#but also one of the symptoms that can show up early for lung cancer is a cough that can come from irritated airways

[iliveinprocrasti-nationn]

doctors are like “look out for symptoms” and im like “but which ones and how do i know they’re not caused by one of my other issues” and there’s no answer

#going to bed now but anyway #‘bring anything up if you’re concerned’ can we scan my body please just to be safe #i mostly wanna make sure my lungs are fine bc i have bad acid reflux that’s probably gerd so that causes a tickle in my throat a lot #but also one of the symptoms that can show up early for lung cancer is a cough that can come from irritated airways #bad fatigue is also a symptom but again. other issues #i don’t want to get to more worrying coughing or something before we look #im a little paranoid bc i had extensive angioinvasion so we don’t know if there are more cells or if they’re setting up shop somewhere else #in my body. and we probably won’t do rai or if we do it’ll be months until we do it #but yea. shits wild. i probably need a new dr. anyway #im like a vampire but not and also worse

[theroyalthrones]

Behind the Scenes | Various Locations | Rosiers, Toulon, Orillia

beginning | previous | next

script below↓↓

The leaves are falling as Francesca walks. The air is crisp in a way that Francesca had never been used to. Having grown up in the more so humid and warm weather of Castellon. Her little sister is chirping at her on the phone. She will miss these times, Just as she misses the times before the present.

Leandra] Yeah, and my friend’s having a birthday party this weekend. I wanted to go but I don’t no if Papa will let me.

F] chuckles Don’t worry Lea, I’lll convince him.

L] I don’t think you can, he’s already asleep. He’s been sleepy a lot!

F] I’ve got my ways…

As she walks, she can feel people staring at her. They are afar, but they are whispering. As she walks up toward the steps of the building, someone bumps into her. Her things clatter to the ground, but the assailant does not help her pick things up.

Person] watch were you’re going, you gold digging leech.

She feels her cheeks burning, but does nothing instead of walking forward toward her counselors office.

C] Ms. Ortega, there really isn’t anything to complain about. You are on track with a high gpa, and a possibility of early graduation if you keep up the good work.

F]Thank you mr.-

C] but your grades currently… I notice a slip since the semester began.

C] Whoever you might be associating yourself with, might not be in your best interests academically. People like you need to work harder. If things keep going in this direction, Post Graduate options might dwindle.

F] Y-Yes I understand.

C] I hope you do.

The sky is dark, it’s been raining all evening. Lucian and Francesca have been sitting in the library, studying for exams. it’s Finals week, of their sophomore year in school. They’re sectioned off a corner of the busy library. They’ve been there since the morning, and the cluttered desk makes that evident.

Francesca phone rings, it echos in the quiet space. She picks it up and whispers.

F] Lea, I can’t-

L] crying Cesca, it’s dad.

She barely registers the words, she’s up before she can even think. Lucian looks up at her puzzled. She’s hyperventilating, she’s crying.

L] Francesca, what?-

F] My dad- cries harder I-

L] Can you walk?

He carts her over to the door.

L] you need to be there.

F] mmhmm she barely makes out

he cups her face in his hand. he forces her to look at him, to focus on what he’s going to say.

L] Listen, Everything’s going to be ok- you’ll be ok. I’m going to make sure of that, ok Francesca?

F]cries harder

They are now at the airport. They rush in to the check-in area. Things are chaotic in the airport like they always are. Lucian pulls her hand, and spins her around to face him.

14-16

L] Are you sure I can’t come?

F] Yes, Stay. It’s finals, you must take them.

L] But yours-

F] I’ll figure it out, Luc.

L]… I love you, Cesca.

They kiss, and he watches her go. It’s 2093, and little does he know that this will be the last time he sees her in person since that fateful day in the news room, 6 years from then (2099).

Weeks pass as she is in Castellon.

She waits for hours in hospitals that feel like asylums. She is anxious always, she feels the clock ticking. This is a waiting game, her father, in a condition neither thought would be possible.

She is with her sister at times too. Eating dinners in hospital cafeterias after picking her up from school. This is just as hard for Leandra as it is for Cesca. Leandra being the one to find him collapsed.

She has also been feeling increasing sick. She looks and feels terrible in fact. She is fighting symptoms of pregnancy, but of course she does not know that yet. She is also throwing up, and showing signs of pregnancy(and in the details of the post. Show bottles of medicines and stiff)

The doctors come in to announce what had already been in the back of her mind for days now.

D] It’s lung Cancer.

F] shocked gasp C-Cancer?

