug status) or that they will be commercially successful; that patents will issue on the Company's owned and in-licensed patent applications; that such patents, if any, and the Company's currently owned and in-licensed patents would prevent competition; that the Company will be able to procure or earn sufficient working capital to complete the development, testing and launch of the Company's prospective therapeutic products (including QN-302, QN-247 and RAS-F, and QN-165); or that the Company will be able to maintain or expand market demand and/or market share for the Company's diagnostic products. The Company's stock price could be harmed if any of the events or trends contemplated by the forward-looking statements fails to occur or is delayed or if any actual future event otherwise differs from expectations. Additional information concerning these and other risk factors affecting the Company's business can be found in the Company's prior filings with the Securities and Exchange Commission, including its most recent Form 10-K, all of which are available at http://www.sec.gov.

The Company disclaims any intent or obligation to update these forward-looking statements beyond the date of this news release, except as required by law. This caution is made under the safe harbor provisions of the Private Securities Litigation Reform Act of 1995.

Contact:

Jules AbrahamJQA Partners, Inc.917-885-7378jabraham@jqapartners.com

Source: Qualigen Therapeutics, Inc.

AACR POSTER

Structural and Chemical Biology

AACR POSTER - CHART 1

New Chemotherapy Agents

AACR POSTER - CHART 2

Tumor Volumes for CTG-1128

AACR POSTER - CHART 3

Tumor Volumes for CTG-0952

AACR POSTER - CHART 4

Tumor Volumes for CTG-2184

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Qualigen Therapeutics Presents Three Posters of QN-302 at American Association of Cancer Research Conference - StreetInsider.com

On March 28, Gov. Ron DeSantis signed into law FloridasHouse Bill (HB) 1557, which disallows or limits schools from instructing children in certain sexual matters. The heart of the new law states, Classroom instruction by school personnel or third parties on sexual orientation or gender identity may not occur in kindergarten through grade 3 or in a manner that is not age-appropriate or developmentally appropriate for students in accordance with state standards.

The news was met in many quarters with histrionic outrage. The American Federation of Teachers presidentRandi Weingartengroused that the law will single out certain kids and families for derision and denigration. It is just wrong. Its intent is to divide our communities and make political hay, but it hurts children, hurts families and makes it hard for teachers to do their jobs.

Hardly. It simply doesnt allow teachers to discuss certain sexual identity issues with young children. Weingarten also inanely insisted that the law would shame LGBTQIA+people back into the closet by policing their identity.

Following the signing of the bill, a gay teacher in Parish, Florida, creepily bemoaned the fact that he canttalk about his love lifewith his kindergarteners anymore.

No one was more outraged than Joe Biden, however. On March 31 the day that some celebrate as the International Transgender Day of Visibility the president insisted that his administration is standing up for transgender Americansagainst hateful bills being passed at the state level and assured them, Youre so brave. You belong. And we have your back.

To show that Biden is really, really serious about his stance, his administrations Department of Health and Human Services raised the pink, white and blue striped Transgender flag at its D.C. headquarters.

Frighteningly, theDepartment of Justicegot into the act, issuing a press release on the Transgender Day of Visibility in which it proclaims that it sent a letter to all state attorneys general reminding them of federal constitutional and statutory provisions that protect transgender youth against discrimination, including when those youth seek gender-affirming care. The missive advises states that laws and policies that prevent individuals from receiving gender-affirming medical care may infringe on federal constitutional protections under the Equal Protection Clause and Due Process Clause of the Fourteenth Amendment. Not surprisingly, the word parent never once appeared in the document.

And California of course is doing what it can to maintain its reputation as the nations wackiest state. Democratic lawmakers areproposing to make California a havenfor transgender youth and their parents who are fleeing other states. State Senator Scott Wiener said apparently with a straight face They have a safe place to go if theyre threatened with prosecution. California will not be a party to this new wave ofdeadly L.G.B.T.Q. criminalization.

Its fascinating how a bill which doesnt allow for sexual identity issues to be discussed in grades k-3 can morph into deadly L.G.B.T.Q. criminalization. How could theBabylon Beepossibly satirize this?

In fact, California is actually the anti-Florida, and has done much do disempower parents. To wit:

AB 2119, which passed in September 2018, provides that the rights of minors and nonminors in foster careinclude the right to be involved in the development of case plan elements related to placement and gender affirming health care, with consideration of their gender identity. At the time, the American College of Pediatricians (ACPeds) filedtestimonyagainst the bill, urging legislators to reject it. Children with gender dysphoria believe they are not their biological sex, the groups March 2018 testimony read. A delusion is a fixed false belief. This bill proposes that foster children with gender dysphoria be socially affirmed into their delusion, and allowed to obtain experimental puberty blockers, and dangerous cross-sex hormones and surgery without parental consent.

