By Tom Anderson

As the elections kick into high gear, the Florida statehouse in Tallahassee finds itself awash in millions of dollars in campaign money channeled through a network of shadowy political action committees whose backers and agenda are too often are too often concealed from the public.

The number of these types of groups in Florida has been on a steady rise since 2013, when then-Governor Rick Scott and the state legislature legalized these groups, despite warnings from public-integrity experts that they would corrupt elections and policy debates.

The groups, often bearing benign names like Floridians for Economic Freedom, operate with minimal oversight as they raise and spend unlimited amounts of money that are difficult to trace back to their original sources.

To be sure, these committees, or PACs, are required to disclose basic facts, including their mission and the candidates and issues that the groups support financially. But government watchdog groups point out that the information disclosed is so basic that it is often impossible to determine who actually benefits from the creation of the groups, who exactly is driving the agenda of the groups, and the precise reasons for the expenditures of the groups.

Consider a current case involving what, on the surface, appears to be a grassroots effort to alert Floridians about the apparent risks of genetic information in the hands of life insurers and long-term care insurers.

The effort has many trappings of a full-blown campaign, including a Facebook page, digital advertisements and a website, Protecting Our DNA, that offers the latest news on genetic privacy, discusses laws and legislative proposals to regulate the use of genetic testing by insurers, and urges voters to sign a petition.

But many important questions remain unanswered about this campaign, particularly since it turns out that it is backed by the powerful incoming House speaker, Chris Sprowls, as well as a largely opaque PAC he runs that has raised more than $4.2 million since 2015 and that currently has $1.8 million in its coffers.

The group, Floridians for Economic Freedom, is an unlikely player in the debate over the ethical, commercial and legal implications of genetic testing, in large part because its stated mission is to support or oppose candidates for statewide, multi-county, legislative, county and municipal office and other activities not prohibited by Chapter 106 F.S.

And so, exactly why it involved itself in this effort is unclear. It is also unclear whether any of the groups big-money donors pushed it to launch the genetic campaign, how much money the group is spending on the campaign and who comprises the movement the campaign suggests it represents.

This kind of information is indispensable to the public given the political and policy stakes involved. Its one thing, for example, if the grassroots campaign is a mere vanity project of the incoming speaker, who has used the issue of genetic testing to garner media coverage. Its quite another thing if there are special interests behind the campaign, including business rivals of the insurance industry.

The impact of these groups has become so pervasive that Joe Gruters, the state GOP chairman, recently raised sharp concerns that the states campaign finance system has contributed to the proliferation of so-called dark money by allowing donations to flow from one opaque committee to another in manner that often masks the identity of the original donor.

It is the political equivalent of money laundering, albeit a legal one. Imagine, for example, that a real estate development company decides it wants to unseat a local lawmaker opposing one of the developers major projects. In this case, the development company does not want its role in trying to unseat the lawmaker from being discovered.

So how does the development company go about putting its secret plan into action? Thanks to the states murky network of PACs, there are more than a few ways, especially since several committees can be run by the same person.

The company could, for instance, donate $30,000 to a hypothetical committee called Floridians For Prosperity. The donation then could be transferred to another committee called Citizens for Economic Growth, which can in turn transfer the money to Save Floridas Future. In the end, the last committee to receive the money is free to invest it in, say, advertising attacking the targeted lawmaker with little risk of exposing the development companys role.

Right now, legislators cant take a cup of coffee from a lobbyist without breaking the law, Gruters, a state senator from Sarasota, recently told the Orlando Sentinel. But here, someone can run $50,000 through the process and use it against you or on your behalf and no one will know. It makes a mockery of the system.

Tom Anderson is a public-integrity expert and investigator and resident of Florida

Link:
Florida's PACs: A Murky Network of Influence - The - The Floridian

Recommendation and review posted by Bethany Smith

With help from Darius Tahir (@dariustahir)

Editor's Note: This edition of Morning eHealth is published Mondays, Wednesdays and Fridays at 10 a.m. POLITICO Pro eHealth subscribers hold exclusive early access to the newsletter each morning at 6 a.m. Learn more about POLITICO Pro's comprehensive policy intelligence coverage, policy tools and services at politicopro.com.

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Jonathan Bush's take on the Epic feud: Bush chatted with POLITICO about privacy, his new board position at Innovaccer and the upcoming interoperability rules.

Apple, Microsoft support API provisions: The tech giants are among more than two dozen signatories on a letter urging HHS to allow API access to patient records in the department's upcoming interoperability rules.

FCC's $20B broadband fund advances: Commissioners on Thursday voted to set rules surrounding a planned subsidy fund supporting broadband in remote areas.

eHealth Tweet thread of the day: Stephanie Hughes @stephanie_h "Had never heard the words 'ambient biometric data' all in one place until I heard @natashanyt say them in an interview with @stewart_jack. Now I'm going to use them all the time."

Natasha Singer @natashanyt "For context: we were discussing Alexa, Ring and other technologies that can collect voice/facial data from visitors/passersby who may not know about, and did not consent to, the surveillance."

It's FRIDAY at Morning eHealth. What stories are flying under the radar as we brace for the interop rules? Keep us posted at mravindranath@politico.com. Tweet the team at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

BUSH CALLS EPIC'S HHS CAMPAIGN 'INDISPUTABLY CYNICAL' HHS' upcoming data sharing rules could loosen electronic health record companies' control over patient information, arousing fierce opposition from some health leaders. But for Jonathan Bush the firebrand founder of athenahealth the rules offer an opportunity not just to help patients, but also to dream up new businesses.

Bush says Epic's opposition to the rules is "indisputably cynical" and he said as much in an email to CEO Judy Faulkner, although the email bounced. (An Epic spokesperson says Faulkner's email is functioning, but did not confirm that she'd received the message.) "I think of you as a good person who wants good things in healthcare....I am losing my grip on that assumption. Please reconsider," Bush wrote.

Faulkner has said the rules, which would make it easier for patients to send their data to apps outside their providers' systems, don't do enough to prevent third parties from exploiting their data. Critics, like Bush, say the company is protecting its own interests.

"Consumers are NOT as dumb as you think they are," Bush told Morning eHealth in an email, noting that in this new data-sharing landscape, patients can send their records to new services that aggregate data and recognize patterns in a way that health systems can't. It could also open the door to companies like Firefly Health, a venture-backed primary care company where he's executive chairman.

"I would fight and die to protect Judys right to behave in an aggressive competitive manner to prevent other entrepreneurs to enter her space," Bush said, but "that falls short of using control of the law/regulatory system."

... Bush also chatted with us about what he's been up to since he stepped down from athenahealth in 2018. In addition to his role at Firefly Health as executive chairman, he recently joined the board at Innovaccer, which sells software to help engage patients, manage pediatric populations, and connect patients to social determinants of health services, among other products.

It's the underlying software platform at Innovaccer that interested Bush, he told us. "For every field, they go through and say, 'what is extractable out of this?' ... They map it to a common data model that anybody later on can come and write apps to [and pull that data]."

That's something he tried and failed to do at athenahealth. "[B]ut we had older architecture and, frankly, we didn't have a business model that justified all that mapping. I ended up spending so much on R&D that I attracted an activist [investor]. Athena had a common data model for claims or insurance rules or insurance package benefits, but we were never able to get a common data model for a medical record. We were in the middle of it and we got shot down."

Your author also asked him what the app economy might look like if the rules are finalized. These days "it's hard for developers to get this data because of sclerosis," he said, referring to lack of common data standards or widely adopted mechanisms for that exchange. Over time, he expects more API-first platforms that developers can use to access data, and that charge very little money. Once data sharing does become standard, "they would be very profitable because they don't have to manually force things through," he said, adding that when he left athenahealth in 2018, "there were still 35 people whose job it was to manually put an ink signature on a paper claim."

APPLE, MICROSOFT SIGN LETTER TO OMB ON APIs Tech giants Apple and Microsoft are on board to get API access into HHS' final interoperability regulations, having signed on to a Thursday letter to OMB with more than two dozen co-signatories.

The letter runs through the standard arguments for API access that itll allow patients to better direct their care and enable better technology and boasts companies like Aledade and Ciitizen as well as the American Academy of Family Physicians as signatories, in addition to the tech giants.

... OpenNotes, an initiative promoting patient access to their doctors' visit notes, sent its own letter to OMB. "A growing evidence base indicates that patients who have access to their full medical record, including the notes their clinicians compose following office visits, report better understanding of their health and illness, feel more in control of their health care decisions, and are able to identify important errors and inaccuracies in their records," they wrote.

FCC BROADBAND PLAN ADVANCES DESPITE OBJECTIONS Agency Chairman Ajit Pai said auctions for broadband buildout subsidies should begin later this year, following this week's vote by commissioners to set rules for the $20.4 billion fund. Pai said the Rural Digital Opportunity Fund would "permanently change the broadband landscape in America for the better."

Telehealth advocates have warned that while virtual care could help patients access care in remote areas with clinician shortages, hospitals don't always have the broadband connectivity to support the technology.

The proposal wasn't without detractors. Commissioners made changes to a letter of credit requirement in an attempt to quell telecom industry concerns, but Democratic commissioners partially dissented over other unresolved spats, Pro Tech's John Hendel writes.

Commissioner Jessica Rosenworcel, for instance, said the proposal relies on flawed broadband mapping, uses "stale" proposed speeds and cuts New York state from eligibility due to its earlier subsidy arrangement with the commission.

Republicans dismissed New York's concerns, which GOP commissioner Mike O'Rielly called "self-serving." And flawed mapping, the commission majority said, still accurately shows the unserved areas targeted in phase 1 of the program.

FLORIDA HOUSE PASSES GENETIC TESTING BILL The Florida House this week passed a bill to prohibit life insurance and long-term care companies from using genetic information when setting prices, our POLITICO colleague Alexandra Glorioso reports.

Speaker-designate Chris Sprowls' bill, FL HB1189 (20R), would stop those industries from using genetic testing data when setting premiums; state law already bars health insurers companies from doing so. The bill is now in position to head to the Senate for a hearing.

A Senate companion, FL SB1564 (20R), was amended Tuesday to allow life insurance and long-term care companies to use genetic information if it's included in a patient's medical record.

The House bill "prioritizes the genetic privacy of Floridians over the desires of big insurance companies who want to deny coverage or charge higher premiums using peoples DNA," Sprowls said late Tuesday.

TELEDENTISTRY FIGHT RESUMES California state lawmakers will consider a bill this year that would require dentists to conduct in-person exams before approving orthodontic treatment, our colleague Alexander Nieves reports. The bill, CA AB 1998 (19R), by Democratic Assemblyman Evan Low, escalates a fight between teledentistry companies and dentists that began last year with legislation requiring in-state dentists to examine X-rays.

The teledentistry model keeps prices low by eliminating in-person exams, Alexander writes. Companies such as SmileDirectClub have storefronts in California, but consumers never meet the doctor prescribing their aligners. Under the bill, a patient couldn't see a local dentist and then get aligners in the mail from a different dentist via a teledentistry company.

California is proud to be the incubator of innovation but we cannot sacrifice patient health and safety in exchange for making billionaires out of tech bros, Low said in a statement. The industry should view AB 1998 as a sign that the Legislature is serious about requiring meaningful safeguards if these questionable and controversial business practices are allowed to continue.

Eran Segal writes in Nature about using detailed data about microbiomes, genomes, physiological measurements and other characteristics for drug design, potentially reducing the cost of drug discovery.

Stat's Sharon Begley writes about the Boston Biotech Working Group's efforts to fix the gender imbalance in biotechnology.

Continue reading here:
Jonathan Bush's take on the Epic feud - Politico

Recommendation and review posted by Bethany Smith

DUBLIN--(BUSINESS WIRE)--Jan 30, 2020--

The Molecular Diagnostics Market Share & Global Forecast, By Application, Technology, End User, Regions, Companies report has been added to ResearchAndMarkets.coms offering.

Increasing prevalence of Infectious diseases such as Influenza, HPV, Hepatitis, HIV and Tuberculosis despite rise in sanitation practices globally. In the past, antimicrobials medicines were used to fight powerful infectious disease but slowly in todays time antimicrobial agent is not able to give the desired results because the problem of drug resistant occurs in many people across the world.

Nowadays, a new diagnostic procedure is being followed to fight infectious disease like molecular diagnostic test is very effective which is quite fast and precise. The number of cancer patients is increasing very fast, so it is believed that in the coming time the molecular diagnostic test market will be growing at rapid pace. Global Molecular Diagnostics Market is likely to surpass US$ 22.5 Billion by the end of year 2025.

There are various reasons that will propel the market growth in forecast year; rising incidence rate of infectious disease, increasing incidence rate of cancer of all type, increasing people awareness regarding molecular diagnostic, rapid technological growth, widely acceptance of personalized medicine, rising healthcare infrastructure, increasing healthcare per capita expenditure across the developed and developing nation, accuracy of diagnosis, growing population of cardiovascular and neurological disorder etc. In addition, increasing prevalence of genetic disorder will further boost the market in forecast period of time.

The report titled Molecular Diagnostics Market Share & Forecast, By Application (Infectious Diseases, Blood Screening, Oncology, Genetic Testing, HLA (Tissue Typing), Microbiology, Cardiovascular Diseases, Neurological Diseases, Pharmacogenomics and Others), By Technology (PCR, Transcription-Mediated Amplification (TMA), Hybridiazation (In-situ Hybridiazation & FISH), DNA Sequencing & NGS, Microarray and Others), By End User (Hospitals & Academic Laboratories, Clinics and Commercial Laboratories, Others), By Regions [United States, Europe (Expect Russia), India, China, Japan, Brazil, South Korea, Mexico, Russia and ROW], Companies (Roche, Abbott, Myriad Genetics, Qiagen, BioMrieux and Others) provides a complete analysis of Molecular Diagnostics Market.

Market Insight by Application

The report provides comprehensive analysis of molecular diagnostic test market by application into ten parts: Infectious Diseases, Genetic Testing, Blood Screening, Oncology, HLA (Tissue Typing), Microbiology, Neurological Diseases, Pharmacogenomics, Cardiovascular Diseases, and Others. This report also provides key opportunities market and specific factors are given by each application market.

Market Insight by Technology

Here the market is fragmented into six parts; PCR, Transcription-Mediated Amplification (TMA), Hybridiazation (In-situ Hybridiazation & FISH), DNA Sequencing & NGS, Microarray and Others. Besides, many factors are analyzed that influence the growth, challenges and opportunities of market in technological context.