D] He’s in the fourth stage, Ms. Ortega. It’d be best to get his affairs in order, as he might…

The sentence blurrs out because, No, she isn’t listening. An overwhelming piercing sound overwhelms her. She is in shock, the last parent she has in the world is dying. And it’s too late to save him. In the room full of doctors, Francesca Ortega Collapses.

She wakes up, she herself is in a hospital bed of her own. A nurse who happens to be in the room, rushes to her side. She tries to speak.

F]Wh- What am I?

N] There’s no need to worry. You collapsed due to dehydration and fatigue. Ms. Ortega, were you aware of the pregnancy?

F] Pregn-?

N] Pregnancy—Yes, you are going to have a child, Ms. Ortega.

This shocks Francesca of course, on top of everything, she is also pregnant. Of course things start clicking into place.

“I’m pregnant” she thinks.

Of course, she has been feeling nasceous, sick, fatigued,etc. all of the normal ailments that something like this could cause. She thought it was because of the stress of her father. Of course she understands now, And this understand makes her panic. How is her life going to be even more fucked up than it already has become? How will she go to graduate school with a mortage to pay for? How will she become what she wants with two children to raise(her little sister)? Her life is forever messed up, and how could she wreck his?

She decides she wont, she won’t say a thing. A few months later she begins to show, she’s on the phone with Lucian, who is none the wiser. (in the shot, show her with a close up on the phone, and then a wide show with her huge belly)

L] Nick is on my ass about trying out for the team next year. I don’t think I will.

F]…

L] My parents are forcing me to figure out my degree. It’s not like I haven’t thought about it, It’s just that…

(fade off, next slide is the next part)

F] Are you excited for the semester?

L] I can’t be, not if you’re not there.

F] she laughs I can’t promise you that.

L] Are you alright, Cesca?

F] couldn’t be better. fake gleefulness

Standing in the hall of the hospital (another day). A Leandra rushed up to her, saying her father is awake.

She runs to his room, Leandra snuggles up to him. he’s laying in the bed, he’s laying with his eyes open, but he can’t speak. He doesn’t move as she gets close to him, and Cesca knows. She walks up to the bed, and lays her head on his chest. She cries.

F] crying Papa

P] Oh, La luz de mis ojos [The light of my eyes]

F] crying somore

P] I’m sorry for all the trouble i’ve caused, You’ll see. This will be behind all of us.

The scene changes, it’s nighttime. Leandra is sleeping in the bed with her father still. Francesca is sitting in a chair close to the bed. She is also dozing but is quickly awaken by the sound of a loud, singular screech. It’s the heart monitor, he’s dying.

beepppppp

F]waking up Papa?

Nurses rush into the room, it’s chaos after that. Cesca scoops her sister into her arms, as the nurses rush around (***use the motion filter on ps). ****The girls stand apart from the chaos. Francesca is shaking, she is scared. Her world has forever changed.

Fully pregnant now, in her second trimester, the girls are in a small church, they are alone in the pews. The only sign of a funeral is the large wreaths and image of their father smiling happily. And the Casket at the front. She is staring blankly, nothing is quite feeling. She feels a buzzing in her bag, it’s a call from Lucian. She see’s this as she stares at her phone.

She goes outside of the place, she stands alone outside in a dark atmosphere of rain and cloudiness.

L] Francesca! You haven’t answered any of my calls!

F] I’m sorry… things have been busy.

L] You’re voice sounds rough… Is everything ok, Cesca?

F] hoarse laugh I love you, Lucian. You know I do?

L] chuckling Why does it sound like you’re saying goodbye?

F] I am.

L] laughing now Sure, I love you too.

She stands in the hallway, the atmosphere darker than ever. She knows that’s the last time they will speak.

Time goes on like it always does. We see shots of her kissing her sister on their way to school. She runs off excitedly.

We see Cesca working at multiple jobs, A barista, a cashier.

We see them surviving, we see them laughing. We see her even more pregnant than the last time. (*maybe in a shot with her being in her third trimester with that skin detail. And in a crop top)

In one of the last scenes, she is at work. Fully pregnant and doing her job. She hunches over in pain, clutching her stomach. Possibly show a bit of blood trickling down her legs. Francesca yells in pain.

She is rushed in an ambulance, the lights are flashing. At the hospital nurses are rushing in and out. All she can do is cry, all she can do is scream.

F] NO! No-nooo

The screams fade to black, They are now back in the present. This clip will be brief. They are now in Francesca’s apartment. sitting on the floor or something. They are both crying, Francesca and Lucian.

F] through the tears Are you happy now? 6 whole years later.

L]also crying…

F] I’ve tried, Luc. To protect— I- there is no amount of words to describe this pain… I feel. How did you not notice, Luc?