In September 2021,AB 1184, a bill cosponsored by Planned Parenthood, became law. As the California Family Council explains, this diktat prohibits insurance companies from revealing to the policyholderthe sensitive services of anyone on their policy, including minor children (starting at age 12), even though the policy owner is financially responsible for the services. The term sensitive services refers to all health care services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infections, substance use disorder, gender affirming care, etc. The bill doesnt detail the kindly sounding gender affirming care, but as defined by the University of California, San Francisco, itshormone therapy and a laundry list of surgeriesincluding vaginectomy, scrotoplasty, voice modification, etc., ad nauseam.

At a California Teachers Association conference in October 2021, teachers were advised on best practices for subverting parents, conservative communities and school principals on issues of gender identity and sexual orientation.

The Los Angeles Unified School Districts Office of Human Relations, Equity and Diversity hosted a 10-weekonline club for LGBT elementary schoolers, including children as young as four years oldin the fall of 2021.

And then theres Disney, which is in a state of rage over the passage of Floridas parental rights bill. As Christopher Rufo explains, Disney executives immediately organized a Reimagine Tomorrow Conversation Series meeting for its leaders and pledgedto mobilize the entire corporation in service of the LGBTQIA+ community. Those recruited included a black, queer, and trans person, a bi-romantic asexual, and the mother [of] one transgender child and one pansexual child, and announced ambitious new initiativesseeking to change everything from gender pronouns at the companys theme parks to the sexual orientation of background characters in the companys films.

Also, speaking in blunt terms, Disney executive producer Latoya Raveneau laid out the companys game plan. She said her team was implementing a not-at-all-secret gay agenda and regularly adding queerness to childrens programming. Production coordinator Allen Martsch, said his team has created a tracker to ensure that they are creating enough canonical trans characters, canonical asexual characters, [and] canonical bisexual characters. Corporate president Karey Burke said she supported having many, many, many LGBTQIA characters in our stories and reaffirmed the companys pledge to make at least 50 percent of its on-screen characters sexual and racial minorities.

The gender obsession has also extended to Disneys theme parks in Anaheim and Orlando. Diversity and inclusion manager Vivian Ware explains that Disney made the decision last year toeliminate all mentions of ladies, gentlemen, boys, and girlsin order to create that magical moment for children who do not identify with traditional gender roles.

It must be noted that Disney, whose name evokes warm and fuzzy images of Mickey, Donald, Goofy and Tinkerbell has been over the years the corporate equivalent of a heavy-breathing, sweaty guy in a trench coat lurking in a park. For example, a six-month investigation in 2014 revealed that at least35 Disney employees had been arrested for sex crimesagainst children, attempting to meet minors for sex, and possession of child pornography over the previous eight years. Additionally, other Disney employees were found to have exhibited an abiding interest in kiddie porn on the internet.

The transgender movement is cultish, and can have dire consequences. Brown University physician and researcher Lisa Littman released a study in 2018, which showed that rapid-onset gender dysphoria in young people may be driven in part by social and peer contagion. She stresses that nearly 70 percent of the teenagers were involved with a peer group in which at least one friend had identified as transgender. In some groups, the majority had done so. Nearly 65 percent of teens had spent an increased amount of time online and on social media, and parents reported that pro-transgender YouTube videos and blogs might have been influential. It is unclear how many of the kids who have joined the cult took it to the next level and actually engaged in hormone blockers and self-mutilation.

In reality, Sex is determined at conceptionby our DNA and is stamped into every cell of our bodies, asserts Dr. Michelle Cretella, President of the American College of Pediatricians. Human sexuality is binary. You either have a normal Y chromosome and develop into a male, or you dont, and you will develop into a female. There are at least6,500 genetic differences between men and women.Hormones and surgery cannot change this. Nor can Disney, Joe Biden, Randi Weingarten or any other gender zealot.

The good news is that a poll taken in late March reveals that when Americans are presented with the actual language of the new Florida law,61% are in favor, while just 26% oppose. Importantly, there is bipartisan support. Republicans are in favor by a 70%-23% margin, while Democrats support it by 55%-29%. And, indeed states are acting.Georgia lawmakers have alreadyintroduceda bill that would similarly restrict classroom discussion of sexual orientation or gender identity, and other bills targeting related content in schools arependingin Indiana, Tennessee, Oklahoma and Kansas. Hopefully, the other 44 states will get aboard soon.