Market Insight by End User

The report provides complete insight of market by End User segments: Hospitals & Academic Laboratories, Clinics & Commercial Laboratories and Others. According to the publisher, Hospitals & Academic Laboratories will hold the largest market in global molecular diagnostic test market in forecast period of time.

Market Insight by Regions

This report covers the complete regional profile by 10 geographical market; United States, Europe, India, China, Japan, Brazil, South Korea, Mexico, Russia and Rest of World (ROW).

Key Topics Covered:

1. Executive Summary

2. Global Molecular Diagnostic Market

3. Market Share - Global Molecular Diagnostics

3.1 By Application

3.2 By Technology

3.3 By Countries

3.4 By Companies

4. Application - Molecular Diagnostics Market

4.1 Infectious Diseases

4.1.1 Hospital Acquired Infections (HAI)

4.1.2 HIV / HCV Testing

4.1.3 STD Testing

4.1.4 HPV Testing

4.2 Blood Screening

4.3 Oncology / Cancer

4.3.1 Breast

4.3.2 Colorectal

4.3.3 Prostate

4.3.4 Others

4.4 Genetic Testing

4.5 HLA (Tissue Typing)

4.6 Microbiology

4.7 Cardiovascular Diseases

4.8 Neurological Diseases

4.9 Pharmacogenomics

4.10 Others

5. Technology - Molecular Diagnostics Market

5.1 PCR

5.2 Transcription-Mediated Amplification (TMA)

5.3 Hybridiazation (In-situ Hybridiazation & FISH)

5.4 DNA Sequencing & NGS

5.5 Microarray

5.6 Others

6. Region - Molecular Diagnostics Market

6.1 United States

6.2 Europe

6.3 India

6.4 China

6.5 Japan

6.6 Brazil

6.7 South Korea

6.8 Mexico

6.9 Russia

6.10 Rest of World (ROW)

7. End Users - Molecular Diagnostics Market

7.1 Hospitals & Academic Laboratories

7.2 Clinics and Commercial Laboratories

7.3 Others

8. Roche Diagnostics - Company Analysis

8.1 Merger & Acquisitions

8.2 Sales Analysis

9. Abbott Laboratories - Company Analysis

9.1 Merger & Acquisitions

9.2 Sales Analysis

10. Myriad Genetics - Company Analysis

10.1 Merger & Acquisitions

10.2 Sales Analysis

11. Qiagen - Company Analysis

11.1 Merger & Acquisitions

11.2 Sales Analysis

12. BioMrieuxs Inc - Company Analysis

12.1 Merger & Acquisitions

12.2 Sales Analysis

13. Market Drivers

13.1 Various Developments in the Molecular Diagnostics Landscape

13.2 Integral to Traditional Labs

13.3 Improved Assay / Test Efficiencies

13.4 Targeting Antibiotic Resistance

13.5 Next Generation Ultrasensitive Molecular Diagnostics

13.6 Increasing Investment in Genomics & Proteomics Research

13.7 Technological Advances in Molecular Diagnostics

13.8 Increasing Acceptance of the Personalized Medicine

13.9 Growing Molecular Diagnostics for Food Safety

14. Challenges

14.1 Dearth of Trained Professionals

14.2 Regulatory Issues

14.3 Various Factors Slowing Growth of Molecular Diagnostics

14.4 Reimbursement Capabilities

14.5 Quality Checkpoints, Awareness & Acceptance

For more information about this report visit https://www.researchandmarkets.com/r/j3on5s

View source version on businesswire.com:https://www.businesswire.com/news/home/20200130005474/en/

CONTACT: ResearchAndMarkets.com

Laura Wood, Senior Press Manager

press@researchandmarkets.com

For E.S.T Office Hours Call 1-917-300-0470

Read the original post:
Global Molecular Diagnostics Market is Likely to Surpass US$ 22.5 Billion by the End of Year 2025 - ResearchAndMarkets.com - Associated Press

Recommendation and review posted by Bethany Smith

From NFL Hall of Famer Kurt Warner leading a recognition service for cancer caregivers during the Super Bowl to Tylenols key ingredient possibly being added to Californias proposition 65 list for chemicals that may cause cancer, heres what is making headlines in the cancer space this week.

We understand that they take their own journey, said Warner in a press release. They take on their own pain. They take on their own suffering. They are unselfishly giving of themselves in so many ways solely to have impact on so many that they are caring for.

Participants in the 30 Days of Cancer Prayer event are sent daily cancer prayer videos by phone, email or Facebook by well-known Christians, like Warner. The range of topics discussed and prayed over in the videos include finances, chemotherapy and multiple tumor types.

We live in a society where I feel like so many give simply due to an expectation of what they are going to receive, Warner explained. With caregivers we know that there is very little that they receive. That it is so much giving.

TrialJectory announced a new partnership with specialty cancer diagnostics companyPrecipio, Inc., to provide patients with cancer worldwide with a first-of-its-kind diagnostic and clinical trial-matching service combining the companies platforms.

While this partnership offers enormous benefits for both patients and physicians, it ultimately allows patients to take back control of their health and empowers them to make decisions that are right for them based on accurate information from advanced new technologies, said Tzvia Bader, TrialJectorys CEO and co-founder, in a press release.

TrialJectory is an A-based clinical trial matching platform that helps facilitate clinical trial searches and enrollment for patients with cancer and their physicians. Precipio is a platform that helps to create accurate diagnostic platforms by using all of the data from academic institutions, and providing that information to patients and physicians. The two combines are looking to their merger to help patients throughout the entirety of their cancer journey, from diagnosis to treatment.

Not only are patients entitled to receive an accurate diagnosis at the start of their battle with cancer, but they also deserve access to match and enroll in the best clinical trials available for their unique situation without having to struggle through the complex matching and enrollment process, explained Ilan Danieli, CEO of Precipio.

Five years after a group of patients were given synthetic psilocybin, the psychedelic compound of magic mushrooms, to help with cancer related depression and anxiety new research shows that they are still feeling the positive effects.

In the initial 2016 study, 80% of the patients reported their symptoms faded and the effects lasted up to 6 months a landmark finding at the time. In the follow up study, which included 15 patients, 80% were still experiencing significant improvement in their cancer-related depression and anxiety and nearly all of them attributed it to the psychedelic-assisted therapy.

Its a powerful experience that creates a lasting memory that involves them dealing with the demons of their cancer or their mortality, explained Dr. Stephen Ross, director of addiction psychiatry at New York Universitys Langone Medical Center, who led the 2016 study and co-authored the new research.

Although some patients in the follow up study noted the return of social anxiety, their fear of their cancer and own mortality did not.

Next Generation Sequencing for people with inherited ovarian or breast cancer will now be covered by the Centers for Medicare & Medicaid Services (CMS).

We recognize that cancer patients shoulder a heavy burden, so were leaving no stone unturned in supporting womens health and getting all patients the care, they need, stated CMS Administrator Seema Verma in a press release. Next Generation Sequencing testing provides clinically valuable information to guide patients and physicians in developing a personalized treatment plan.

Patients with inherited ovarian and breast cancer have a limited number of treatments, and for patients on Medicare even more so. Now, patients will have access to the genetic testing that allows patients access to personalized treatments that can better target their cancers.

This spring, California lawmakers will hold a public hearing to determine whether acetaminophen, the key active ingredient in Tylenol, should be added to the states list of chemicals that are known to the state to cause cancer or reproductive toxicity.

This falls under the states Proposition 65, otherwise known as the Safe Drinking Water and Toxic Enforcement Act of 1986. The list includes arsenic, asbestos, cocaine, coke oven emissions, wood dust and over 900 other chemicals. However, acetaminophen marks a major possible addition to the list as its a key ingredient in drugs meant to relieve pain or reduce fever.

In addition to Tylenol, acetaminophen is also found in other over-the-counter medications, such as Alka-Seltzer Plus Liquid Gels, Dayquil, Dimetapp, Excedrin, Midol, Nyquil, Sudafed and Theraflu.Cancer risk associated with acetaminophen have only been associated in animal studies where mutations have been observed and indirect evidence in other studies where further study is ongoing. The Food and Drug Administration has not seen fit to issue a warning.

Continued here:
Friday Frontline: Cancer Updates, Research and Education on January 31, 2020 - Curetoday.com

Recommendation and review posted by Bethany Smith

You wouldnt know that Lynda Marino has a serious heart condition, save for the scar that ends near the top of her breastbone.

Marino, 40, a busy mother of two young children, is tall, slender and outgoing and fortunate to be alive.

She was diagnosed in her mid-20s with cardiomyopathy, nearly died from cardiac arrest four years ago and weathered open-heart surgery on New Years Eve at the Cleveland Clinic.

Her sister, 35-year-old Marianne Potratz, has the condition that thickens and endangers heart muscle, too.

We don't look like the average people you might expect to have heart disease, Marino said.

The two sisters have become leading advocates for the Buffalo Niagara affiliate of the American Heart Association during the last few years, not so much because their condition is rare but because heart disease is so common.

They dont want themselves or you to become another statistic for the No. 1 killer in the nation.

Cardiovascular disease can take a life suddenly or over time, at any age. Those stricken young often have a genetic predisposition like Marino, who lives in East Amherst, or Potratz, of Grand Island, but the Heart Association estimates that 80 % of cases can be prevented with healthy living and decision-making.

You need to eat right, exercise regularly and talk with your primary care provider about your family history of heart disease. Health care visits and screenings are important as often as your provider recommends, said Dr. Vijay Iyer, chief of cardiovascular medicine in the University at BuffaloJacobs School of Medicine and Biomedical Sciences.

Nobody should get to the age of 25 without knowing their blood pressure and their cholesterol numbers, he said.

Action saves lives when it comes to heart disease

Ignorance is hardly bliss when it comes to heart disease, either.

High blood pressure and even diabetes, for example, often don't manifest themselves till theyve gone too far, said Iyer, who also directs structural heart interventions at Gates Vascular Institute and the complex valve clinic at Buffalo General Medical Center.

Most of the early symptoms can be very subtle or there may be no symptoms at all, he said. People could have had hypertension for a long time, and slowly built blockages in the arteries, and the first time they show up is in the hospital when theyve had a heart attack or had a stroke so not knowing about your physical condition, your medical history, can be quite deleterious. It can be potentially fatal.

Lynda Marino, left, and her sister, Marianne Potratz, right, walk with their mother, Susan Minbiole, near the house where they grew up in East Amherst. Genetic testing after Marino suffered a cardiac arrest in 2015 showed that the sisters and their father, Barry Minbiole, have a genetic mutation that predisposes them to cardiomyopathy, a heart condition that must be closely monitored. (Robert Kirkham/Buffalo News)

It can be easy to take health for granted, particularly when you lead a busy life.

Marino knows. She learned she had cardiomyopathy in 2006, while in her mid-20s, when she was diagnosed with pneumonia. Her primary physician ordered a chest X-ray that showed signs of the condition, which thickens the heart walls, hampers blood flow and sometimes damages valves.

Marino was encouraged to see her doctor regularly, limit her exercise to moderate levels and eat right. She also was urged to be mindful of dizziness or extreme fatigue two signs of disease progression.

In the years that followed, she felt fine. She and her husband, John, chief technical officer in the Cleveland Hill School District, started a family. She also landed a job as marketing director with Canterbury Woods retirement communities.

Things changed unexpectedly on Sept. 12, 2015, when Marino went into cardiac arrest while driving home from T.J. Maxx and Aldi in the Town of Lockport.

I had a newborn son at home, she said. I had a 2-year-old daughter. I worked full time. Who knows what I was feeling, or just ignoring, beforehand because life was so insane.

Her right foot slipped off the gas as she slumped past the steering wheel onto the console. The car crawled south on Transit Road at 5 mph, while her daughter, Claire, cried frantically in a car seat behind her.

Thats when the miracles started happening, she said, recounting what others since have told her.

Chris James, a fellow motorist, saw what was happening, stopped his car, ran to the side of Marinos Forester SUV and was able to open the door because it didnt have automatic locks. He directed the car to the side of the road, turned off the ignition and called 911.

Bill and Peggy Killewald watched the commotion across four lanes of traffic while Bill, a retired veterinarian, pumped gas at a NOCO station. The couple ran to Marino, whose electrical impulses to her heart had stopped.

When Bill was doing CPR, he said I had no pulse, she said. My lips were blue and he, as a doctor, thought I was gone.

A Niagara County sheriffs deputy armed with an automated external defibrillator next joined the life-saving effort. At the time, the department was one of few in regional law enforcement that equipped its patrol cars with AEDs. Had she driven a few miles south into her home county, her odds of survival would have been worse.

Rescue workers rushed her first to Lockport Memorial Hospital, then Buffalo General, where she spent four days in an induced coma to help her recuperate.

In the coming weeks, both she, her sister and parents were tested for a gene mutation that predisposes people to cardiomyopathy.

Both sisters already knew they had the condition, confirmed through echocardiograms years earlier. They now learned they had the mutation, along with their father, Barry, 68, a retired Praxair engineer.

Nobody should get to the age of 25 without knowing their blood pressure and their cholesterol numbers, says said Dr. Vijay Iyer, a cardiologist at Gates Vascular Institute and Buffalo General Medical Center, as well as chief of cardiovascular medicine in the University at Buffalo Jacobs School of Medicine and Biomedical Sciences. (John Hickey/News file photo)

Several weeks later, surgeons at Buffalo General implanted defibrillators and pacemakers into Marino and Potratz, who have since called themselves the Sling Sisters because they needed to wear left arm supports for six weeks as they recovered.

The regional American Heart Association affiliate offered them support along the way, which is why they now share their stories as part of the Go Red for Women campaign, which encourages women to know their cardiovascular risks and take action to reduce them.

They were discouraged from eating too much salt, fatty meat and processed foods, running marathons or lifting heavy weights. They were encouraged to walk for exercise, eat more fruits, vegetables and seafood, and drink plenty of water.

Heart Association staff also encouraged the sisters to know their health screening numbers, particularly blood pressure, cholesterol, blood sugar, weight, and any sudden increases in fluid retention.

Both women also were put on beta blocker drugs to help regulate their heart rhythms.

We live very normal lives, Marino said, or at least I did for a couple of years.

She and her sister returned from a trip to Iceland and Paris in late 2018 and Marino began to experience more dizziness, shortness of breath and chest pressure when exerting herself. She led a nearly yearlong effort to find the best solution to removing substantial muscle scarring on her heart, and secure health insurance approval.