L] I didn’t—…I-

F] He is- Was yours, Lucian.

L] crying intensified Mine? My?… (clearly in shock)

L] sobbing…

F] leave. GET OUT LUCIAN, LEAVE! Please. crying

he gets up, and leaves. this is it, they’re done.

#ts4 storytelling #ts4 royal family #ts4 royals #ts4 royalty #royal sims #TheThronesStory #ts4story #sims story #sims storytelling #ts4 screenshots #ts4 story #ts4 legacy #House of Crimson #Sim: Lucian #Sim: Francesca #Sim: Leandra #twMiscarriage #twDeath #twVomiting #twPregnancyComplications

[indiamedicaltourism]

Sickle Cell Anemia Treatment in India for Foreigners

Sickle cell is a disease in which a group of red blood cells affects the hemoglobin. In Sickle Cell anemia red blood cells don't flow from the capillaries because of this the major organs of the body like the liver, heart; kidney, gallbladder, eyes, bones, and joints may get damaged. Sickle cell is inherited and is caused due to defective genes. A child is born with sickle cell he/she gets this from both his parents and this happens when mother and father both are the conveyor of the sickle cell gene. Many modern techniques help to find out the disease like hemoglobin electrophoresis and Genetic test. Sickle cell anemia is seen in children who start showing symptoms from around 5 months of age or any time before the child is one year old. Symptoms that can be seen are recurring pain or recurring extreme pain and pain cries are the main symptoms. It can also have frequent infection, problems in vision, slow growth, and adulthood. It can be treated through medication like blood transfusion, regular vaccination and bone marrow transplant a person with sickle cell anemia can live up to 50 to 60 years of age with proper treatment depending upon the stage of it. Sickle Cell anemia treatment has a 90 to 95% success rate; however, it should be diagnosed and treated at an early age before it could cause any damage to the major organs of the body, because after the damage the success rate of the treatment reduces. Bone marrow transplant which is (also known as stem cell transplant) is the most effective treatment for sickle cell anemia though it is a lifelong disease a healthy diet and Lifestyle may lessen some complications.

Cost of Sickle Cell Anemia Treatment in India: The sickle cell anemia treatment cost includes many factors like hospital stay, before and after tests, and any additional test if required. 

Bone Marrow Treatment:                 Rs 664000 to Rs 887000 

Top Hospitals for Sickle Cell Anemia Treatment in India: Our hospitals are embraced by a team of the best hematologists, oncologists, and pediatric hematologists. It comprises many other facilities like modern machinery, pathology labs, and trauma Unit. It is convenient for bone marrow transplantation and blood transfusion. A team of experts and doctors is available in the hospital each hour to have a close observation of the patient in case of any side effects and infection during or after the treatment. It also provides pastoral care to the patient and family.

Top Doctors for Sickle Cell Anemia Treatment in India: Sickle Cell anemia is diagnosed by doing genetic screening; it is done at the time of birth. Our hematologist experts in blood disease or pediatric hematologists specialize in sickle cell anemia treatment. There are highly certified doctors here in India for bone marrow transplantation treatment and blood transfusion which is the most effective treatment for sickle cell anemia. Doctors and the hematology squad take proper care of the patient and support the family to be strong to deal with that disease. Our proficient team of pediatric hematologists directs the medical treatment to gain efficient results.

Al Afiya Medi Tour is a leading medical tourism company in India. We offer medical tourism services such as finding the right doctor, the right hospital, and cost estimation etc. Some of the main countries are Bangladesh, South Africa, Egypt, Uganda, Zambia, Sudan, Dubai, Namibia, Iraq, Kenya, Saudi Arabia, Ethiopia, Nigeria, and so on. We provide free medical assistance for TURP surgery cost, lung cancer treatment, liver transplant cost, blood cancer treatment cost, the best hospital for heart valve replacement, heart valve surgery, arthroscopic surgery, bone marrow transplant cost, best liver transplant hospital, brain tumor surgery cost, cosmetic and plastic surgery, heart surgeryspine tumor surgery, cancer treatment cost, hip replacement surgery, best bone marrow hospital, etc. 

Source: https://alafiyameditour1.blogspot.com/2024/05/sickle-cell-anemia-treatment-in-india_9.html

[sunnysharmaseo]

7 Health Tips for Women

Women, especially in India, often prioritise the well-being of their loved ones over their own. Although this trend is gradually evolving, many women either don’t know about basic healthy practices or don’t have access to them. Raising awareness about women’s health is extremely important in such cases.

Some women struggle to take any time out to take care of themselves with the responsibility of managing the household, while others may neglect their well-being amid the demands of a busy lifestyle. With easy and manageable ways to improve women’s health, they can enhance their overall quality of life. So, keep reading to learn more about health tips for women.