First published at: For Kids and Country.

Photo by skyseeker, Attribution 2.0 Generic (CC BY 2.0).

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News - The Sandstorm: The Gender Cultists Meet Resistance - The Heartland Institute

For those of us who work, commute, have relationships, care for families and try to pack too many responsibilities into each day, stress may be an ever-present, unwanted companion.

You experience stress when your body responds to an emotionally or physically challenging situation. Short-term stress isnt associated with health problems, but long-term or chronic stress is.

When your body recognizes that you are stressed, it releases hormones to help you get through the situation, but in the modern world, those hormones arent always helpful, says Eric C. Alcera, M.D., a behavioral health specialist at Hackensack Meridian Health. In the past, a burst of stress hormones like cortisol or adrenaline may have helped you run to safety when you were being chased by wild animals, but when youre sitting at your desk feeling stressed about a work project, the influx of stress hormones doesnt have the same effect.

Common health problems that are associated with chronic stress include:

Chronic stress may also impact your body in unexpected ways.

Adopting healthy habits may help you feel less stressed, which may make you less likely to experience stress-related health problems. Try to incorporate these lifestyle habits into your routine:

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.

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Doctor Shares 5 Surprising Things That Stress Does To Your Body - Hackensack Meridian Health

Medina, OH: The safe and effective hormone therapy at Advanced Age Management targets people with various health issues, including weight gain, tiredness, declining sex drive, and depressed mood. For men over 35 years, these health problems could result from low testosterone levels and other hormonal issues. That is why the trt center is happy to work with all symptomatic patients. The wellness center for men is well-equipped to offer Hypothyroidism Therapy, Hormone Replacement Treatment, Erectile Dysfunction Treatment, and Low T Symptoms. Other treatments offered by Advanced Age Management are Testosterone Replacement Therapy and Growth Hormone Releasing and Medical Peptide Therapy.

For over 15 years, Advanced Age Management has served patients from varied backgrounds, including professional athletes. The advanced treatment facility for men is owned and managed by John Kocka M.D., a board-certified physician and age management specialist. Dr. Kocka is board-certified in Age Management from the American Academy of Anti Aging, Age Management Medical Group and physician-certified by the Cenegenics Medical Institute. He is a member of the International Hormone Society, International Society for the Study of the Aging Male and the American College of Sports Medicine. He is a trusted authority in testosterone replacement therapy.

Hormone Replacement Therapy (HRT) is a process of replenishing naturally produced hormones among men. The process usually happens when men age and may lead to increased pain and aches, insomnia, sleep disturbance, and slower metabolism, which often leads to increased body fat and other health complications. The pros of choosing Advanced Age Management include an opportunity to work with a leading doctor, access to comprehensive and tailored treatment solutions, and ongoing support from in-house physicians.

The HRT treatment for men plays a vital role in revitalizing sex drive, building muscle mass, and promoting the production of red blood cells. For men with low testosterone levels, the treatment can go a long way to promote vitality, health, and enhance the quality of life. Dr. Kocka begins treatment by creating a custom treatment solution. Treatments such as medina testosterone replacement therapy are supplemented by healthier habits, such as exercise, improved diet, and quality sleep.

Another critical treatment offered by Advanced Age Management is Vitamin B12 and other Amino Acid Treatments. The cost of treatment varies depending on the type of treatment and personalized medical treatment plans. Patient reviews posted on the website paint a picture of an advanced treatment facility that is highly recommended for its friendly and knowledgeable staff and excellent treatment facilities.

To get in touch with the treatment experts at Advanced Age Management, call 216.471.8220, or visit them at 1188 Medina Rd R18, Medina, OH, 44256. The clinic is keen to address health concerns and improve quality of life. They operate Monday to Friday at different hours, between 8:00 am to 5:30 pm.

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Company NameAdvanced Age ManagementContact NameJohn Kocka, M.D.Phone216.471.8220Address1188 Medina Rd R18CityMedinaStateOHPostal Code44256CountryUnited StatesWebsitehttps://www.lowtohio.com/

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About the Advanced Age Management Medina Testosterone Replacement Therapy in Medina, OH - Digital Journal

TUESDAY, March 29, 2022 (HealthDay News) -- Fully half of all women who have annual mammograms to screen for breast cancer will receive a false-positive test result over a decade of screening, according to a new study.

False-positive results call for further testing and eventually rule out cancer. False alarms can certainly increase anxiety.