On New Years Eve, a cardiomyopathy team at the Cleveland Clinic performed an extensive myomectomy, slicing nearly a half ounce of damaged muscle from Marinos heart nearly twice as much as generally creates urgency for such open-heartsurgery.

Before this procedure was perfected, the only alternative was a heart transplant, said the sisters' mother, Susan Minbiole.

From left, Lynda Marino, Susan Minbiole and Marianne Potratz have become key supporters of the Go Red for Women campaign, which encourages women to know their cardiovascular risks and take action to reduce them. (Robert Kirkham/Buffalo News)

Marino hasnt been able to drive or lift anything heavier than a milk carton since her surgery. She has returned to the Cleveland Clinic twice since surgery and will do so less often going forward. She also continues to work with cardiologists and electrophysiologists in Buffalo.

The Minbiole family always has been tight. Marino lives just a few blocks from her parents, while Potratz and her husband, Seth, also are regulars at family gatherings that have taken on greater meaning in recent years. Family members vacation together more regularly, and their gratitude and giving has taken on greater proportions.

Friends and family members became part of the Sling Sisters team that has become a force in regional Heart Association fundraisers.

The experience also helped underline the importance of family, community and preparedness when it comes to good health.

We really promote hands-only CPR because my life was saved in part by bystanders, complete strangers, that jumped in to help me, Marino said. You could be someone else's hero by learning CPR or suggesting your friend go see the doctor because you're hearing her complain about an ache in her arm or other symptoms of heart disease.

The sisters are CPR-trained and, because there is little research on cardiomyopathy, Marino has enrolled in a Yale University study on exercise for those with the condition.

Meanwhile, they and their families marvel at medical advances that help Marino and Potratz stay on top of their challenges.

Marino has a device similar to an Apple Watch that can take an EKG, and both sisters have another device, half the size of a toaster, that takes heart readings from their pacemakers and defibrillators and transmit them by cell signal to health specialists in the event of an unusual reading.

The pacemaker and defibrillator will always be there to protect against any future cardiac arrest, Marino said. It doesn't stop it from happening, but it would stop it from killing me.

They hope more advances will come in the future and work toward that end in part because Marinos now 6-year-old daughter and 4-year-old son, Logan, also have the MYBPC3 gene mutation that predisposes them to the same condition.

As is the case for everyone, the sisters said, its better to know something like that than not.

Some say ignorance is bliss, Potratz said, but in my case, knowing that I'm protected is far more valuable than not having the information at all.

WNY's unhealthy habits could stunt economic growth, study says

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Two sisters, one near-death experience, and a warning about heart disease - Buffalo News

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Ahead of Rare Disease Day, here is what you need to know about pheochromocytoma and paraganglioma, two rare types of tumors.

BY Kristie L. Kahl

In pheochromocytoma, the tumor originates from chromaffin cells in the inside portion of the adrenal gland (a small gland that makes steroid hormones like adrenaline, and noradrenaline). A neuroendocrine tumor is one that forms from cells that release hormones into the blood in response to a signal from the nervous system and may make higher-than-normal amounts of hormones.

Paraganglioma, which are closely related to pheochromocytoma, allows the nerve cells to form anywhere along the sympathetic and parasympathetic nervous systems. There are two types: chromaffin paragangliomas and nonchromaffin paragangliomas.

These two types of tumors can be benign in that the one tumor is surgically removed and does not spread or come back. However, some pheochromocytomas and paraganglioma can be metastatic.

Recent research, according to the Pheopara Alliance, shows that approximately one in 3,000 individuals have pheochromocytomas and/or paraganglioma.

(These tumors) are extremely rare, Dr. Daniel Pryma, division chief of Nuclear Medicine and Clinical Molecular Imaging at Penn Medicine, said in an interview with CURE. There are ones that are metastatic and ones that are non-metastatic, and it can be a difficult distinction. It's not like other cancers where you can tell on a biopsy which one is malignant, and which one is not. These are sort of, until they spread, in limbo.

Symptoms of the tumor types include:

To diagnose, a 24-hour urine test can measure the amounts of catecholamines (adrenaline or noradrenaline) or metanephrines in the urine, where an unusual amount of a substance can be a sign of disease in the organ or tissue that makes it. In addition, blood catecholamine studies can measure the amount of certain catecholamines into the blood. Moreover, CT scans, gallium dotatate scans (a procedure to detect areas of the body where cells are dividing rapidly), an MIBG scan (a procedure used to find neuroendocrine tumor), an MRI, PET scans, a plasma-free metanephrines test (a blood test that measures the amount of metanephrines in the blood) and a somatostatin receptor scintigraphy (a type of radionuclide scan that may be used to find tumors) can be used.

The tumors have a really, really well-developed blood supply and so they tend to bleed and also if you do anything to manipulate them, you can cause a huge release of hormones, which can be fatal, Pryma explained. So typically, biopsies are either not done or done with significant associated pre-medication and anesthesia. So very often these go straight to surgery.

Individuals can see an endocrinologist, a doctor who has special training in diagnosing and treating disorders of the endocrine system.

Of note, 30%-40% of those with pheochromocytomas and/or paraganglioma cases are hereditary. There is a 50% chance you can pass it down to your children if you carry a genetic mutation, the alliance noted in its website. If you are diagnosed with (pheochromocytomas and/or paraganglioma), discuss genetic testing with your doctor.

Currently, the only treatment for these tumor types is surgical resection. However, there are a few treatment options available to patients that cannot be operated on, or have tumor metastasis, according to the alliance, and there are more studies and research being done each year to find a cure. Azedra (iobenguane I 131) is currently the only medication approved by the Food and Drug Administration to treat these tumors.

Its a cancer but it behaves differently than many other cancers, Pryma said. It really shouldn't be treated the same way as cancer. We sometimes see patients who are diagnosed in a place that doesnt have expertise in it, and they sort of get this kitchen sink approach where they just try sort of generic things that work in cancers. (These therapies) really aren't effective and it ends up causing the patient more harm than good. So really getting that subspecialty information sooner rather than later is helpful.

For more information, visit pheopara.org.

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The Basics of Pheochromocytoma and Paraganglioma - Curetoday.com

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When Heather Woock was in her late 20s, she started researching her family history. As part of the project, she spit into a tube and sent it to Ancestry, a consumer DNA testing service. Then, in 2017, she started getting messages about the results from people who said they could be half siblings.

I immediately called my mom and said, Mom, is it possible that I have random siblings out there somewhere?' said Woock, of Indianapolis. She recalled her mom responded, No, why? Thats ridiculous.

But the messages continued, and some of them mentioned an Indianapolis fertility practice that she knew her mom had consulted when she had trouble conceiving.

Woock researched and finally learned the truth. Dr. Donald Cline, the fertility doctor her mother saw in 1985, is her biological father.

I went through an identity crisis, she said. I couldnt look in the mirror and think about, Where did my eyes come from? Where did my hair color come from? I didnt even want to think about any of that.

Woock hadnt known that her mom had used artificial insemination to conceive her, and neither of them knew the doctor had used his own sperm.

We now know Cline used his own sample and squirted it into my mom, Woock said.

In the 1970s and 80s, Cline deceived dozens of patients and used his sperm to impregnate them. He has more than 60 biological children and counting.

For Woock, as the story of her parentage sunk in, it was distressing for another reason: She wanted to start her own family and was having trouble conceiving. And now she needed to turn to the fertility industry that had so badly betrayed her mom.

We were doing all of the calendaring everything that is out there to help you get pregnant, we were doing that, Woock recalled.

But after six months, when she still wasnt pregnant at 32, she went to a fertility clinic for some tests.

I had to fill out all this paperwork, and theres a slot that says kind of like, Is there anything else youd like to share? Woock said.

Yes, there most certainly was.

The Odds Of Fertility Fraud These Days

New allegations of doctors using their own sperm keep coming to light because of genetic-testing services like Ancestry revealing networks of half siblings in states like Idaho, Ohio, Colorado and Arkansas.

But those doctors performed artificial inseminations decades ago. Could what happened to Woocks mom happen in a modern fertility clinic?

Dr. Bob Colver, a fertility specialist in Carmel, Indiana, said its a question many of his patients have asked. But its unlikely, he said. These days, there are more people involved in the process, and in vitro fertilization happens in a lab, not an exam room.

Unless youre in a small clinic where theres absolutely no checks and balances, I cant even imagine that today, Colver said.

Its now illegal inIndiana, Texas and California for a doctor to use his sperm to impregnate his patients. But theres no national law criminalizing whats called fertility fraud.

Fertility medicine has advanced a lot since the 1980s, but women trying to get pregnant today with the help of medicine face a baffling array of treatment options that can be hard to navigate and can be hugely expensive. And some critics say the growing, multibillion-dollar fertility industry needs more regulation.

For example, sperm banks may not get accurate medical histories from their donors, who could pass along genetic diseases. And theres no limit on how many times a donors sperm can be used, which some donor children worry could increase the chance of inbreeding. Sperm donation guidelines from organizations like the American Society for Reproductive Medicine are voluntary. There was a contestant onThe Bachelorette last year who said his sperm had helped father more than 100 kids.

Unrealistic Expectations

When Woock decided to get her first fertility treatment, she set preconditions with the clinic. She insisted on having a female doctor and insisted that a doctor be in the room for all appointments and oversee everything that happened.

Her experience with her clinic was very different from her mothers with Cline, but nonetheless there were surprises along the way.

The clinic told her that her problems conceiving could be because of husband Robs low sperm count and motility (meaning his sperm werent great swimmers). They advised a form of in vitro fertilization that involved injecting one sperm directly into one of her eggs in a petri dish.

When doctors told Woock she needed IVF, she felt pretty optimistic.

Im thinking going into this that our chances of success are 70, 75%, Woock said.

Fertility treatment can be really expensive, and patients may start treatment with unrealistic expectations. Thats because success rates are complicated, and some clinics use only the best numbers in theiradvertising.

For example, clinics can advertise high fertilization rates. But a 70% fertilization rate doesnt mean 70% of eggs turn into babies plenty can go wrong after the lab combines egg and sperm.

Success depends on your age, your clinic and the type of procedure you need. But most of the time, assisted reproduction procedures such as IVF dont work. The Centers for Disease Control and Prevention, which tracks assisted reproduction ratesin the U.S., reports only about 24% of attempts result in a baby.

Add-On Technology And Prices

When Woock started her first IVF cycle, she gave herself shots, a couple a day, to stimulate her ovaries to get multiple eggs ready at once. Multiple eggs means more chances for fertilization.

But the drugs have side effects. They gave her headaches and made her moody and less patient.

I was actually allergic to one of the medications, which just means that you keep taking it and deal with the itching and rash, Woock said.

But she hung on until it was time for a doctor to surgically retrieve her eggs, at which point patients can face even more choices. Because the couples fertility problem appeared to be with Robs sperm, the clinic offered to use a special device to help pick the best sperm for IVF.

We were kind of like, Yeah, why wouldnt you?' Woock said. If its gonna give us a better chance, do it.

A device like that is called an add-on. Add-ons are often new technology, described as cutting-edge, which can appeal to patients. Examples of add-ons include genetic testing for chromosomal abnormalities in embryos which some specialists argue improves the odds of a live birth and assisted hatchingandendometrial scratching, both methods claiming to facilitate implantation.

Jack Wilkinson, a biostatistician at the University of Manchester in England, researches add-ons, which he has found can increase costs and, he said, they may not work.

We quite often see theres no benefit at all, Wilkinson said. Or, possibly even worse, that theres a disadvantage of using that treatment.

Wilkinson said the device Woocks clinic offered could work, but the evidence supporting it is thin.

Failed Fertilizations

The clinic called Woock the morning after her egg retrieval. None of Woocks eggs fertilized. The procedure revealed that her husbands sperm quality wasnt the only fertility issue the couple faced.

They immediately saw that there was something wrong with my eggs, Woock said. My eggs are just total crap.

She underwent a second round of IVF with the same result no fertilization.

Getting that news the second time felt even more set in stone that this was going to be a very long, challenging road, Woock said.

Challenging and expensive. Most states, including Indiana, dont require insurers to cover fertility treatment. Without insurance, a round of IVF can cost more than $10,000 even more than $20,000 with no guarantee the patient will get pregnant.

Woock was lucky that her employer-provided insurance covered a lot. But it still wasnt cheap. She had to pay for some medications, plus, you have to pay lab and facility fees that insurance doesnt pay, Woock said.

Donor sperm and eggs arent generally covered, either. Those can be tens of thousands of dollars.

Woock faced a hard choice: After two failed attempts, did she want a kid enough to go through IVF again? She and her husband decided they did. So Woock did a third round of IVF. And then a fourth. When that didnt work, she gave up on using her own eggs.

What I expected as I was growing up and picturing my children is not what I will see, Woock said.

Woock and her husband decided to try donor eggs. If all goes according to plan, she could still carry a child. She wants to keep trying.

I realize that pregnancy is incredibly challenging on your body and your mental state, she said. If I can make it through a year of IVF, I can make it through morning sickness.

This story is part of a partnership that includes Side Effects Public Media, NPR and Kaiser Health News. The story was adapted from Episode 6 of the podcast Sick. You can hear more about the fallout from Dr. Donald Clines deception on Sicks first season, atsickpodcast.org.

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Conceived Through Fertility Fraud, She Now Needs Fertility Treatment - Kaiser Health News

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Hypothyroidism, hyperglycemia, and low adrenocorticotrophic hormone (ACTH) levels are associated with lower bone mass in patients with thalassemia major, according to study results published in The Journal of Clinical Endocrinology & Metabolism.

The major mechanisms of endocrine dysfunction that lead to decreased bone mineral density (BMD) and increased risk for fracture in patients with thalassemia major remain poorly understood. Researchers aimed to identify the mineral and hormonal factors associated with low BMD in adults with -thalassemia major in a retrospective study of patients who received treatment at the National Taiwan University Hospital (ClinicalTrials.gov Identifier: NCT03951818).

Medical history was obtained for 29 patients (51.7% women), including bone-associated biochemical markers such as serum calcium, phosphorus, intact parathyroid hormone, vitamin D, and fibroblast growth factor 23 levels. Pituitary function and thyroid hormone levels were used as a proxy for endocrine function. BMD was measured using dual-energy x-ray absorptiometry. Expected height was calculated for each individual based on parental height from patient records.