Effective Tips for Improving Women’s Health

There are some health problems exclusive to women, and diseases that affect both men and women can have a different impact on women. Here, you will find seven simple and easy tips to improve women’s health.

1. Exercise Regularly

You don’t have to work out an hour a day, do a specific number of push-ups, or lift weights to stay fit. As little as 30 minutes of moderate physical activity can help you feel energised and improve your immunity. However, it is important to stay consistent.

Many women struggle with the social stigma of going to the gym or looking a certain way if they gain muscles. However, the benefits of exercise and being strong outweigh the perceived downside of gaining muscle mass. Additionally, if you are just starting out, pick out a form of exercise that is fun for you.

2. Get Ample Sleep

While sleeping, the body removes all the toxins in your brain, among other important functions. Compromising on your sleep may leave you feeling confused and lethargic or give you a brain fog.

With proper sleep, you can prevent the premature signs of ageing and improve your overall well-being.

3. Eat Balanced Meals

One of the most important health tips for women is to prioritise the right nutrition for a healthy lifestyle. Although crash diets may promise quick results, they can have severe impacts on your health. Additionally, overindulging in a particular flavour or type of food, even if it is as healthy as eating spinach, is not beneficial. Your meal plan should focus on balanced meals that are realistic to achieve, with plenty of colourful fruits and vegetables

4. Manage Stress

Whether due to personal reasons or slightly imbalanced biochemistry, stress can negatively impact your body and mind. Additionally, the hormone cycles of a woman are complex and may also contribute to increased stress at times. It is best to proactively manage stress by indulging in mindful activities such as meditation, yoga, and prayer, whichever suits you best.

5. Get Sun Exposure

Women are more prone to developing health problems like osteoporosis due to reduced bone mineral density. Vitamin D plays a major role in maintaining optimum bone density. Therefore, getting ample sun exposure will help you avoid vitamin D deficiency and adjust your circadian rhythm, ultimately improving your sleep quality.

However, it is essential to note that too much sun exposure during the daytime can damage your skin and may increase your risk of developing cancer or skin lesions. It is crucial to strike a balance and practice sun safety

6. Quit Smoking

Another valuable health tip for women is to stop smoking. Smoking has been identified as one of the major causes of heart disease and lung problems. It significantly increases your chances of developing such health disorders and affects the whole body.

7. Regular Health Check-ups

Did you know many diseases, including liver cirrhosis and hypertension, don’t show any early signs and symptoms? Some diseases are silent killers that are extremely difficult to detect early on; however, early detection can make managing these diseases relatively easy. By going for annual health check-ups, you can ensure your body is in its optimal condition.

Healthcare for Women

A woman’s body differs greatly from a man’s, and so do their healthcare requirements. Thus, getting a health insurance plan made for women can help you stay on top of your health if you are a woman. With benefits like suitable annual female health screenings and other features, a health insurance plan can help you avoid major health problems and manage pre-existing conditions. Additionally, planning a family becomes less stressful with a health insurance plan for women. You can get additional cover for your special requirements as a top-up on your existing health insurance.

Source URL: https://www.sbigeneral.in/blog-details/7-health-tips-for-women

[filaantrocrowdfunding]

Uniting Against Cancer: A Call to Action on World Cancer Day

“Cancer is just a chapter in our lives and not the whole story.”

— Allie Moreno

World Cancer Day, celebrated every year on February 4th, serves as a worldwide initiative to heighten awareness about cancer, promote preventive measures, early detection, and effective treatment. Observed for the first time on February 4th, 2000 at the World Summit Against Cancer for the New Millennium in Paris, the day advocates for policies aimed at minimizing the impact of this devastating disease.

Significance of World Cancer Day

Cancer remains one of the leading causes of morbidity and mortality worldwide, affecting millions of lives each year. The disease knows no boundaries, affecting people of all ages, races, and socioeconomic backgrounds. From lung and breast cancer to leukaemia and melanoma, the spectrum of cancer types is vast and diverse, making it crucial to address the various facets of this global health challenge.

Creating Awareness on World Cancer day

World Cancer Day encourages individuals and communities to come together, share experiences, and support one another to foster a sense of solidarity and break down the stigma associated with the disease. Here are some of the effective ways to create cancer awareness:

1. Wear Unity Bands: One of the signature symbols of World Cancer Day is the Unity Band, a simple and powerful way to show support. These bands are often available for purchase, with proceeds going towards cancer research and support organizations.

2. Organize Awareness Events: Consider organizing or participating in events that promote cancer awareness in your community. This could include educational seminars or workshops on cancer prevention and early detection.