"Women undergoing screening mammography should be aware that being recalled for additional imaging is common and try not to worry," said study author Diana Miglioretti, a professor and division chief of biostatistics at the University of California, Davis. "Most of the time, the additional imaging shows that everything is normal."

For the study, Miglioretti and her colleagues analyzed data from close to 3 million screening mammograms for more than 903,000 women between 40 and 79 years of age. The participants underwent breast cancer screening between 2005 and 2018 at 126 radiology centers.

The study found the risk of false-positive results is lower in women who are screened every other year.

Yearly screening with newer 3D technology called digital breast tomosynthesis or 3D mammography modestly decreased the odds of a false positive when compared with the standard digital 2D mammography.

Of women who received a false-positive result after an annual 3D mammogram, 17% needed additional imaging, and 11% needed a biopsy to rule out cancer. These numbers were just slightly higher among women screened with digital 2D mammograms.

Older women and women who don't have dense breasts were less likely to get a false-positive result, the study showed.

There's been an ongoing debate within the medical community about how often women should undergo breast cancer screening.

The U.S. Preventive Services Task Force recommends women who are at average risk for breast cancer get their first mammogram at age 50, and then every two years until age 74.

Meanwhile, the American Cancer Society says 40- to 44-year-old women should consider annual mammograms. They are recommended for women between 45 and 54 years of age.

"Screening every two years has been found to be effective for most women in terms of detecting cancer early while reducing the harms of screening such as false positives," Miglioretti said.

Still, she said, guidelines aren't written in stone.

"Some women at higher risk of advanced cancer despite screening might choose to screen annually, for example, postmenopausal women who are obese or taking hormone replacement therapy," Miglioretti said. "If women are unsure, they should talk with their clinicians about the tradeoffs of annual versus biennial screening."

The study was published March 25 in JAMA Network Open.

Being called back after a screening mammogram or ultrasound for additional images or a biopsy should be considered routine, said Dr. Laurie Margolies, chief of breast imaging at Mount Sinai Health System in New York City. She was not part of the study, but reviewed the findings.

"It is not a cause of alarm as most of the time we can clear people with additional images," Margolies said.

Getting a mammogram every two years instead of yearly is a "major mistake," she warned. The new study doesn't look at cancers found by yearly screens compared with screens done every two years.

"People who skip a mammogram often have larger cancers and are really sorry that they didnt come the previous year when the cancer would have been smaller and easier to treat," Margolies said.

Mammograms aren't perfect, but they are getting better, said Dr. Marisa Weiss, founder and chief medical officer of Breastcancer.org and Breasthealth.org in Ardmore, Pa.

"We still need better methods of early detection that both reduce the risk of a false positive [false alarm] and lower the risk of a false negative [missing a cancer] for all women, especially young women who are more likely to have dense breasts, an inherited high-risk predisposition, and more at stake: young children, growing careers, more years of life at risk," said Weiss, who has no ties to the research.

More information

Breastcancer.org has more about breast cancer screening.

SOURCES: Diana Miglioretti, PhD, professor, division chief of biostatistics, University of California, Davis; Laurie Margolies, MD, chief, breast imaging, Mount Sinai Health System, New York City; Marisa Weiss, MD, founder/chief medical officer, Breastcancer.org and Breasthealth.org, Ardmore, Pa.; JAMA Network Open, March 25, 2022

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Half of Women Will Get False-Positive Mammogram Over 10 Years of Screening - HealthDay News

Today thanks in large part to a law passed in 1993 that mandated that women and minorities be included in medical research funded by the National Institutes of Health women are more systematically included in studies, yet there are still huge knowledge gaps.

For instance, women with heart disease often have different symptoms from men with heart disease, yet doctors are much more familiar with the male symptoms, said Dr. Jennifer Mieres, a cardiologist with Northwell Health in New York. When women show up with symptoms that dont fit into the algorithm were taught in medical school, she said, they get gaslit and ignored.

By the time Michelle Cho, 32, was diagnosed with systemic lupus erythematosus, a disease in which the body slowly attacks its own tissues, she had developed kidney failure, a heart murmur and pneumonia yet the first doctor she went to diagnosed her with allergies, she said, and the second doctor thought she was pregnant.

I left each time feeling disappointed, sad and uneasy, because I knew they had not solved my problem or helped me in any way, and it had been yet another wasted day, said Ms. Cho, a New York City-based medical student. It felt like they were saying, Its all in my head.