The mean observed height across all patients was lower than expected (women, -3.7 cm; men, -7.3 cm). Abnormal BMD, defined as a z score 2 standard deviations away from normal BMD, was observed in 42.9% of women and 23.1% of men. In addition, 26.7% of women and 35.7% of men had a history of fracture. Vitamin D deficiency (women, 100%; men, 81.8%), hypogonadism (women, 60%; men, 57.1%), and growth hormone deficiency (women, 75%; men, 57.1%) were highly prevalent in the study group.

Several factors were associated with either femoral neck or lumbar spine BMD, but only thyroid status and lower ACTH levels correlated with BMD at both sites (P <.05). Along with thyroid status (P =.016) and ACTH levels (P =.005), glycated hemoglobin levels (P =.039) were significantly different in patients with normal vs abnormal BMD. When included in a multivariate regression model adjusted for ferritin level, age, and sex, however, hypothyroidism was the only factor significantly associated with lower femoral neck BMD (P =.034). Patients with hypothyroidism had lower BMD at both the lumbar spine (P =.024) and femoral neck (P =.004). No association was found with fracture risk.

Our study is the first study to review the complete endocrine and mineral profiles to identify factors related to the severity of decreased BMD in patients with [thalassemia major], the researchers noted. We found that hypothyroidism and hyperglycemia were the most relevant factors of lower bone mass, while ACTH had a protective role.

The researchers also noted that the interplay between these factors supports the idea that iron overload may be a driver of decreased bone mass in patients with thalassemia major.

Based on these findings, it is promising to conduct interventional trials in the future that evaluate the effect of treating hypothyroidism or glycemic control on BMD and the risk of fracture in patients with [thalassemia major], the researchers concluded.

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Reference

Yang WP, Chang HH, Li HY, et al. Iron overload associated endocrine dysfunction leading to lower bone mineral density in thalassemia major [published online January 7, 2020]. J Clin Endocrinol Metab. doi:10.1210/clinem/dgz309

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By Marie White

Nithyananda Swami is accused of raping a woman named Aarthi Rao some 40 times over a period of five years. There are three arguments that suggest the criminal accusation is false.

Aarthi Rao, alleged victim of rape.

Nithyananda had a sexual potency test taken at Victoria Hospital in Chennai, done supposedly under strict medical supervision. The results have been released and reportedly entered into evidence in his rape case.

The test shows Nithyananda has a testosterone level that precludes his having sex. and that this has been the case since before the alleged five-year span of rapes began.

The test reveals he has a lower testosterone level than a child and, additionally, lack of blood flow, anorchidism, and hypogonadism make it impossible for him to have penile penetration.

Blood flow, hypogonadism, and anorchidism are measured independently of testosterone levels. The test was reportedly studied by a government appointed panel and a private panel of experts and it was unanimously concluded that the Swami is not physically capable of having sex.

It has been argued that there are other kinds of rape, that he could have forcibly held her and assaulted her with his tongue or a flaccid penis. But this is not what the alleged victim claims.She said she was raped by a virile man with full penetration more than 40 times.

The alleged victim, Aarthi Raos purportedly authentic medical records from the University of Michigan were released as part of discovery in a civil lawsuit in Michigan State Court. They show that Aarthi Rao has STDs including a longstanding case of contagious genital herpes.

Nithyananda also reportedly took a test, which shows he is 100 percent STD free.

If this is true, could Nithyananda have had 40 rape sessions with Aarthi Rao, all unprotected, as she claims, and not contract herpes from Aarthi Rao? According to medical reports, she has had herpes for more than a decade.

The alleged victim, Aarthi Rao claims the tests that show she has genital herpes are fake. However, the Indian courts have accepted these records as authentic.

Aarthi Rao claims she was raped repeatedly over a period of five years. She lived in Michigan during the rape period and had to leave the US and come to India where she alleges she was raped.

Even if she was raped the first time, it is undisputed that she continued to visit the ashram of Nithyananda.

If she chose not to tell anyone of being raped, as many fearful victims do, why did she choose to go back?

She did not live with Nithyananda. She lived with her husband in the US. She came periodically to visit the ashram in India where Nithyananda lived.

Her emails show she had to argue with her husband to get permission to come to India to stay at the ashram. Sometimes her husband did not permit her to go and she was despondent.Why would she be despondent about being forbidden to go and get raped?

Most victims would avoid their rapist if they could, even if they do not tell authorities.

Instead she fought to get back.She lied to her husband. She never told him she was raped during the five year period of her alleged rapes.

It defies reasonable credulity and speaks to this being, as some people say, a purely political prosecution.

No rape victim keeps coming back for five years.Its not as if the rapist and his victim lived in the same house and she had no option but to tolerate being raped again and again out of fear or lack of means to escape.

She did not have to escape him. She had to escape her husband to get raped. She had to make extraordinary efforts and undertake international travel to get to her alleged rapist.

We have seen emails that show her husband did not want her to leave and go to Nithyananda. All she had to do was to not come to India and to his ashram to avoid being raped. But she did not.

She fought with her husband to get to India and get raped.

This is what Aarthi Rao wants us to believe.

Obviously, if there was sex, she wanted it. That is so clear that it boggles the mind that anyone could think this is a reasonable prosecution and not a political prosecution.

Something must have changed for Aarthi Rao that made her want to file a charge of rape against her former guru.Perhaps she saw an opportunity to profit.

Nithyananda claims he is a life long celibate and the tests suggest he cannot have sex. Perhaps the tests are fake. Perhaps Aarthi Raos herpes tests are also fake.

But one thing is not fake. It is based on her own admissions: A woman flew halfway across the world to keep getting raped and spending her and her husbands money to go back and get raped!

I think it interesting that her husband left her after finding out she had sex, [or was raped].

He is not a disciple of Nithyananda. I suspect he did not believe her when she said she kept going back and getting raped?

He may have thought she was lying and that she wanted to have sex with Nithyananda.Think about this. She flies to India from America. She has sex with her guru/lover 40 times over 5 years on numerous, separate trips.

Her husband finds out she has herpes. He is angry. She tells him she was raped by Nithyananda and that is how she got herpes.

He does not buy it and decides to leave her. He remembers the fights they had, with her pleading and demanding to got to India. And when she came back she did not act as if she were raped. She could not wait to go back again.

Nithyananda is wealthy. It might be a financial incentive, or perhaps, as likely, she had to defend herself from claims of adultery by charging rape.

In India, adultery is look down upon far more than it is in the USA. Her family is from India and live there still. After her husband left her, she has returned to India.She had motive to lie and offers an implausible story.

The rape case against Nithyananda should be dropped.

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The Rape Case Against Nithyananda Should Be Dropped If They Had Sex, She Obviously Wanted It! - Frank Report

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Spinal cord injury (SCI) is a common disease with high incidence, disability rate and treatment cost. microRNA (miR)-200a is reported to inhibit Keap1 to activate Nrf2 signaling. This study aimed to explore the effects of lentivirus-mediated miR-200a gene-modified bone marrow mesenchymal stem cells (BMSCs) transplantation on the repair of SCI in a rat model. BMSCs were isolated from the bone marrow of Sprague-Dawley rats. miR-200a targeting to Keap1 was identified by luciferase-reporter gene assay. The expressions of Keap1, Nrf2, NQO-1, HO-1 and GCLC were detected by Western blotting in SCI rats. The locomotor capacity of the rats was evaluated using the Basso, Beattie and Bresnahan scale. The levels of malondialdehyde (MDA) and activities of superoxide dismutase (SOD) and catalase (CAT) were measured. miR-200a inhibited Keap-1 3 UTR activity in BMSCs. Transplantation of BMSCs with overexpression of miR-200a or si-Keap1increased locomotor function recovery of rats after SCI, while decreased MDA level, increased SOD, CAT activities and Nrf2 expression together with its downstream HO-1, NQO1, GCLC protein expressions in SCI rat. These results indicated that overexpressed miR-200a in BMSCs promoted SCI repair, which may be through regulating anti-oxidative signaling pathway. 2020 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

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Upregulation of microRNA-200a in bone marrow mesenchymal stem cells enhances the repair of spinal cord injury in rats by reducing oxidative stress and...

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Photo Courtesy of Michael MankowichAbove, Michael Mankowich and his wife, Kathleen, in Patagonia

NUTLEY, NJ When Nutley resident Michael Mankowichs lower back started to bother him, he figured it was a souvenir from his earlier athletic days. Mike, 58, had been a top-notch wrestler at 132 pounds at Long Islands Commack North High School. Hed been an all-American, in fact, as well as a two-time all-Ivy, three-time New York state champ and three-time EIWA tournament placer as a wrestler at Cornell University. An old wrestlers injury was all it was, he figured, a physical reminder of a quick takedown of an opponent 40 years long forgotten.

But the pain did not go away.

Mike began to see a doctor and a chiropractor, and eventually he got an MRI. The news he received at Memorial Sloan Kettering Cancer Center in February 2017 was not good. He was diagnosed with multiple myeloma, a cancer that attacks the blood plasma cells responsible for creating disease-fighting antibodies.

They figured it out quickly at Sloan, he said recently, seated with his wife, Kathleen, in their Rutgers Place home. I kept it from Kathleen.

With this news, he became withdrawn, and his wife realized something was wrong. Mike told her what he had learned, and, as so often happens when a couple puts their heads together, they found some reason for hope: multiple myeloma is a blood disease in the bone marrow and, as such, does not metastasize.

Thats where all the action takes place, in the bone marrow, Mike said. You have to keep your chin up.

For treatment, he became part of a six-month chemotherapy clinical study. Mike was glad to be in the study, because most multiple myeloma patients go on chemotherapy for three months and then undergo a stem-cell transplant. He, however, would not.

A stem-cell transplant blows out the immune system, he said.

Kathleen, an administrative coordinator at Felician University School of Nursing, said her husband, a real estate management employee, did not break stride and never missed the commute to New York City during the clinical study.

A member of Nutley High Schools Class of 1976, Kathleen got on the computer.

When your spouse is diagnosed with an incurable cancer, you do a bit of research, she said.

She discovered the Multiple Myeloma Research Foundation website and learned it was founded 30 years earlier by a woman named Kathy Giusti, who was living with the disease.

That gave me hope, Kathleen said.

She also learned about a collaboration between MMRF and CURE Media Group called Moving Mountains for Multiple Myeloma, or MM4MM.

This collaboration promotes endurance events, undertaken by multiple myeloma patients, to places like Mount Fuji, Mount Kilimanjaro and Iceland. The treks raise money for research, as well as public awareness about the disease. A patient selected to participate in one of these exotic treks had to raise funds, but the trip itself was underwritten by Celgene, a pharmaceutical company headquartered in Summit.

Mike was interested and applied in November 2018 for a spot on a team going to Patagonia. He was interviewed and accepted on condition of raising $10,000 for MMRF research. He suggested that Kathleen accompany him, and they eventually raised $30,000 through social media and by asking friends, family and neighbors.

The online MMRF page devoted to Mikes fundraising shows a photograph of him with his arms around Kathleen and their daughter, Mary, a Class of 2020 NHS student.

In a letter featured on the page, Mike informs the reader that MMRF is one of the worlds leading private funders of myeloma research, with 10 new treatments approved by the Food and Drug Administration.

In August 2019, Mike and Kathleen were flown to Oregon to meet their teammates and to get a taste of what was in store for them in Patagonia. According to the MM4MM website: Each team is carefully selected, representing a microcosm of the myeloma community patients, caregivers, health care professionals and clinical trials managers, as well as representatives from our pharma partners, from CURE Magazine and the MMRF to emphasize the collaboration necessary to drive toward cures.

The foundation sent the group to Mount Hood, Mike said. It was the first time we met. What a great group of people. There were around 15 from all over the country, and there was one other couple, but no one else from New Jersey.

Four other multiple myeloma patients were in the group, he said. he team climbed for nine hours and then headed home.

To prepare for the trip to Patagonia, a region containing part of the Andes mountain range, Mike and Kathleen began a regime of long walks. For instance, theyd walk from Nutley to South Orange and went hiking in New Yorks Harriman State Park.

The MMRF website described the journey as one of arduous adventure: This team will traverse Patagonia crossing over glaciers, through deep valleys, and ascending challenging peaks. This is a powerful and life-changing experience, as the team overcomes challenges, pushes beyond perceived limits and honors loved ones and friends living with multiple myeloma.

For the trek, the team flew to El Calafate, Argentina. As the team embarked on different climbs, documentary filmmakers accompanied them.

The hiking was physically difficult, Mike said. We hiked in rain and incredible winds. In one particular hike, as soon as you felt the winds, you hit the ground. I was surprised nobody got hurt. Some of those slopes were pretty steep. But the scenery was unworldly, and there were condors.

Both Mike and Kathleen agreed that the most memorable sight was La Condorera, which their itinerary described as a nearly vertical massif, offering a home to one of the greatest concentrations of endangered condors in the world. A massif is a group of mountains standing apart from other mountains.

It was a difficult hike, Kathleen said. Youre ready to pass out getting to the top. But its so worth it. The panorama is a view of glaciers and condors. It was spectacular.

Mike and Kathleen returned home on Nov. 16, but there were no goodbyes at the airport. The team had grown so incredibly close that everyone felt they would be seeing each other again, a feeling grounded in the knowledge that multiple myeloma can be challenged and hopefully, one day, defeated.

Our goal in all of this is that you can have multiple myeloma and still do incredible things, Kathleen said.

Its an incentive to other patients to get out there and enjoy their lives, Mike said. And find a cure for multiple myeloma. I have a little bias. I have it.

FEATURED, MOBILE

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Fighting cancer with every step to Patagonia - Essex News Daily

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When David Wilsons spine snapped, leading to a cancer diagnosis, there were fears he would be left paralysed.

But the cyclist and mountaineer had his back rebuilt and went through gruelling chemotherapy and now, just a year later, he is planning a very physical challenge to raise funds for charity,

The Fort William man, who is 60, has journeyed across the globe to the far reaches of the Himalayas, Greenland, Norway and New Zealand. And now he is cycling from London to Paris.

In the summer of 2018, he was cycling the Great Divide Mountain Bike Trail a 3,083-mile off-road ride from Canada to Mexico when his back began to hurt.

He cut the trip short, putting his injury down to old age and wear and tear.

And in February last year his spine suddenly snapped due to a form of blood cancer called Multiple Myeloma.

Following his devastating diagnosis, Mr Wilson owner of the Limetree Hotel, restaurant and art gallery in Fort William was transferred to hospital in Glasgow where he underwent surgery to rebuild his spine.