3. Share Personal Stories: Share your own experiences or those of friends and family members affected by cancer through social media, blogs, or community events. These stories humanise the struggle against cancer, helping to break down stigma and encourage open conversations.

4. Social Media Campaigns: Leverage the power of social media to spread awareness on World Cancer Day. Use dedicated hashtags, like #WorldCancerDay #CancerAwareness to share informative content, and encourage friends and followers to do the same.

5. Host Fundraising Initiatives: Fundraising events can be an impactful way to contribute to the fight against cancer. Organize charity runs, walks, or online fundraisers to raise funds for cancer research, treatment canters, or support organizations.

6. Educational Workshops: Host educational workshops at local schools, community centres, or workplaces to provide information on healthy lifestyles, cancer risk factors, and the importance of early detection. Empowering individuals with knowledge can contribute to long-term prevention efforts.

Early Detection and Screening:

Early detection is key to improving cancer outcomes. Regular screenings and health check-ups can identify cancer at an early, more treatable stage. World Cancer Day emphasizes the importance of proactive health measures, encouraging individuals to schedule regular screenings and seek medical advice if they notice any unusual symptoms. Early detection not only improves the chances of successful treatment but also reduces the emotional and financial burden on individuals and their families.

One of the main missions of Child Help Foundation and its crowd funding partner Filaantro is to support cancer encapsulated underprivileged children through fundraisings. Under the Sustainable Development Goal of Emergency Medical Support, 3023 financially constrained children have received successful treatments and are now living normal lives.

On World Cancer Day, let us unite in the fight against cancer, standing together as a global community committed to reducing the burden of this disease and providing hope for a healthier future.

#filaantro #crowdfunding #raise funds #fundraising #nonprofits #charity #education #donate #donations #volunteering

[marcuslausen79]

No More Errors With Fashion Island Clothing Instagram

Even nonsmoking parents can act in ways that inadvertently make it easier for their children to start smoking. Whether you are looking for a dress or a blazer or a blouse or a skirt or even a bow ring or a hair band, you find all these items when you go through their website. https://theafra.org/from-catwalk-to-sidewalk-making-fashion-waves-with-kawaii-rabbit-ears-sweatshirts/ and DressGoddess are excellent websites that offer leading brands such as Faviana, Tony Bowls and La Femme. In fact, fake shoe brands have gotten so good and so sophisticated that law enforcement agencies admit it is increasingly hard to spot counterfeit footwear. Statement eyebrows have real drama, especially when set off with dark hair and monochromatic garments. Smoking in the media can have the same influence as fashion or the appearance of a trendy gadget in an actor's hand. Since there's no universal sizing standard, designers can basically create a clothing line and slap on any range of sizing they want.

One only has to look at how hairstyles or clothing fashions can be launched by a single movie or TV episode to see the extent of this power in many parts of the world. One past contestant on "The Voice" wrote on Reddit that her auditions, recording sessions and interviews were all recorded well before the show, which then made it look like they were recorded the same day. One popular look pairs a pointy toe with a medium heel. An eerie shot of one of the buildings at the Kalaupapa leprosarium in Hawaii. A large part of the reason peer pressure comes under scrutiny is that one of the groups most likely to begin smoking -- young teenagers -- is also one of the most susceptible to peer pressure. This reason for smoking is tied to peer pressure, although it's a little more complex and has the potential to affect more than just peer-pressure-sensitive tweens and teens. If one has never tried to discover such jacket on the internet then they should talk to people who know more about this way of shopping. But these rules -- legal, physical and social -- can offer tempting lines to cross for young people who tend toward risk-taking behavior.

Some may have a genetic predisposition toward addiction, making it harder to resist the habit.

In addition they usually are not sure whether they can be delivered the correct article in the good new state by the online boutiques. where can i buy kawaii clothes are social animals. Quite often, this is the time of life when young people rely most heavily on friends of the same age for social support and affirmation. Have your child regularly show you his or her social networking pages and other favorite Web sites, and check your Web browser's history to see where your child has gone online (also forbid erasing the browser history). Some may have a genetic predisposition toward addiction, making it harder to resist the habit. Beyond addiction, the risks of lung disease, cancer, heart disease and early death mean nicotine, while potentially effective in treating some disease symptoms, is truly a double-edged sword when used to self-medicate. While a Tyrolean traverse is a common mountaineering practice (shimmying across a line to cross between two steep points, sometimes without a pulley at all), the zip line one-upped the Tyrolean by using the gravity of the slope to make the process a little quicker. After each application -- while the aesthetician waits for a mask to work or a cream to soak into the skin -- he or she might massage your face, neck, shoulders or feet.