When Raimey Gallant, a 42-year-old writer who lives in Winnipeg, began dropping weight, losing her hair and breaking out in a full-body rash in her 20s, she said her male doctor told her she was young, healthy and just lazy, when in fact, later that year she was diagnosed with Graves Disease, an autoimmune disorder in which the body produces too much thyroid hormone.

She also struggled for 20 years with disabling period pain before finally getting diagnosed last year with endometriosis, an inflammatory disease characterized by the presence of endometrial-like tissue outside the uterus. Ill never get back the pieces of life Ive lost to medical neglect, she said.

Its hard to know how to begin to address these systemic problems, experts said, but scientists argue that at the very least, there needs to be more research on womens health conditions.

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What Is Medical Gaslighting and How Can You Elevate Health Care - The New York Times

Anyone whos ever tried to conceive knows that there are countless highs and lows during the process. To say you might be a little stressed during this period is a bit of an understatement.

While trying to conceive (TTC) can be an emotional rollercoaster on its own, the experience can become even more emotionally fraught for people relying on fertility treatments, such as in vitro fertilization (IVF).

How do you go on with everyday life while undergoing treatments? In particular, many people going through fertility treatment still work full time. Understanding how to manage that stress and finding positive outlets for encouragement and support can help you manage.

Experiencing fertility concerns can be an isolating experience, but the reality is that theyre incredibly common. According to the American Society for Reproductive Medicine (ASRM), roughly 10 to 15 percent of American couples experience infertility.

Fertility concerns can impact the sperm-giving partner, too. Male and female infertility each contribute to one-third of infertility cases, according to ASRM. The remaining one-third is a combination of both male and female infertility.

If youre going to continue working during fertility treatment, certain factors can make the experience more complicated. Insurance coverage can vary widely by company, and family leave policies can depend on both your employer and the state you live in.

Before you can begin figuring out how to work through fertility treatments, you need to determine your rights, and what benefits if any you have access to.

Depending on your employer and how long youve worked with them, you might qualify for FMLA. While FMLA guarantees only unpaid time off, you could get up to 12 weeks of unpaid leave every year. You could use this leave toward parental leave.

By strict definition, FMLA isnt designed to cover infertility treatments. However, if your healthcare professional can affirm that your fertility treatments are medically necessary for you to become pregnant, you may potentially apply FMLA leave toward treatments or even medically required bed rest during pregnancy.

Many companies that arent governed by FMLA do offer generous parental leave and health policies including covered health expenses. When in doubt, speak with your companys human resources or benefits manager to fully understand what leave if any you can use. They can also tell you whether your insurance will cover any treatments.

In theory, your medical situation is no ones business, and you have a right to privacy. But depending on the type of fertility treatments youre using, it might be unrealistic to keep this process to yourself.

For example, IVF is managed in cycles that usually coincide with your menstrual cycle. This means that a full IVF cycle can last several weeks, and many couples require more than one cycle to achieve success. Youll need to factor in several appointments, including procedures like egg retrieval and embryo transfer.

Beyond that, keep in mind that some treatments require taking fertility medications. These can create unexpected reactions both physically and emotionally. Many fertility specialists recommend taking 1 or 2 days off from work for the egg retrieval procedure, and some doctors recommend taking a few days off after the embryo transfer as well.

Only you know how agreeable your workplace will be to you taking time off periodically throughout the month to manage fertility treatments. At a minimum, be prepared to talk with direct managers or your human resources point of contact because youll need their approval to take time off or coordinate benefits.

But youll also need to consider other factors.

If youre thinking of taking a hybrid work approach, where youre primarily in the office but working remotely during critical points in an IVF cycle, other people might also need to know why youre out of the office. Anyone considered critical to ensuring that your job runs smoothly should realistically be kept in the loop.

Additionally, if you have close work friends who you trust and believe will provide much-needed support, you might want to tell them. We cant stress enough that fertility treatments can be draining both emotionally and physically.

ASRMs Mental Health Professional Group (MHPG) agrees about this psychological impact. So, having a solid support system in all aspects of your life can be very helpful.

Remember that you control the narrative. You can provide general information without sharing all the details. Fertility concerns are a sensitive topic that not everyone is comfortable talking about.

Plus, theres the added reality that while legal protections against workplace gender discrimination exist, some people have reported feeling like their work ethic or capabilities were questioned once disclosing that they were undergoing fertility treatments.

So, if youre only comfortable saying you have to undergo medically necessary procedures, leave it at that and dont feel pressured to share more. If necessary, get documented support from your healthcare professional.

The TTC process is a rigorous one, but even more so when youre also battling infertility. While its important to cover your bases professionally, you also need to be kind to yourself as you navigate treatment.