He explained: I was taken from the Belford Hospital to Inverness, then transferred from Inverness to Glasgow to the surgeons there and they were able to rebuild my spine by putting in a scaffolding in my back with titanium and screws. That stage was touch and go on whether I would be paraplegic now and being an outdoors geezer I was pretty fed up about that.

Following a successful surgery, the visual artist began to slowly walk again before enduring a rigorous six month cycle of chemotherapy to attack the disease.

On September 20, he then received a stem cell transplant, giving him a new lease of life.

The father-of-two said: I had a very adventurous life.

I have been in situations where death has been very close to me, people have been killed right next to me but I have always felt there was a way in those situations that you could get out of them but with cancer like this particular cancer there is no escape. Youre in the hands of the disease and you have to take your chances when you get them.

Now in remission, Mr Wilson is aiming to defy the odds by cycling 500km from London to Paris in September, arriving in Paris exactly a year following his stem cell treatment.

He has now launched a Just Giving page in the hopes of raising 1,500 for Myeloma UK towards finding a cure for the crippling disease.

Multiple myeloma, also known simply as Myeloma, is a form of blood cancer arising from plasma cells causing problems to various areas of the body such as the spine, skill, pelvis and ribs.

It develops in abnormal plasma cells, which release a large amount of a single type of antibody known as paraprotein which has no useful function.

Myeloma affects where bone marrow is normally active in an adult, such as in the bones of the spine, skull, pelvis, the rib cage, long bones of the arms and legs and the areas around the shoulders and hips.

Each year in the UK, approximately 5,700 people are diagnosed with myeloma.

Myeloma mainly affects those over the age of 65, however it has been diagnosed in people much younger.

In the early stages of developing the disease, patients rarely experience side effects and is only diagnosed through routine blood or urine tests.

As the disease progresses, the cancer can cause a range of problems including aches and tender areas in your bones, causes bones to break and fracture easily, kidney problems and repeated infections.

Patients can also become lethargic, weak and short of breath caused as a result of anaemia.

In most diagnosed cases of myeloma it cannot be cured, however, treatment can be given to control the condition and minimise its effects for several years.

Treatment includes anti-myeloma medicines to destroy the cancer cells or control the cancer if patients suffer a relapse as well as a range of medicines to prevent or treat side effects of myeloma.

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Lochaber cyclist pledges to cycle from London to Paris in aid of charity - Press and Journal

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KAPOSVAR, Hungary, Jan 31 (Reuters) - The Pongracz family, a couple who both serve as Lutheran pastors in western Hungary, consider it Gods blessing that they had their first baby after undergoing in-vitro fertilization in 2015.

Since their son Lazar was born, they also had twins - a boy and a girl - from a second IVF pregnancy, so their red-brick home attached to their church in a leafy district of Kaposvar is now filled with babies laughter.

They assist young couples with fertility problems by encouraging them to seek doctors help if thats the only way.

It was such an intense period for us, from the hormone treatment to the implantation of the embryos ... until it turned out that it was successful, that this gave us such a deep relationship with God that we never thought could be possible, said the mother, Boglarka Gyori.

Prime Minister Viktor Orban has made families a priority and introduced tax breaks and cheap loans to persuade more Hungarians to marry and have children as Hungarys population is declining rapidly.

It is an uphill struggle, with a productivity rate of 1.49, when 2.1 is needed to reverse the trend.

In December the government bought out six privately-owned fertility clinics. Drugs used in fertility treatments will be free of charge and waiting lists abolished, making state-financed IVF accessible to many more couples.

Some observers question why state ownership was needed and why the government did not just boost funding instead.

They say the move fits with Orbans efforts to centralise control over certain sectors and it could also help him lock in more of the conservative vote.

A human being cannot be a consumer item, family affairs state secretary Katalin Novak said, adding that the aim was to make treatments transparent and accessible to all.

When it turned out that she had a blockage in her fallopian tubes, making natural pregnancy almost impossible, Boglarka and her husband Mate wasted little time.

She was 27 and Mate was 30, and they spent all their savings on IVF at a clinic to avoid having to wait eight months for state-financed care. The second time they went for state-financed IVF, but still had to pay for medicines.

There were the parents, or rather the would-be parents, who were waiting and hoping, said Mate. With respect to our faith, the IVF programme was not a question for us. We have to take the opportunity that God had given us. (Reporting by Krisztina Than; Editing by Mike Collett-White)

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For Hungarian couple, prayers and science followed by gift of family - Reuters

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INDIANAPOLIS, Jan. 28, 2020 /PRNewswire/ -- Starting this month, Eli Lilly and Company (NYSE: LLY) will donate at least 200,000 KwikPensto three relief organizations Americares, Direct Relief and Dispensary of Hope to stock insulin at nearly 200 U.S. free clinics through 2022. These donations will directly support lower-income people living with diabetes who qualify for free clinic services.

Separately, Lilly is providing $2 million to fund grants that relief agencies will distribute to a wide range of eligible free clinics. The grants will fund programs intended to help people with diabetes understand and access resources that can help them obtain medicine and supplies, medical care, insurance coverage and more.

The insulin donations include KwikPens of Humalog (insulin lispro injection 100 units/mL), Humalog Mix75/25 (insulin lispro protamine and insulin lispro injectable suspension), and Basaglar(insulin glargine injection 100 units/mL).Shipments to relief agencies have already started, giving lower-income people another option for accessing insulin.

"Dispensary of Hope is excited to expand the ongoing effort with Lilly's insulin donation program," said Chris Palombo, Dispensary of Hope CEO. "Insulin saves lives, and the addition of donated Humalog and Basaglar KwikPens is important for the nation's uninsured, low-income community."

In 2018, Lilly announced plans to donate insulin vials to stock approximately 150 U.S. free clinics. Since then, Lilly has donated 120,000 vials that have been used by people who qualify for free clinic services. Lilly is now sending KwikPens to the relief agencies for distribution to nearly 200 free clinics.

"This donation of KwikPens will help many people across the U.S. get the treatment they need," said Mike Mason, president, Lilly Diabetes. "With the help of the relief agencies, Lilly insulin will now be available in many free clinics that are equipped to properly store it. These clinics help people find comprehensive care such as medicine, devices, and physician support, and are very important to people who live with diabetes and use these services. We will continue to evaluate the needs of these communities and enhance our insulin donations as necessary.

"Lilly is committed to offering the broadest suite of solutions for people who need help affording their insulin," Mason continued. "But real change to our reimbursement system is needed. Insurance coverage should ensure no one with diabetes is forced to ration or skip doses for financial reasons."

These donations are part of a broader suite of solutions that Lilly is providing to people who need help affording their insulin. These options include lower-priced versions of branded insulins, out-of-pocket price caps at pharmacies for people with commercial insurance plans and help for people with immediate needs. Anyone who uses a Lilly insulin can call the Lilly Diabetes Solution Center at (833) 808-1234 (9 a.m. to 8 p.m. EST Monday through Friday) to see whether there is an option that reduces their out-of-pocket costs, including information about how to receive free insulin through a free clinic if they meet income requirements.

More information about the grants that relief agencies will receive can be found on our blog.

Important Safety Information for Basaglar, Humalog (Humalog U-100 and Humalog U-200), Insulin Lispro Injection, Humalog Mix75/25, and Humalog Mix50/50

ContraindicationsBasaglar, Humalog (Humalog U-100 and Humalog U-200), Insulin Lispro Injection, Humalog Mix50/50, and Humalog Mix75/25 are contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to insulin glargine, insulin lispro, or any of their excipients.

Warnings and Precautions Never share a prefilled pen, cartridge, reusable pen compatible with Lilly 3 mL cartridges, or syringe between patients, even if the needle is changed.Patients using vials must never share needles or syringes with another person. Sharing poses a risk for transmission of blood-borne pathogens.

Changes in insulin strength, manufacturer, type, injection site, or method of administration may affect glycemic control and predispose to hypoglycemia or hyperglycemia. Any changes in insulin regimen should be made cautiously and only under close medical supervision, and the frequency of blood glucose monitoring should be increased. Due to reports of hypoglycemia and hyperglycemia, advise patients who repeatedly inject into areas of lipodystrophy or localized cutaneous amyloidosis to change the injection site to the unaffected areas and to closely monitor blood glucose. For patients with type 2 diabetes, dosage adjustments of concomitant anti-diabetic products may be needed.

Hypoglycemia is the most common adverse reaction associated with insulins, including Basaglar, Humalog, Insulin Lispro Injection, Humalog Mix75/25, and Humalog Mix50/50.Severe hypoglycemia can cause seizures, may be life threatening, or cause death.

Accidental mix-ups between insulin glargine (100 units/mL), basal insulin products, Humalog Mix75/25, Humalog Mix50/50, and other insulins, particularly rapid-acting insulins, have been reported.To avoid medication errors between insulins, instruct patients to always check the insulin label before each injection to confirm that the correct insulin is injected, including the correct insulin brand and concentration.

Do not transfer concentrated insulins (Humalog U-200) from the KwikPen to any syringe as overdosage and severe hypoglycemia can occur.

Severe, life-threatening, generalized allergy, including anaphylaxis, can occur with insulin products,including Basaglar, Humalog, Insulin Lispro Injection, Humalog Mix75/25, and Humalog Mix50/50. If hypersensitivity reactions occur, discontinue use; treat per standard of care and monitor until symptoms and signs resolve.

All insulin products, including Basaglar, Humalog, Insulin Lispro Injection, Humalog Mix75/25, and Humalog Mix50/50, cause a shift in potassium from the extracellular to intracellular space, possibly leading to hypokalemia. Untreated hypokalemia may cause respiratory paralysis, ventricular arrhythmia, and death. Monitor potassium levels in patients at risk for hypokalemia if indicated.

Thiazolidinediones (TZDs), which are peroxisome proliferator-activated receptor (PPAR)-gamma agonists, can cause dose-related fluid retention, particularly when used in combination with insulin.Fluid retention may lead to or exacerbate heart failure. Patients treated with insulin, including Basaglar, Humalog, Insulin Lispro Injection, Humalog Mix75/25, or Humalog Mix50/50, and a PPAR-gamma agonist should be observed for signs and symptoms of heart failure. If heart failure develops, dosage reduction or discontinuation of TZD must be considered.

Malfunction of an insulin pump device, infusion set, or insulin degradation can rapidly lead to hyperglycemia and ketoacidosis.Patients using Humalog U-100 or Insulin Lispro Injection in subcutaneous insulin infusion pumps must be trained to administer insulin by injection and have alternate insulin therapy available in case of pump failure.

Adverse ReactionsAdverse reactions commonly associated with insulin glargine products, Humalog, Insulin Lispro Injection, Humalog Mix75/25, and Humalog Mix50/50 are hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, and rash.

Other adverse reactions commonly associated with insulin glargine products, Humalog Mix75/25, and Humalog Mix50/50 are weight gain and edema.

Drug InteractionsCertain drugs may affect glucose metabolism, requiring insulin dose adjustment and close monitoring of blood glucose. The signs and symptoms of hypoglycemia may be blunted when beta-blockers, clonidine, guanethidine, and reserpine are co-administered with Basaglar, Humalog, Insulin Lispro Injection, Humalog Mix75/25, or Humalog Mix50/50.

Click to accessBasaglar Full Prescribing Information, Humalog Full Prescribing Information, Insulin Lispro Injection Full Prescribing Information, Humalog Mix75/25 Full Prescribing Information and Humalog Mix50/50 Full Prescribing Information.

See Instructions for Use provided with pen/vial/syringe.

BV HI BOI SP HCP ISI NOV2019

About DiabetesApproximately 30 million Americans1 and an estimated 463 million adults worldwide have diabetes.2 Type 2 diabetes is the most common type internationally, accounting for an estimated 90 to 95 percent of all diabetes cases in the United States alone.1 Diabetes is a chronic disease that occurs when the body does not properly produce or use the hormone insulin.

About Lilly DiabetesLilly has been a global leader in diabetes care since 1923, when we introduced the world's first commercial insulin. Today we are building upon this heritage by working to meet the diverse needs of people with diabetes and those who care for them. Through research, collaboration and quality manufacturing we strive to make life better for people affected by diabetes. We offer a wide range of therapies and a continued determination to provide real solutionsfrom medicines and technologies to support programs and more. For the latest updates, visit lillydiabetes.com or follow us on Twitter: @LillyDiabetes and Facebook: LillyDiabetesUS.

About Eli Lilly and CompanyLilly is a global healthcare leader that unites caring with discovery to create medicines that make life better for people around the world. We were founded more than a century ago by a man committed to creating high-quality medicines that meet real needs, and today we remain true to that mission in all our work. Across the globe, Lilly employees work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to communities through philanthropy and volunteerism. To learn more about Lilly, please visit us at lilly.com and lilly.com/newsroom. P-LLY

This press release contains forward-looking statements (as that term is defined in the Private Securities Litigation Reform Act of 1995) about Humalog (insulin lispro injection 100 units/mL), Basaglar (insulin glargine injection 100 units/mL), and Humalog Mix75/25 (insulin lispro protamin and insulin lispro injectable suspension) as a treatment for patients with diabetes and reflects Lilly's current belief. For further discussion of these and other risks and uncertainties, see Lilly's most recent Form 10-K and Form 10-Q filings with the United States Securities and Exchange Commission. Except as required by law, Lilly undertakes no duty to update forward-looking statements to reflect events after the date of this release.

PP-DB-US-0697 1/2020Lilly USA, LLC 2020. All rights reserved.

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SOURCE Eli Lilly and Company

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Lilly plans donation of 200000 insulin KwikPens over next three years to support lower-income communities - P&T Community

Recommendation and review posted by Bethany Smith

Hitting the snooze button more? Having a lot of off days at the gym? If you exercise seven days a week without any rest, you might be exhibiting signs of overtraining. Trying to power through your workouts when you're not feeling right can sabotage your fitness goals and lead to more serious problems.

Both your mind and your body need a break from the gym.

Credit: John Fedele/Tetra images/GettyImages

Here, Geoff Tripp, CSCS, certified personal trainer and head of fitness at Trainiac, shares five reasons you shouldn't be working out every day, plus how often you should hit the gym for optimal results and overall health.

If you train without recovery days, you're likely to encounter a sharp decline in adaptation, or your body's ability to absorb the training load, Tripp says. When this happens, you'll usually experience exhaustion, weakness, and "excessive soreness that lingers for days," he says.