Parents of younger children might also seize the opportunity to make the trip educational by pointing out the various wildlife, trees and plants in the area. Your pint-sized daughter might want to help out children her own age by volunteering at the local pediatric hospital, or your teen might prefer to build a house with Habitat for Humanity. Making a habit of giving thanks will give your kids a better appreciation of people and privileges they might otherwise take for granted. Truly ambitious families might choose to forego a traditional vacation in favor of a volunteer-based one, such as a church mission trip to Haiti or other areas devastated by natural disaster. Combine that with the natural tendency of many teenagers to push the limits of rules imposed by school, parents and their communities, and it's no wonder that many young people will instinctively push against any limit. Your kids will love this opportunity to hike, fish and explore. Whether you make it a weekly, monthly or quarterly event, consider giving each family member the opportunity to choose the cause you support. On designated nights, turn off all televisions, computers and cell phones, and seize the opportunity to talk instead.

#kawaii clothes #kawaii clothes shop.Kawaii

[nileshcarrerhospital3]

HPV vaccine – Why is it so important

Ramesh Chouhan felt a lump on his neck. Within a few days, it grew bigger. He immediately booked an appointment with his doctor and was advised of a biopsy. The results indicated that the lump was cancer caused by the HPV virus. This shocked Ramesh and many others too who thought that the HPV virus only led to cervical cancer among women.

But the fact is that the HPV virus can affect men and anyone sexually active. 

Usually, the HPV virus is killed by the immune system in almost 2 years along with medications depending on each case. But in some cases, a part of the virus lingers on in the body and turns normal cells into cancerous cells. 

Vaccines save millions of lives every year. Natural immunity toward a particular disease develops after one has contracted the virus and recovers but at times the virus can lead to death therefore vaccination against diseases is most important.

Similarly, the HPV Vaccine or the vaccine against cervical cancer can protect you against the life-threatening human papillomavirus virus which is a sexually transmitted infection. 

Two vaccines licensed globally are available in India; Gardasil and Cervarix but at high rates. The launch of the CERVAVAC vaccine made in India at an affordable rate for the HPV virus can save many lives. India accounts for 1.23 lakh cases and around 67,000 deaths every year due to the HPV virus.

This vaccine will be commercially available in India by the end of 2022.

Why is the HPV Vaccine important? 

This vaccine can give you 90% protection against the HPV virus. It also protects against the head, neck, and anal cancers in both men and women. It also protects men against penile cancer, and women against cervical cancer, vaginal cancer, and vulvar cancer. 

The vaccine can also be administered to children and can be given from the age of 9 yrs. and adults up to age 45.

There is no test to detect the early onset of HPV vaccine among men therefore vaccination is a must. Among women, a pap test can detect the early onset of cervical cancer. 

Cervical Cancer is preventable with the help of the vaccine and can be treated effectively among those vaccinated. 

Facts about the HPV vaccine 

Research has shown that receiving the HPV vaccine at a young age is not linked to an early start of sexual activity. 

Yes, the vaccine needs to be given before contracting the virus. Once diagnosed with the virus the vaccine is not that effective. 

Yes, the response to the vaccine is much better when given at a young age compared to an older age. 

Testing positive for the virus does not necessarily mean that you also have cancer. Further tests and diagnoses along with follow-up tests are required and very important.

The possibility of developing HPV cancer increases with age.

You will not contact the virus from the vaccination and develop cancer. This is a false thought.

What is the dosage of the HPV Vaccine 

The two-dose schedule is effective among teenagers up to the age of 15. 

Those who receive the dosage after the age of 15 need a three-dose schedule

Research shows everyone should be vaccinated before the age of 26 years. 

The HPV vaccine is given as an injection on the upper arm.

A gap of 6 months is required between each dose.  

Side effects of the Vaccine. 

There is no risk associated with taking the HPV vaccine and it is as safe for boys/men as for girls/ women.

Research has shown that minimal side effects like soreness around the injected area, slight flu like symptoms or a runny nose is all that may occur. 

best lung cancer hospitals in bhopal

#best lung cancer hospitals in bhopal

[greyssell]

Dr ten thumbs

Dr ten thumbs how to#

Pseudoclubbing is also more likely to be asymmetric. Pseudoclubbing: distinguished from clubbing by the preservation of the nail-fold angle and bony erosion of the terminal phalanges on radiography. The causes of HPOA are the same as those of clubbing. Median nerve palsy may make one hand produce a.