Between the physical side effects of fertility drugs and the shifting emotions, you might not be up to maintaining your usual schedule. This is especially true if youre juggling a full-time job, multiple fertility appointments and procedures, and remembering to take medications.

Dont feel pressured to maintain your pre-fertility treatment schedule if its going to leave you frazzled and exhausted. Taking care of yourself is priority number one!

No matter how you conceive, anyone whos ever attempted to get pregnant will tell you that having a sympathetic and supportive network can help make the experience more manageable.

You may choose to round up friends and family in your social network who can help you get through this time. Its also good to connect with fertility treatment support groups so you can talk with someone who knows what youre going through.

Youre going through a rough period, so feel free to pamper yourself just a bit more. Whether self-care looks like booking a massage or having a reality show marathon, you deserve to spend a few moments not being preoccupied with your fertility.

If youre undergoing fertility treatments, youre already taking one of the most proactive steps possible to achieve your ultimate goal of getting pregnant.

It can be tempting to spend time online looking up details about fertility treatment success rates, plus what early pregnancy symptoms to expect and how to spot them. But this can encourage rumination and spiraling thoughts, which can make an already stressful situation feel worse.

If you have questions about fertility or fertility treatments, talk with your healthcare professional about them instead. After all, theyre the pro!

Dont underestimate the importance of spending time talking with someone whos not in your social circle and who can serve as a neutral sounding board. Again, fertility concerns and, by extension, fertility treatments can throw you for many emotional loops.

Countless studies have shown that living with infertility can have a serious and long-term impact on your mental health, according to a 2008 research review. Having a safe space to talk through whats bothering you, as well as learning other effective coping methods, is important.

Not everyone can take time off from work to accommodate fertility treatments. If youre able, work with your companys human resources or benefits director to determine what leave or medical coverage can be applied to your treatments.

While you may need to tell key stakeholders at work whats going on, dont feel pressured to share every little detail or tell every single person. Its important to take care of yourself and make sure you have a strong support system around you during treatment.

Excerpt from:
What You Need to Know When You're Working During Fertility Treatment - Healthline

Ovarian cancer is a growth of cells that forms in the ovaries.The cells multiply quickly and can invade and destroy healthy body tissue.The female reproductive system contains two ovaries, one on each side of the uterus.The ovaries each about the size of an Almond produce eggs(ova) as well as the hormones estrogen and progesterone.

Signs & symptoms

When ovarian cancer first develops,it might not cause any noticeable symptoms.When ovarian cancer symptoms happen,they're usually attributed to other,more common conditions.

Signs and symptoms of ovarian cancer may include:

a.Abdominal bloating or swelling.

b.Quickly feeling full when eating.

c.Weight loss.

d.Discomfort in the pelvic area.

e.Fatigue.

f.Back pain.

g.Changes in bowel habits,such as constipation.

h.A frequent need to urinate.

Causes of Ovarian Cancer

It's not clear what causes ovarian cancer, though doctors have identified things that can increase the risk of the disease.

Doctors know that ovarian cancer begins when cells in or near the ovaries develop changes(mutations) in their DNA.A cell's DNA contains the instructions that tell the cell what to do.The changes tell the cells to grow and multiply quickly,creating a mass (tumor)of cancer cells.The cancer cells continue living when healthy cells would die.They can invade nearby tissues and break off from an initial tumor to spread (metastasize) to other parts of the body.

Types of ovarian cancer

The type of cell where the cancer begins determines the type of ovarian cancer you have and helps your doctor determine which treatments are best for you.Ovarian cancer types include:

a.Epithelial ovarian cancer:This type is the most common.It includes several subtypes, including serous carcinoma and mucinous carcinoma.

b.Stromal tumors:These rare tumors are usually diagnosed at an earlier stage than other ovarian cancers.

c.Germ cell tumors:These rare ovarian cancers tend to occur at a younger age.

Risk factors

Factors that can increase your risk of ovarian cancer include:

a.Older age:The risk of ovarian cancer increases as you age. It's most often diagnosed in older adults.

b.Inherited gene changes:A small percentage of ovarian cancers are caused by genes changes you inherit from your parents.The genes that increase the risk of ovarian cancer include BRCA1 and BRCA2. These genes also increase the risk of breast cancer.Several other gene changes are known to increase the risk of ovarian cancer, including gene changes associated with Lynch syndrome and the genes BRIP1, RAD51C and RAD51D.

c.Family history of ovarian cancer:If you have blood relatives who have been diagnosed with ovarian cancer,you may have an increased risk of the disease.