And when you feel like crap and can't perform your best, you're more prone to hurting yourself. Going beast mode 24/7 and not following a proper recovery protocol can result in overuse injuries like tendinitis or stress fractures, according to the Mayo Clinic.

What's more, pushing too hard all the time can also throw your hormones into chaos. Overtraining can lead to problems with your adrenal glands and hormonal imbalances that cause chronic fatigue, per a February 2013 review in the Journal of Novel Physiotherapies.

"Just like we can see a stall in physical adaptation, we can also see a slowing of weight loss due to overtraining," Tripp says. Exercise taxes your body, and working out too hard and too much can increase stress hormones like cortisol. And persistently elevated cortisol levels are associated with obesity and a larger waist circumference, according to a February 2017 study published in Obesity.

To make matters worse, chronic stress can increase your appetite and cravings for foods high in fat and sugar, according to Harvard Health Publishing. Conversely, some people may lose the desire to eat when overstressed due to overtraining, Tripp says. Under-eating forces your body to shift into conservation mode, he says. That is to say, it protects itself from starving, and, in doing so, stops weight loss in its tracks.

A big drop or steady decline in heart rate variability (HRV) is a telltale sign of stress that someone's been burning the fitness candle at both ends, Tripp says. HRV a measure of the variation in time between each heartbeat is regulated by the autonomic nervous system, which is responsible for the body's fight-or-flight and relaxation responses, according to Harvard Health Publishing.

An HRV on the low end which happens when you overtrain indicates that your system is operating in fight-or-flight state whereas a higher HRV signifies a more relaxed condition. In other words, when you regularly overdo it at the gym, your body's stress mode remains turned on. Prolonged stress can increase your risk for a range of health problems, from heart disease to digestive issues and cognitive impairment, per the Mayo Clinic.

Can't drag yourself off the couch? Lack of motivation is another big red flag when it comes to overtraining, Tripp says. Turns out, pushing yourself too much not only exhausts you physically, but also mentally and emotionally. In fact, overtraining has been associated with depressive feelings, according to a March 2012 review published in Sports Health.

"If you begin to experience sluggish workouts, general tiredness and little enthusiasm for exercise, it's time to take a few rest days or even a full week for recovery," Tripp says. "A recovery week can focus on light cardio activities, mobility activities, clean nutrition and sleep."

Struggling to roll out of bed in the morning? Sleep is essential for repairing, growing and strengthening your muscles. That's because working out especially weight-lifting creates microscopic tears in your muscles, and you need rest to heal and rebuild them.

"If you're experiencing restless sleep after a string of very active weeks, you could be teetering on the edge of overtraining," Tripp says. And, unfortunately, the stress that results from overdoing it at the gym isn't improving your sleep quality. Case in point, a November 2015 review in Sleep Science linked high levels of the stress hormone cortisol with insomnia.

That depends on your fitness level and health goals, Tripp says. The current Physical Activity Guidelines for Americans recommend at least 150 to 300 minutes a week of moderate-intensity cardio or 75 to 150 minutes a week of vigorous-intensity aerobic physical activity, plus muscle-strengthening activities of moderate or greater intensity two or more days a week.

But "rest days should be a part of everyone's weekly workout schedule too," Tripp says. "Generally, when you have an overtraining issue, it's a combination of too many intense efforts in a row and not enough easy days."

The main takeaway? Don't go full throttle every day, and when you do have a particularly tough sweat session, offset it with a rest day or active recovery. Go on an easy hike, take a yoga class or focus on breathing and meditation, Tripp says.

Always listen to your body. Everyone has off days, but if you feel like every workout is a struggle, it's time to take a break.

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Why You Shouldn't Work Out Every Day Without Rest Days - LIVESTRONG.COM

Recommendation and review posted by Bethany Smith

Got to lunchtime and suddenly realised you forgot to take your contraceptive pill this morning? Or worse, looked at the packet and realised you missed it yesterday too? If you're not planning on procreating any time soon, that sudden feeling of pregnancy panic and anxiety about what you should do next can be very real.

Missed pill advice can be pretty confusing, so Dr Juliet McGrattan is here to walk you through what you should do if you forget to take you contraceptive pill and when you might need emergency contraception.

Remember: if you arent using your pill for contraception and only take it to treat medical conditions such as heavy periods, then theres no need to worry, you can just take the pill youve missed and carry on as normal.

There are three factors that are important to take into consideration when it comes to missing a pill: what type of pill you are taking, when you last took your pill and where you are in your pill packet.

Containing a combination of oestrogen and progestogen, combined oral contraceptives (COCs) are the most common type of contraceptive pill. Theyre taken daily with scheduled breaks for withdrawal bleeds.

After 21 days of daily pills, the level of hormones in your system is enough to protect you from pregnancy during a seven-day break. Its easy to see how missing a pill and extending this break by forgetting one just before or in the first few days after the break could put you at risk of pregnancy.

Take the pill as soon as you realise youve missed it and carry on as normal. Dont change the timing of the next pill, it doesnt matter if you end up taking two close together. Theres no need for extra contraception, your hormone levels wont have dropped enough to put you at risk of pregnancy.

When youve missed two or more pills, the level of hormones may have dropped enough to put you at risk of pregnancy. Take the most recent pill youve missed and leave the others. Carry on taking your pills as normal but to avoid pregnancy, either avoid having sex or use another method of contraception such as condoms for seven days.

If you are due to have a pill break within these seven days, dont take the break, just go straight onto the next packet. Remember, if you use an everyday (ED) COC then you will need to miss out the inactive tablets in the pack and go on to a new packet starting with the active pills.

You may need emergency contraception so read on.

If youve missed two or more pills, then you might need emergency contraception if youve had unprotected sex within the last seven days and if any of the following applies:

Its important to take emergency contraception as soon after sex as possible. The most effective form is insertion of a copper intra-uterine device (IUD) into the uterus (womb) but there are also hormone tablets that can be taken to prevent pregnancy. No method is 100 per cent effective but the sooner it is taken, the better. You can access emergency contraception in a number of ways including through a Family Planning clinic, your GP, your pharmacist or a sexual health clinic.

There are certain COCs where missed pill advice is different. If you are taking any of the following COCs; Qlairia, Daylette, Zoely and Eloine. Please read the information sheet that comes with the pills and contact your doctor or family planning clinic for further advice.

The progestogen only pill (POP) only contain progestogen, theres no oestrogen in them. They are taken continuously without a break so there are no pill free days and you simply finish one packet and go straight on to the next.

POPs need to be taken at the same time every day for them to be effective. For most POPs, there is a three-hour window in which to take them, for POPs containing the progestogen called desogestrel, there is a 12-hour window.

Simply take the late pill and carry on as normal, theres no need to worry.

If you are more than three hours late (or more than 12 hours for desogestrel POPs) Take the most recent pill you have missed and carry on. Dont change the timing of the next pill, it doesnt matter if you end up taking two close together. You are at risk of pregnancy so you need to abstain from sex or use another method of contraception for two days. If you have unprotected sex during these two days you may need emergency contraception. See the advice above regarding this.

If you miss a pill, then dont bury your head in the sand. Prompt action and emergency contraception if necessary can prevent unplanned pregnancies. Read the instruction leaflet that comes with your pill packet and speak to your GP, practice nurse, family planning clinic, pharmacist or sexual health clinic if you need advice. You can also get advice and information on the Family Planning Association website.

For contraceptive pills to be effective you need to be a good pill taker. Some people find this easier than others. Here are some things you can try to make sure you dont miss pills in the future:

Find the best time of day for you to take your pill. For some women this is in the morning but for others the evening or at lunchtime is best.

Associate pill taking with something you do every day such as brushing your teeth or making a cup of tea.

Set a reminder on your phone.

Use a specific pill taking app to keep you on track, some will give you advice about missed pills too.

For further advice and information on contraception, try one of the following:

Last updated: 30-01-2020

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Missed contraceptive pill: what to do if you miss the combined contraceptive pill or the progestogen only pill - Netdoctor

Recommendation and review posted by Bethany Smith

If you have a confirmed testosterone deficiency, its important to identify if there are any reversible causes that can be addressed before committing to, what should be considered a lifelong therapy. Testosterone Replacement Therapy (TRT) is an involved process. In my professional opinion, the most effective method of replacement is daily Testosterone Cypionate and Human Chorionic Gonadotropin (HCG) injections. Your dose is carefully titrated to normalise your male androgen levels.

TRT is an involved process, its a financial commitment and its a time-consuming process. Two daily subcutaneous injections, admittedly with a tiny 29-gauge insulin needle, preparation of your multi-dose vial, every 3 months for Testosterone Cypionate and monthly for HCG, regular blood tests, additional blood tests after a protocol change. We have patients from all over the UK, Europe and further afield, they all have an initial face to face consultation and yearly thereafter, the rest can be managed remotely. Some of my patients travel thousands of miles, Denmark, Norway, Spain, Portugal, Dubai, the Philippines to ensure they receive Gold Standard care. Londoners often complain a trip to Poole is too far, little do they know.

TRT has traditionally been thought of as simply replacing the testosterone. It makes sense, replace the testosterone that is deficient. The issue lies with the subsequent negative effect on other important parameters administration of exogenous testosterone has on the body. Injecting testosterone shuts down the Hypo-pituitary Gonadal (HPG) axis, you know longer produce Lutenising Hormone (LH) and Follicle Stimulating Hormone (FSH) from the pituitary gland in the brain. LH stimulates the Leydig cells of the testes to produce testosterone, the FSH stimulates the Sertoli cells to produce sperm through a process called spermatogenesis.

HCG mimics LH, it is used in the treatment of male infertility. Intra-testicular testosterone is partly converted to oestradiol by the aromatase enzyme, this helps facilitate spermatogenesis. The Mens Health Clinic now has 20 pregnancies with the concurrent use of HCG alongside testosterone. Its important to appreciate that there are LH receptors all over the body, most noticeably the brain. HCG is clearly important to help maintain fertility and testicular size, but its effects are more wide ranging. Men report an improved sense of well-being and libido using HCG alongside testosterone.

I am uncomfortable with allowing an organ, in this case your testicles, to atrophy with testosterone monotherapy. It seems illogical to me that this should be accepted. I believe that irrespective of whether you want to conceive or not, you should replace this hormone. TRT should be considered hormone replacement therapy (HRT), we should be maintaining function with HCG and supplementing with testosterone to ensure your male androgen levels are normalised.

I am rather shocked and appalled that the medical community has such a simplistic approach to TRT, as one NHS Endocrinologist recently said to me either the patient wants to retain fertility in which case you offer HCG or they do not want to retain fertility in which case you treat with testosterone. This regressive and outdated attitude and approach to TRT is one of the reasons men are willing to travel from all over the world to The Mens Health Clinic, Gold Standard care.

More:
Testosterone Replacement Therapy or Hormone Replacement Therapy? - Reno Hotline

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Stress is most definitely a mood killer and life stressors can hit us at any angle.

From relationship woes to financial troubles, illnesses, work and fatigue, finding the time and energy to focus on your body and partner in tandem could be the last thing on your mind.

Kate Moyle, a sex expert for LELO a company that specialises in pleasurable toys told The Express: Sex lives need nurturing. They won't just change or improve on their own. The couple needs to make a commitment to doing or trying something new together.

I often talk to couples about trying to change one thing each time that they have sex, and this could be as small as starting with clothes on or off, taking the bedding off and making a bed on the floor, lights on or lights off, trying a new position, using lubricant or not, introducing a sex toy, giving a massage - the list is endless.

READ MORE: How to sleep: Sniff this oil before bed to get a good nights sleep

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Low libido: Your daily life could be affecting your sex drive - how to increase libido - Express

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Weearnacommissionforproductspurchasedthroughsomelinksinthisarticle.

If youve been in a romantic relationship, youre probably used to holding hands. Whether youre walking together or sitting down to relax, its a nice experience.

But aside from being a natural, romantic activity for couples, holding hands strengthen your emotional connection too. Theres a good reason for this too.

According to Silva Neaves, psychosexual and relationship psychotherapist, when you hold the hand of someone you love, your breathing starts to sync up with the person youre with. She also revealed that emotions will flow from one person to the other.

Speaking to Cosmopolitan, she said, It appears that holding hands serves the purpose to feel a deepening in human connections.

In addition to this, Silva said, Many studies in neuroscience show that touch produces oxytocin, a feel-good chemical that is very good for your mental and physical health.

Credit: Getty Images

Oxytocin is a hormone that promotes bonding, connection, empathy and trust, and is also the hormone that is released during sex. Our hands are one of the most sensitive parts of our bodies, so it makes sense that theres a deep emotional connection when you hold the hand of someone you love.

Dr Becky Spelman from Private Therapy Clinic added that holding hands means we can instinctively interpret the other persons anxiety or comfort levels. We can do this by feeling how much theyre sweating, their pulse, and the strength of their grip.

Hand holding is also a learned behaviour, as Dr Spelman points out that babies are born with a grasping reflex and will curl their tiny hands around any finger placed in their palm.

The act of hand holding is associated with safety too, as parents hold childrens hands to keep them safe when crossing the road. Childhood behaviours can transfer to romantic relationships later in life, so it makes sense that hand holding is considered intimate when were in relationships.

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This is why holding hands with your partner deepens your bond - goodtoknow

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On Thurs Jan 23, University of Toronto professor of psychiatry Dr. Ken Zucker, a leading international expert on gender dysphoria, and editor-in-chief of Archives of Sexual Behaviour, spoke at McGill University. Dr. Zuckers presentation was titled, Children and Adolescents with Gender Dysphoria: Some contemporary research and clinical issues.

Inviting Dr. Zucker to speak in an open forum was an act of courage, as he is Canadas most controversial researcher/clinician in this domain. In a recent column for the National Post on the run-up to this event, I summarized the story of his persecution by hostile trans activists and linked to a more detailed account.

Dr. Zuckers critics accuse him of practicing conversion therapy, by which they mean his objective is to prevent his patients from transitioning. But what Dr. Zucker actually practices, as he explained to me in an interview, is Developmentally Informed Psychotherapy.

In laymans terms, Dr. Zucker looks at his patients holistically in order to determine if the distress that brought them to his attention is a function of gender dysphoria alone, or gender dysphoria as one of a number of factors, including issues arising out of family dynamics, autism spectrum disorder, depression, anxiety and so on. If in the course of treatment, it becomes clear that finding comfort in his or her natal sex is a reasonable goal for the client, Dr. Zucker offers guidance to that objective. If it becomes clear that only transition will answer to the patients need, Dr. Zucker endorses transition, and puberty blockers or hormone therapy as required.