If a patient has painful wrists, painful ankles and comes to see you and you miss that they also have clubbing, you will go down the wrong path looking for RA etc, when what they have is Hypertrophic Pulmonary Osteoarthropathy. Ask patient to use both hands to make and Okay sign by forming a circle with thumb and index finger.

Ideal for adults and kids alike, Ten Thumbs teaches you the 5 habits of highly effective touch typing that will last you a lifetime. Have you noticed a slight shaking or tremor in your finger, thumb. The condition is often painless, but your child may also experience pain when straightening her digits and. Ten Thumbs is the easy and fun way to learn to type. Know the 10 early signs of Parkinsons disease to tell if you or a loved one has PD.

There are other causes of clubbing, outside the heart and lungs, but these are the important ones. Trigger thumb, stuck in a flexed position (flexion).

COPD IS NOT A CAUSE OF CLUBBING (if you seen clubbing in a COPD patient, think lung cancer).

The M-Disc can be used with any standard DVD drive to read information.

Pus in the lung (bronchiectasis as in CF, but also lung abscess and empyema) A more realistic lifespan for magnetic tape is about ten to twenty years.

(Yellow from nicotine, and clubbed from cancer).

Lung Cancer (clubbing is in general an ominous sign for this, and remember "beware of the yellow clubbed digit".

Use the new window to locate the files you would like to copy.Important causes of clubbing in the adult: While keeping the USB drive window open, press Ctrl+N to open a new File Explorer window.

Dr ten thumbs how to#

RELATED: How to Find Your Missing USB Drive in Windows 7, 8, and 10 Find the Files You Want to Copy Natural selection just favours the configurations which currently. If the USB drive doesn’t show up in your “Devices And Drives” list, you’ll have to perform some in-depth sleuthing to figure out what it going on. Why did human evolution stop at 8 fingers, 2 thumbs, and 10 toes Evolution never stops. Generally, its additional files, such as preference files and application support files, still remains on the hard drive after you delete Ten Thumbs Typing. There may also be a visible growth or bump at the joint as. The first thing you may notice is swelling and pain in the joint of the thumb, accompanied by aching and tenderness and loss of strength. The calcium in your kidneys can trigger a plethora of symptoms including increased urination and kidney stones. When you have too much calcium in your blood, some of it may be deposited into your kidneys. All Motorcyclerepair Results in Goetz Dr, Canyon Lake, CA 92587. Note that the “C:” drive is almost always the main drive on your PC, unless you go very out of your way to change it.ĭepending on how File Explorer is configured (see the “Layout” options under the “View” menu), the style of the icons within this window may appear different on your machine. The symptoms of basal thumb arthritis are distinct, and as soon as you think you may have an issue in the joint, you should seek medical attention. Tums can raise your blood calcium level to a point of essentially overdosing on calcium. I personally recommend him and his shop to anyone. If your USB drive has been recognized correctly and is ready to receive files, it will appear in this location with a name and a drive letter assigned to it, such as “D:”, “E:”, or “F:”, or another letter. In the window that pops up, locate the section called “Devices And Drives.” If necessary, click the small carat-shaped arrow to the left of the section header to reveal a list of the drives.

#Dr ten thumbs

[jeanfrancoisgeschwind]

Jean-Francois Geschwind Things You Can Do To Promote Health During Cancer Treatment

Jean-Francois Geschwind Professional tips provider.Cancer is an extremely scary disease that affects the lives of millions. If you or a family member has cancer, make sure that you're doing your best to help the problem. Read on to see an article full of tips about how to deal with this devastating disease.

So many people diagnosed with cancer just want to give up. They may feel hopeless and sure that they are certainly dying. This isn't true in a vast amount of cancer cases! Studies show that people who face their disease with a positive attitude and who visualize the tumors dying, have a much better rate of survival!

Dealing with a devastating disease like cancer can cause many fears about life and death. A good way to help yourself overcome these feelings is to become more spiritual! Studies show that people who engage in regular worship and prayer fare much better and live longer than those who don't.

You can significantly reduce your risk of cancer with a healthy diet full of antioxidants, which help protect cells from damage that can lead to cancerous changes. Eat a diet rich in green, leafy vegetables, tomatoes, broccoli and blueberries as well as hundreds of other antioxidant-rich foods.

Skin cancer can be very serious, even deadly. Malignant Melanoma is a serious type of skin cancer that often can't be cured. Be proactive and have your skin checked regularly by your doctor or dermatologist. He or she can see places you can't and examine you for suspicious moles and skin changes.

Jean-Francois Geschwind Expert tips provider. It's important to take detection and the possibility of early treatment, seriously, when thinking about cancer. Learn how to self-examine yourself for cancers of the skin, colon, prostate, cervix and breast. Be sure to perform checks regularly so that you can start fighting early and give yourself the best chance possible.