Being overweight or obese.Being overweight or obese increases the risk of ovarian cancer.

d.Postmenopausal hormone replacement therapy:Taking hormone replacement therapy to control menopause signs and symptoms may increase the risk of ovarian cancer.

e.Endometriosis:Endometriosis is an often painful disorder in which tissue similar to the tissue that lines the inside of your uterus grows outside your uterus.

f.Age: Age when menstruation started and ended.Beginning menstruation at an early age or starting menopause at a later age, or both,may increase the risk of ovarian cancer.

g.Never having been pregnant:If you've never been pregnant, you may have an increased risk of ovarian cancer.

Prevention

There's no sure way to prevent ovarian cancer.But there may be ways to reduce your risk:

a.Consider taking birth control pills:Ask your Physician whether birth control pills (oral contraceptives)may be right for you. Taking birth control pills reduces the risk of ovarian cancer.But these medications do have risks,so discuss whether the benefits outweigh those risks based on your situation.

b.Discuss your risk factors with your doctor:If you have a family history of breast and ovarian cancers, bring this up with your doctor.Your doctor can determine what this may mean for your own risk of cancer. You may be referred to a genetic counselor who can help you decide whether genetic testing may be right for you.If you're found to have a gene change that increases your risk of ovarian cancer,you may consider surgery to remove your ovaries to prevent cancer.

Diagnosis

Tests and procedures used to diagnose ovarian cancer include:

a.Pelvic exam:During a pelvic exam,your physician inserts gloved fingers into your vagina and simultaneously presses a hand on your abdomen in order to feel(palpate) your pelvic organs.The doctor also visually examines your external genitalia,vagina and cervix.

b.Imaging tests:Tests,such as ultrasound or CT scans of your abdomen and pelvis, may help determine the size,shape and structure of your ovaries.

c.Blood tests:Blood tests might include organ function tests that can help determine your overall health.

Your doctor might also test your blood for tumor markers that indicate ovarian cancer. For example, a cancer antigen(CA) 125 test can detect a protein that's often found on the surface of ovarian cancer cells.These tests can't tell your doctor whether you have cancer,but they may provide clues about your diagnosis and prognosis.

d.Surgery:Sometimes your doctor can't be certain of your diagnosis until you undergo surgery to remove an ovary and have it tested for signs of cancer.

e.Genetic testing:Your doctor may recommend testing a sample of your blood to look for gene changes that increase the risk of ovarian cancer.Knowing you have an inherited change in your DNA helps your doctor make decisions about your treatment plan.You may wish to share the information with your blood relatives,such as your siblings and your children,since they also may have a risk of having those same gene changes.Once it's confirmed that you have ovarian cancer,your doctor will use information from your tests and procedures to assign your cancer a stage. The stages of ovarian cancer range from 1 to 4, which are often indicated with Roman numerals I to IV.The lowest stage indicates that the cancer is confined to the ovaries. By stage 4,the cancer has spread to distant areas of the body.

Treatment

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.Other treatments may be used in certain situations.

a. Surgery to remove one ovary:For early-stage cancer that hasn't spread beyond one ovary, surgery may involve removing the affected ovary and its fallopian tube.This procedure may preserve your ability to have children.

b. Surgery to remove both ovaries:If cancer is present in both your ovaries,but there are no signs of additional cancer,your surgeon may remove both ovaries and both fallopian tubes.This procedure leaves your uterus intact,so you may still be able to become pregnant using your own frozen embryos or eggs or with eggs from a donor.

c.Surgery to remove both ovaries and the uterus:If your cancer is more extensive or if you don't wish to preserve your ability to have children,your surgeon will remove the ovaries,the fallopian tubes,the uterus, nearby lymph nodes and a fold of fatty abdominal tissue(Omentum).

d. Surgery for advanced cancer:If your cancer is advanced,your doctor may recommend surgery to remove as much of the cancer as possible.Sometimes chemotherapy is given before or after surgery in this situation.

e.Chemotherapy: Chemotherapy is a drug treatment that uses chemicals to kill fast-growing cells in the body,including cancer cells.Chemotherapy drugs can be injected into a vein or taken by mouth.Chemotherapy is often used after surgery to kill any cancer cells that might remain.It can also be used before surgery.In certain situations, chemotherapy drugs may be heated and infused into the abdomen during surgery (Hyperthermic Intraperitoneal Chemotherapy).The drugs are left in place for a certain amount of time before they're drained.Then the operation is completed.

f.Targeted therapy: Targeted drug treatments focus on specific weaknesses present within cancer cells. By attacking these weaknesses,targeted drug treatments can cause cancer cells to die.