But any form of traditional psychotherapy is considered to be a form of subversion by many trans activists because trans activists reject assumptions that gender dysphoria is a disorder or even a distress requiring psychotherapy. Their watchword is affirmation, the assumption that if a young child even as young as three says he or she wants to change genders, they know what they want and their wish must be respected, often without any further exploration at all before social transition is encouraged.

Watchful waitingwithholding immediate affirmation, giving the childs parents and professional observers time to assess the depth and putative permanence of the expressed desireis also anathema to a small, but vocal group of trans advocates. To these activists, Dr. Zuckers perspective is superannuated, offensive and, in their discourse, harmful. It was a given that the announcement of the event would spark protest. It was just a matter of what kind, and how obstructive it would be.

The presentation was sponsored by the Culture, Mind and Brain Program, a subdivision of McGills Division of Social and Transcultural Psychiatry. Assistant professor of psychiatry Samuel Veissire, co-director of the program, who headed up the organizing team for the talk, was fully cognizant of the tension that would surround it, and did a great deal of spadework in reaching out to stakeholding organizations like Queer McGill, expressing sympathy for their concerns and soliciting their attendance.

Some individuals from these groups did attend, although McGill Equitys Subcommittee on Queer People preferred to hold their own alternative positive space for trans and non-binary students, staff and faculty (and their allies) who would feel the need to gather and be together in solidarity[with] snacks, tea and hot chocolate [provided].

The important thing is that protest was carried out on Facebook pages calling for boycotts of the event, and letters to the administration asking for cancellation (the administration did not waver in the face of this pressure, to their credit), rather than in attempts to physically inhibit, or even shout down the speaker. In fact, not a single active protester showed up at the lecture site in McGills Neurological Institute-Hospital (the Neuro), and those who came to the lecture itself with a view to challenging Dr. Zucker, listened respectfully, calmly voicing their disagreements with him in the extended Q&A. That in itself is a triumph in these days of cancel culture and a tribute to the organizers and to the maturity of the opposition.

A trans-advocacy mantra one continually hears from those protesting the scholarship of Dr. Zucker and others with his perspective is nothing about us without us. That is, trans advocates believe they have the right to participate in any public forum on this subject, because science, they rightly observe, is never entirely neutral, and has often been exploited to uphold societal values, notably in the case of homosexuality, which was only depathologized in medical texts mere decades ago.

They are understandably defensive about research, however sound by objective standards, that might be driven by unconscious bias. Whether that suspicion confers a right to insert representation of their own belief system into all public forums in which opposing views are featured is debatable, to say the least. Practically speaking, if that were the rule, scholars like Dr. Zucker would find their time slots so reduced in length as to trivialize their contribution.

Prof Veissire addressed these concerns with exquisite delicacy and eloquence in his introductory remarks to the full lecture room:

Two key issues in particular strike me as exceptionally important. These two issues are in fact questions. They are questions about neutrality and advocacy, on the one hand, and questions about who can speak for whom on the other In recognition of past and ongoing medical injustice, I want to proposespeaking from my own perspective herethat the relevant point here is not so much that science cannot be neutral, but that it shouldnt be.

I speak as an anthropologist and cognitive scientist now, as one who is committed to documenting and honouringa set of core values found in absolutely all cultures.These are the values ofcharityfor those in need,hospitalityto those different from us, and commitmentto the greater human good.Charity and hospitality also teach us to engage inforgiveness andreconciliation.These core values are often translated and lived in traditions ofloving-kindness..

Given its long and ongoing history of marginalization, the trans community can often feel excluded and harmed when conversationsabout themare taking placewithout them.We all need to listen to this point and learn from it.Similarly, when some parents who are doing their best to help their gender-nonconforming child live a good life tell us they feel excluded from the current conversation when they want to ask more questions, we need to listen and learn.When individuals for whom transition didnt work tell us they feel excluded from this conversation, we need to listen and learn.

This is what I want to invite you all to do together today. Listen to and learn from each othersdiverse perspectives and experiences in the spirit of loving kindness and democracy.

Tucked in between the statistics, graphs and pie charts of his PowerPoint, Dr. Zucker made allusion to certain trigger points. One is the widely acknowledged fact in the non-trans academic community that most effeminate little boys are not gender dysphoric, but gay. These desistors children whose gender preference may be ambiguous in childhood, but who after puberty revert to comfort in their natal sex, albeit with same-sex preference, present a difficulty for trans advocates. Were they really trans to begin with, if they can revert? This begs the question of what it means to know you are in the wrong body. In his somewhat puckish manner, Dr. Zucker slipped in some zingers. Noting the disappearance of the butch lesbian, Dr. Zucker asked, Is trans the new tomboy?

Another hot button in the clash between unconditional affirmers and watchful waiters is the looming shadow of suicidality. Better a trans kid than a dead kid is a frequently adduced trans credo. Here Dr. Zucker pointed out problems in methodology with the various alarmist suicidality studies. Some predictors of suicidal ideation, he said, were general behavioural problems and, for example, being female in a single-parent family. Adolescents with gender dysphoria that are referred for treatment do indeed demonstrate higher rates of suicidality, but then so do non-trans kids who are referred for other problems. This is an area that needs more research and more control groups, he said.

Rapid Onset Gender DysphoriaROGDis the most divisive and controversial issue in the debate. The cynosure for trans advocates anger is a study on ROGD published by researcher Lisa Littman of Brown University on PLOS ONE, the most downloaded study in that journals history. It suggests that for many teenage girls (the great majority of ROGD subjects), identifying as trans is a maladaptive coping mechanism for girls suffering from other problems, and its startling escalation expressive of a social contagion. Dr. Zucker alluded to the reception of the report by trans advocates as an attack on trans people and a debunked right-wing conspiracy theory.

(Full disclosure: I have met with many of the parents cited in the Littman study as part of my work. The accusations against them by hostile trans activists are absurd and defamatory. Those I met are loving parents, tortured by their childrens sudden conversion and withdrawal from thema strategy promoted on the websites they are obsessed withand desperate to help them achieve mental and psychological stability. They are neither politicized nor biased against homosexuality or gender dysphoria. The Littman study, in my opinion, is responsibly conceived and executed, persuasive and grounded entirely in good-faith efforts to understand an unprecedented social phenomenon.)

The ROGD debate hinges on treatment. In The Netherlands, Dr. Zucker noted, the Dutch do longer assessments before prescribing blockers or HRT, so treatment may only begin two years after referral. In Canada, you can be prescribed blockers after 15 minutes. Theres food for thought there, no matter what side of the debate you are on.

The Q & A was intense but restrained.

Standouts: a young woman, a detransitioner who had stopped taking hormones and wished to live in accordance with her biology, spoke quietly and sadly about her experience of being encouraged into hormonal transitioning by therapists in spite of a history of depression. She had experienced suicidal ideation as a result of her experience. She believes therapists should insist that anyone with depression be treated primarily for that, only secondarily for gender dysphoria.

Literally and figuratively on the other side of the room, a young transman countered with I was mentally ill and also trans, declaring that if it were not for rapid affirmation and treatment, he would have committed suicide. Dr. Zucker responded that in his opinion an individual is not getting good quality care if she or he is not treated holistically. He noted, however, that some advocates are arguing that mental health people should no longer be involved in the transition process altogether.

Thats worrisome for those of us opposed to radical trans solipsism, because what is argued for today may well be public policy tomorrow. After all, conversion therapy is illegal in some provinces already, and a Senate Bill (S-260), presently in first reading, seeks to have it included in the Criminal Code.

Many of the attendees were academics in this domain. Prof Veissires was gratified in particular that a leading trans positive researcher in the field from the Universit de Montral had not only attended, but engaged in a collegial discussion with Dr. Zucker during the Q & A, and afterward. This was precisely the form of reconciliation he was seeking to encourage.

One student spoke to the freedom of speech issue, arguing that even if people feel harmed, higher education institutions exist to accomplish goals that override the putative right not to be offended. Universities must deliberate all sides of issues, so that later we arent flailing making policy decisions. The Neuro, he pointed out, is not only a learning institution but a clinic that aims to relieve actual harms and sufferings. Theres a cost/benefit analysis to be done.

As you see, the mixed audience raised a gamut of difficult questions, and I think all present felt their minds were stretched in a positive way by the need to juggle their own settled opinions with opinions they do not normally hear in their academic and social silos. Was the young transman harmed by hearing the point of the view of the detransitioning woman? Were the many trans allies present harmed by the opinion that freedom of speech in universities should take precedence over the wish not to be offended? I saw no evidence of that, and I hope all those present would agree that the space was safe for everyone.

If you have read this far, I congratulate you on your stamina and thank you for your patience. I have gone on at such length, because although McGills administration stood fast on this invitation, I have seen enough of the correspondence around the event between and amongst trans stakeholders in the McGill community to fear that wheels have been set in motion with a view to formal internal roadblocks that would preclude further invitations to speakers whose views do not align with those of gender-fluidity theorists. I therefore wanted to be on record in a detailed way as a witness to the success of the program.

Two attendees referred to Dr. Zuckers presence as provocative. The logic in applying the word provocative is circular. Basically, it means, We, trans advocates and allies, do not approve of Dr. Zuckers findings or conclusions or clinical principles because some of them conflict with our preferred understanding of the phenomenon of gender dysphoria. We cannot prove that our findings are more scientifically viable than his, but since his are offensive to us, they must be provocative in general.

This is the Humpty-Dumpty school of rhetoric. It is professionally feckless, not to mention an unworthy smear of Prof Veissire, whose compassion for gender-dysphoric people is palpable, and whose invitation to an ultra-accredited colleague to speak on the issue was issued in good faith.

Moreover, there is debate within the trans community itself overdiagnosis and treatment, and many non-ideological trans people find such provocative opinions as Dr. Zuckers both reasonable and admirable. Where childrens interests are at stake, the precautionary principle should never be considered offensive. Provocative should be reserved for hatemongers, or speakers of dubious accreditation in spouting demonstrably fallacious theories (an accusation often directed at gender theorists themselves, but without attempts to de-platform them on that account).

Beyond suggesting that Dr. Zuckers ideas are both wrong and dangerous, there is a further dimension to the word provocative that I think most people outside the trans movement find disturbing.

The trans movement has worked very hard to normalize the concept of gender fluidity. Transgenderism is often wrongly conflated with homosexuality. But living happily gay does not involve bodily changes, lifelong medication or surgery to produce psychological comfort with ones biology or gender.

As a consequence of accepting that gender transitioning is normal, however, one must accept easy and immediate affirmation, and everything that goes with itpuberty blockers, cross-sex hormones, surgeries, infertilityas normal too. If society, in general, accepts this premise, then parents who wish to slow down this allegedly normal process may legitimately be labelled obstructive. Their stubbornness in resisting rapid affirmation may be labelled provocative as well.

As a result, prudent and protective parentswhat I would call normal parents are often positioned as enemies of the childand their status as enemies is often communicated to the child. The isolated child finds a new family amongst the many trans allies only too happy to welcome him or her into the fold. The distress of parents caught up in this Kafkaesque nightmare, as I learned firsthand from interviewing parents of ROGD teenagers, cannot be overstated.

Observers in the public are extremely uneasy about this situation. They know very well that true gender dysphoria is quite rare. But they also know that in the present cultural climate, it is increasingly difficult to find a therapist or educator who does not recommend instant affirmation. They feel they will be vilified for stating the obvious in what they wish for their children.

They know, and so do we all that: it is preferable to be comfortable in your own body than uncomfortable; it is preferable to expend ones mental energies on the world around one than to be constantly mentally consumed by ones gender identity; it is preferable to live a life free of daily hormone ingestion and not at risk for their negative side effects than to be condemned to a lifetime of them; it is preferable to know that having children or not will be an informed adult choice than a choice made for you when you are incompetent to understand its ramifications; it is preferable to live life in a whole body than in a mutilated one; it is preferable to have uncomplicated sexual relations as an adult than complicated.

All parents want to see their children following the path of least resistance to health and happiness. Thus, all these statements being so evidently true, they ought to be considered banal. But todaybecause it is provocative they must not voice these banalities. They are afraid, reasonably so, that they will be labelled transphobic.

Sadly, we now see parents who pretend for the sake of wokeness that it is a matter of indifference to them whether their child is comfortable in his or her natal sex or prefers to transition. We even see parents who establish an artificial environment of gender neutrality to create a level playing field between the two outcomes. They win fawning plaudits from a vocal band of activists, but the silent majority of people are appalled by such social engineering, the use of ones own children as gender-theory lab rats

This is why many of those who can afford to turn to Dr. Zucker for guidance when their children show signs of gender confusion, which may be transient or early evidence of homosexuality, or which may be signs of genuine and permanent self-identification as the opposite sex. They know he will allow them to express their preference and their fears without judgment, but if it turns out to be necessary, will help them to accept what they fear with empathy.

I walked down the mountain from The Neuro to Sherbrooke St with Dr. Zucker after the event, and we held an informal post mortem of it. That it was not cancelled was in his eyes a good outcome.

We both mused on the strangeness of trans activists demands that they be part of every presentation regarding gender dysphoria. Their slogan, nothing about us without us suggests that researchers are talking about them as individuals rather than the phenomenon of gender dysphoria. To my mind, theres a certain narcissism in such an absurd implication. Anorexics do not demand to be given equal time with anorexia researchers in the public forum. Neither do people with Autism Spectrum Disorder, even though in the past science was not particularly kind to them either.

Dr. Zucker treats children from toddlerhood on. Exploration of all contributing factors is extensive and as leisurely as necessary. He says occasionally a therapeutic breakthrough can turn on a dime. In one case, as an example, the underlying issue for the girl a natal female expressing the wish to transition to male was a conflict with her abusive father. Her epiphany came one day when Dr. Zucker asked her, If you are afraid of your father, why do you want to be the same gender as he is? This brought her up short, he said, and she was silent. The next day, she told him she had decided she wanted to remain a girl.

I asked him how many of his patients resolved their distress without a need for transitioning, and ended up identifying with their natal sex. As if he knew that question was cominghe surely must have knownDr. Zucker briskly replied, eighty-eight percent. It is probably just as well that the question and the provocative answer did not arise in the Q&A.

See the rest here:
Convicted sex predator of young children to be released for being trans - The Post Millennial

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Shift workers comprise more than 15% of the U.S. workforce, with 10% demonstrating shift work sleep disorder (SWSD). SWSD is a circadian rhythm disorder caused by a reduction of total sleep time due to a work schedule and has been found to be associated with hypogonadism in men.1 Pastuszak et al. had previously provided the foundation for this research, identifying that non-standard shift workers with poor sleep quality were at increased risk for hypogonadal symptoms and sexual dysfunction.2

In this present study, Balasubramanian et al. surveyed men presenting to a single academic mens health clinic between July 2014 and June 2017. The administered research instruments included questionnaires about work schedules, a validated SWSD screening questionnaire and validated questionnaires such as the Androgen Deficiency in Aging Males (ADAM) and non-validated quantitative Androgen Deficiency in Aging Males (qADAM) questionnaires. Ultimately, the authors found that males working non-standard shifts with a high risk for SWSD had worse hypogonadal symptoms and lower testosterone levels compared to daytime workers and non-standard shift workers with low risk for SWSD.The authors provide important insights into the emerging relationship between sleep quality and hypogonadism. Separate studies assessing the impact of obstructive sleep apnea and sleep restriction on testosterone levels have been performed, similarly concluding that poor sleep quality is associated with hypogonadal symptoms.3,4 While the mechanism between sleep quality and hypogonadism is not completely understood, it is evident that further research into this relationship is critical for optimizing the care for patients with SWSD and hypogonadal symptoms. As sleep is increasingly recognized as a determinant of overall health, future work will continue to define the role of sleep habit modification in the management of men with hypogonadal symptoms, particularly amongst those who may be considered ineligible for testosterone therapy based on current American Urological Association (AUA) guidelines.

Written by: Eric M. Lo, Adithya Balasubramanian, LarryI. Lipshultz, Baylor College of Medicine, Houston, Texas, USA.

References:

Excerpt from:
Increased Risk of Hypogonadal Symptoms in Shift Workers with Shift Work Sleep Disorder - Beyond the Abstract - UroToday

Recommendation and review posted by Bethany Smith

Hypothyroidism, hyperglycemia, and low adrenocorticotrophic hormone (ACTH) levels are associated with lower bone mass in patients with thalassemia major, according to study results published in The Journal of Clinical Endocrinology & Metabolism.

The major mechanisms of endocrine dysfunction that lead to decreased bone mineral density (BMD) and increased risk for fracture in patients with thalassemia major remain poorly understood. Researchers aimed to identify the mineral and hormonal factors associated with low BMD in adults with -thalassemia major in a retrospective study of patients who received treatment at the National Taiwan University Hospital (ClinicalTrials.gov Identifier: NCT03951818).

Medical history was obtained for 29 patients (51.7% women), including bone-associated biochemical markers such as serum calcium, phosphorus, intact parathyroid hormone, vitamin D, and fibroblast growth factor 23 levels. Pituitary function and thyroid hormone levels were used as a proxy for endocrine function. BMD was measured using dual-energy x-ray absorptiometry. Expected height was calculated for each individual based on parental height from patient records.

The mean observed height across all patients was lower than expected (women, -3.7 cm; men, -7.3 cm). Abnormal BMD, defined as a z score 2 standard deviations away from normal BMD, was observed in 42.9% of women and 23.1% of men. In addition, 26.7% of women and 35.7% of men had a history of fracture. Vitamin D deficiency (women, 100%; men, 81.8%), hypogonadism (women, 60%; men, 57.1%), and growth hormone deficiency (women, 75%; men, 57.1%) were highly prevalent in the study group.

Several factors were associated with either femoral neck or lumbar spine BMD, but only thyroid status and lower ACTH levels correlated with BMD at both sites (P <.05). Along with thyroid status (P =.016) and ACTH levels (P =.005), glycated hemoglobin levels (P =.039) were significantly different in patients with normal vs abnormal BMD. When included in a multivariate regression model adjusted for ferritin level, age, and sex, however, hypothyroidism was the only factor significantly associated with lower femoral neck BMD (P =.034). Patients with hypothyroidism had lower BMD at both the lumbar spine (P =.024) and femoral neck (P =.004). No association was found with fracture risk.

Our study is the first study to review the complete endocrine and mineral profiles to identify factors related to the severity of decreased BMD in patients with [thalassemia major], the researchers noted. We found that hypothyroidism and hyperglycemia were the most relevant factors of lower bone mass, while ACTH had a protective role.

The researchers also noted that the interplay between these factors supports the idea that iron overload may be a driver of decreased bone mass in patients with thalassemia major.

Based on these findings, it is promising to conduct interventional trials in the future that evaluate the effect of treating hypothyroidism or glycemic control on BMD and the risk of fracture in patients with [thalassemia major], the researchers concluded.

Reference

Yang WP, Chang HH, Li HY, et al. Iron overload associated endocrine dysfunction leading to lower bone mineral density in thalassemia major [published online January 7, 2020]. J Clin Endocrinol Metab. doi:10.1210/clinem/dgz309

This article originally appeared on Endocrinology Advisor

The rest is here:
Mineral, Hormonal Dysfunction Associated With Lower BMD in Thalassemia Major - Rheumatology Advisor

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GlobalHormone Replacement Therapy (HRT)Market study of 118+ data Tables, Pie Chat, Graphs & Figures spread through Pages and easy to understand in depth analysis. Hormone Replacement Therapy (HRT) Market by Type(Oral, Parenteral, Transdermal, Others),by Application(Menopause, Hypothyroidism, Male Hypogonadism, Growth Hormone Deficiency, Others)and Region Forecast and Status to 2026. At present, the market is developing its presence. The Research assessment of the Market contains a historical trend, current growth factors with opinions view & industry certified market details. The research study provides estimates for Global Hormone Replacement Therapy (HRT) Forecast till 2026*. The report provides key statistics on the market status of the leading market players and offers key trends and opportunities in the Hormone Replacement Therapy (HRT) Market.The major players covered in Hormone Replacement Therapy (HRT) areAbbott Laboratories, Novartis, Pfizer, Mylan Laboratories, Merck & Co., Amgen, Novo Nordisk, Bayer, Eli Lily, Wyeth, Genentechand others.

Request for Sample Report @https://www.industryandresearch.com/report/Hormone-Replacement-TherapyHRTMarket-by-Type-Oral-Parenteral-Transdermal-OthersApplication-Menopause-Hypothyroidism-Male-Hypogonadism-Growth-Hormone-Deficiency-OthersGlobal-Insights-Trends-and-Forecast-2012-2024/162230#samplereport

computation of The Hormone Replacement Therapy (HRT) Market:

Global Hormone Replacement Therapy (HRT) Market is valued at USD XX million in 2019 and is projected to reach USD XX million by the end of 2025, growing at a CAGR of XX% during the period 2019 to 2025.Hormone Replacement Therapy (HRT) market report examines the short-and medium-term economic and profitability outlook for Hormone Replacement Therapy (HRT) industry.. A comprehensive research report created through extensive primary research (inputs from industry experts, companies, stakeholders) and secondary research, the report aims to present the analysis of Hormone Replacement Therapy (HRT) Market.

Report SynopsisThis report offers an inclusive evaluation of the global Hormone Replacement Therapy (HRT) market. The report cover market revenue forecast, until 2025. The market size presented in the report is based on certain parameters that are considered critical for the evaluation purpose. The complete evaluation is based on factual finding pertaining to production, sales, and consumption trends. The report also includes an intensive discourse on market dynamics such as drivers, restraints, market trends, and opportunities. The scope of the discourse also covers operations and services. Hormone Replacement Therapy (HRT) Market report includes the estimation of market size for value (million USD) and volume (M Sqm). Both top-down and bottom-up approaches have been used to estimate and validate the market size of Hormone Replacement Therapy (HRT) market, to estimate the size of various other dependent submarkets in the overall market.

The study objectives of Hormone Replacement Therapy (HRT) Market:1) This report discusses the market summary & market scope gives a brief outline of the Market.2) Clear information for market players to sustain and enhance their market footprint.3) Analysis of various perspectives of the market with the help of SWOT analysis & Porters five forces analysis.4) Focused Hormone Replacement Therapy (HRT) Market Production, Consumption, Export, Import by Regions.5) Geographic breakdown Historical, current and projected market size in terms of value.6) A neutral perspective towards market performance.

Furthermore, Market Research Following Points Are Included Along With An In-Depth Study of Each Point:

Competitors Key players have been studied depending on product portfolio, their Hormone Replacement Therapy (HRT) company profile, capacity, price, price, and earnings.

Production Analysis Generation of the industry is tested regarding applications, types, and regions with price analysis of players.

Sales & Revenue Evaluation Revenue, sales are studied for this market, involving various elements along yet another facet is appraised in this section for leading regions.

Investigations and Analysis Market investigation, the information, and supply, contact information from manufacturers, consumers and roviders can also be awarded. Additionally, the feasibility analysis of investment and SWOT analysis for attempt has been comprised.

Browse full report @https://www.industryandresearch.com/report/Hormone-Replacement-TherapyHRTMarket-by-Type-Oral-Parenteral-Transdermal-OthersApplication-Menopause-Hypothyroidism-Male-Hypogonadism-Growth-Hormone-Deficiency-OthersGlobal-Insights-Trends-and-Forecast-2012-2024/162230

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Global Hormone Replacement Therapy (HRT) Market: Industry Analysis and Forecast (2020-2026) - NY Telecast 99

Recommendation and review posted by Bethany Smith

Ghaziabad, Jan 23 (IANS) Galactorrhea, in which a whitish or greenish discharge occurs from the nipples, affects nearly 24 per cent of women but has no association with breast cancer, health experts said on Thursday.

Galactorrhea is a milky nipple discharge unrelated to the normal milk production for breastfeeding. It is not a disease itself but could be a sign of an underlying problem. It usually occurs in women, even those who have never had children or after menopause.

According to the doctors at Columbia Asia Hospital in Ghaziabad, pre-menopausal women who are not breastfeeding may experience a condition where they produce breast milk.

The condition may indicate high levels of the hormone prolactin in the body, caused mainly by some malfunction in the pituitary gland that produces the hormone, the experts said.

Galactorrhea may occur when your body produces too much prolactin, (a hormone produced by the pituitary gland in the brain that stimulates the production of milk when a woman has a baby). Any woman who has had a baby, whether or not she breast-fed her baby, may later have galactorrhea, said Vinita Diwakar, Obstetrics and Gynaecology department, Columbia Asia Hospital.

Too much estrogen in the body due to birth control pills or an underactive thyroid gland can also cause the condition. Nipple stimulation due to sexual activity or sports activities such as jogging, can also increase prolactin production, Diwakar added.

According to the hospital, some of the other causes of galactorrhea may include consumption of drugs, such as oral contraceptive pills, some high blood pressure medications, sedatives and antidepressants; disorders or non-cancerous tumours of the pituitary gland; opivid use violactinoma other medical conditions such as kidney failure, cirrhosis of the liver, and tumours of the spinal cord.

If the breast tissue is particularly sensitive to prolactin in blood, it may cause idiopathic galactorrhea the reason for which remains unknown.

In men, galactorrhea may cause testosterone deficiency or male hypogonadism and usually occurs with breast enlargement or tenderness (gynecomastia). It may also cause erectile dysfunction and a lack of sexual desire due to testosterone deficiency, Diwakar said.

If a woman experiences a mild idiopathic galactorrhea, a tight breast support may help stop the discharge by preventing stimulation of the nipples, the doctor said.

In newborns, galactorrhea may be caused due to high maternal estrogen levels that cross the placenta and reaches the babys blood. This can enlarge the babys breast tissue, which may be associated with a milky nipple discharge, though it is temporary and resolves on its own. If the discharge is persistent, consult a doctor, Diwakar stressed.

See more here:
Galactorrhea affects 24% women, not linked to breast cancer - The Sentinel Assam

Recommendation and review posted by Bethany Smith

This weeks Round-up looks to the future, as nanoparticles and stem cell-derived cardiac muscle cells get a closer look. More good news for lovers of yogurt, and a smelly but effective treatment for atherosclerosis as well.

Using stem cells extracted from the patients own blood and skin cells, this Japanese research team completed the first-in-human transplant of cardiac muscle cells derived from pluripotent stem cells. The team achieved this by reprogramming them, reverting them to their embryonic-like pluripotent initial state. I hope that (the transplant) will become a medical technology that will save as many people as possible, as Ive seen many lives that I couldnt save, Yoshiki Sawa, a professor in the Osaka University cardiovascular surgery unit, said in apress report.

Stem Cell-Derived Heart Muscle Transplanted Into Human for First Time: Researchers

Like something from a sci-fi horror novel, this team of researcher examined the role that nanoparticles that eat dead cells and stabilize atherosclerotic plaque may be able to play in the future of atherosclerosis treatment. We found we could stimulate the macrophages to selectively eat dead and dying cells these inflammatory cells are precursor cells toatherosclerosis that are part of the cause of heart attacks, one of the authors said in press release. We could deliver a small molecule inside the macrophages to tell them to begin eating again. The authors noted that after a single-cell RNA sequencing analysis, they observed that the prophagocytic nanotubes decreased inflammatory gene expression linked to cytokine and chemokine pathways in lesional macrophages, thereby treating the cell from the inside out.

Are Nanoparticles Potential Gamechangers for Treating Clogged Arteries?

In this large analysis of more than 120,000 individuals, the authors reported multivariable-adjusted hazard ratios (95% CI for all) for mortality were reduced in regular (more than four servings per week) consumers of yogurt, and there was an inverse relationship between regular consumption and cancer mortality as well as cardiovascular-related mortality in women. In our study, regular yogurt consumption was related to lower mortality risk among women, the authors wrote. Given that no clear doseresponse relation was apparent, this result must be interpreted with caution.

Yogurt Consumption Associated with Reduced Mortality Risk (Plus a Caveat)

This research teamlooked human microphages and compared them to dying cells in a dish. They observed that macrophages reclaim arginine and other amino acids when they eat dead cells, and then use an enzyme to convert arginine to putrescine. The putrescine, in return, activates a protein (Rac1) that causes the macrophage to eat more dead cells, suggesting to the authors that the problem of atherosclerosis may be, in part, a problem of putrescine. The findings, according to the accompanying press release, suggest that the compound could be use to potentially treat conditions with chronic inflammation, such as Alzheimers disease.

The Nose Knows: Pungent Compound Associated with Improvements in Atherosclerotic Plaque

Excerpt from:
Cardio Round-up: Nanoparticles and Stem Cells in the Spotlight - DocWire News

Recommendation and review posted by Bethany Smith