If you're considering targeted therapy for ovarian cancer,your doctor may test your cancer cells to determine which targeted therapy is most likely to have an effect on your cancer.

g.Hormone therapy: Hormone therapy uses drugs to block the effects of the hormone estrogen on ovarian cancer cells.Some ovarian cancer cells use estrogen to help them grow,so blocking estrogen may help control the cancer.

Hormone therapy might be a treatment option for some types of slow-growing ovarian cancers.It may also be an option if the cancer comes back after initial treatments.

h.Immunotherapy: Immunotherapy uses the immune system to fight cancer.The body's disease-fighting immune system may not attack cancer cells because they produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.Immunotherapy might be an option for treating ovarian cancer in certain situations.

i.Supportive(Palliative)care: Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care.Palliative care can be used while undergoing other aggressive treatments,such as surgery and chemotherapy.When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.Palliative care is provided by a team of doctors,nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families.This form of care is offered alongside curative or other treatments you may be receiving.

Coping and support

A diagnosis of ovarian cancer can be overwhelming.In time you'll find ways to cope with your feelings,but in the meantime,you might find it helpful to:

a.Find someone to talk with:You may feel comfortable discussing your feelings with a friend or family member, or you might prefer meeting with a formal support group. Support groups for the families of people with cancer also are available.

b.Let people help:Cancer treatments can be exhausting.Let people know what would be most useful for you.

c.Set reasonable goals:Having goals helps you feel in control and can give you a sense of purpose.But choose goals that you can reach.

d.Take time for yourself:Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer.

e.Preparing for your appointment:Start by making an appointment with your family Physician or gynecologist if you have any signs or symptoms that worry you.If your primary care Physician suspects that you have ovarian cancer,you may be referred to a specialist in female reproductive cancers(Gynecological Oncologist).A gynecological oncologist is an obstetrician-gynecologist(OB-GYN)who has additional training in the diagnosis and treatment of ovarian cancer and other gynecological cancers.

f.What you can do: Be aware of any pre-appointment restrictions,such as not eating solid food on the day before your appointment.

g.Write down your symptoms,including any that may seem unrelated to the reason why you scheduled the appointment.

h.Write down your key medical information, including other conditions.

i.Write down key personal information, including any major changes or stressors in your life.

j.Make a list of all your medications,vitamins or supplements.

k.Ask a relative or friend to accompany you, to help you remember what the doctor says.

l.Write down questions to ask your doctor:

l What's the most likely cause of my symptoms?

l What kinds of tests do I need?

l What treatments are available,and what side effects can I expect?

l What is the prognosis?

l If I still want to have children,what options are available to me?

l I have other health conditions.How can I best manage them together?

l In addition to the questions that you've prepared to ask your doctor,don't hesitate to ask other questions that occur to you.

m.What to expect from your doctor:Your doctor is likely to ask you a number of questions.Being ready to answer them may make time to go over points you want to spend more time on.You may be asked:

l When did you first begin experiencing symptoms,and how severe are they?

l Have your symptoms been continuous or occasional?

l What,if anything,seems to improve or worsen your symptoms?

l Do you have any relatives with ovarian or breast cancer?

l Are there other cancers in your family history?

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Introduction to Ovarian Cancer - Rising Kashmir

Mridula George, MD, discusses efforts to address unmet needs in HER2-low breast cancer.

Mridula George, MD, medical oncologist, Stacy Goldstein Breast Cancer Center, Rutgers Cancer Institute of New Jersey, assistant professor of medicine, Rutgers Robert Wood Johnson Medical School, discusses efforts to address unmet needs in HER2-low breast cancer.

The phase 3 DESTINY-Breast04 trial (NCT03734029) investigated fam-trastuzumab deruxtecan-nxki (Enhertu) vs. physicians choice of chemotherapy in patients with unresectable or metastatic HER2-low breast cancer. This study was pivotal because there is currently no treatment for this subgroup of patients, George says.

DESTINY-Breast04 met its primary end point of progression free survival, plus the secondary end point of overall survival in the subgroup of patients with hormone receptorpositive disease, George explains.

Future research could explore potential combinations withtrastuzumab deruxtecan, such as CDK4/6 inhibitors, George continues. The HER2-low space will generate more clinical trials to better understand treatment options for this subtype of breast cancer, George concludes.

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Dr. George on Efforts to Address Unmet Needs in HER2-Low Breast Cancer - OncLive