There are certain tests that aid in the early detection of certain cancers. These tests can detect cancer cells before they cause any symptoms, increasing the chances for successful treatment. See your doctor regularly and have the recommended tests for breast cancer, testicular cancer and pap smears. Early detection is key to surviving cancer.

Immediately after your cancer diagnosis, begin investigating insurance options. Look into whether or not your state gives assistance to people suffering from cancer. You may also want to research The Family and Medical Leave Act and the Americans With Disabilities Act; it is important to make sure you are covered during this time.

One of the best cancer-prevention tips you can ever use is to check out your family's medical history in detail. Most people who contract cancer have genetic markers that make it more likely to grow and spread. Know and understand your family's medical history and you can do more to prevent cancer.

The one big benefit from having survived cancer is that you now know what the signs and symptoms of the disease are, so make sure you're fully aware of any changes in your life so that you can catch it in time. If you have any symptoms of the cancer returning rush to get help while you are still able.

Jean-Francois Geschwind Qualified tips provider. A great way of avoiding cancer is, DO NOT SMOKE! At least three in every ten cancer deaths is linked to smoking as cigarettes are filled with poisons and chemicals that you inhale with every drag. Quitting is not easy but your body will thank you daily for doing so.

Do not be afraid to get your mammogram. It should never be a painful experience for anyone. Schedule your appointment for the week following your monthly cycle. Your breast tissue is less sensitive at that time. Take some ibuprofen before the appointment to lessen any potential discomfort you may have.

Don't smoke, or stop if you have already started. Smoking is linked to about three out of every ten cancer deaths. It is damaging to your heart, lungs, and skin. Even moderate smoking carries heavy risks. If you choose not to start, or can stop today, you'll be well on your way to a healthier life.

Many people do not think to protect their lips when they are out in the sun. No matter the season or the length of time you are going to be in the sun, take the time to apply lip balm. Be sure that the balm that you choose has a good SPF level to protect your lips.

Jean-Francois Geschwind Skilled tips provider. If you are not coping very well, or even if you are coping well, consider looking for a support group in your area. They will be able to listen and relate to what you are going through and you will likely find a good bit of comfort in being surrounded by others who are going or have been through the things that you are.

If your cancer treatments are limiting your mobility, begin sleeping in a bedroom with easy access to a bathroom. You do not want to hurt yourself trying to get to a bathroom that is too far away or too difficult to enter. You may also want to consider making a few modifications to the bathroom, including installing a handrail.

If you find that your hair is falling out from chemotherapy treatment, do not be ashamed to get a wig. By wearing a wig, not only will you have your hair, but you will be protecting your scalp from dirt and germs. If you cannot afford a wig, certain organizations may provide one for you.

Stay organized. You are going to have many appointments to go to and have to keep track of many different dates. Get a calendar and use it to keep track of things that are important. You can even log how you have felt on different days so you can let your doctor in on your progress.

Jean-Francois Geschwind Top service provider. As you can see, there are many things you can do to help the condition if you or somebody you know has been diagnosed with cancer. Try applying the advice you've read in this article to give yourself or your loved one the best chance they can have against this disease.

#jean-francois geschwind #jeff geschwind #jf geschwind

[lindabrown1812]

First red flags of cancer

How can you tell something’s not quite right? Pay attention to the clues from your body.

Cancer Signals in Both Men and Women:-

Appetite loss: Many conditions, from depression to the flu, can make you feel less hungry. Cancer can have this effect by changing your metabolism, the way your body turns food into energy.

Blood in the stool: Cancers can bleed, but so can a bunch of other things, like ulcers, hemorrhoids, infections, or a sore. One way to tell where the blood is coming from is by how light or dark it looks. Bright red could mean the bleeding is in your rectum or the end of your intestines. A darker color means it may be from higher up, like a stomach ulcer (the stool is darker because it’s been exposed to stomach acid).

Blood in the urine: When it shows up in your pee, blood could be a warning sign of a problem in your urinary tract.

Cough that doesn’t go away: A cold or the flu can make you hack away, but it’s also a potential symptom of lung cancer, along with red flags like chest pain, weight loss, hoarseness, fatigue, and shortness of breath.

Extreme fatigue: It’s one of the most common cancer symptoms. We’re not talking about a normal type of tiredness here — it’s exhaustion that doesn’t go away.

Night sweats: In middle-aged women, it can be a symptom of menopause, but it’s also a symptom of cancer or an infection.

Lump in the neck: It could be an infection, but it’s also an early warning of thyroid cancer. Cancer lumps usually don’t hurt.

Night sweats: In middle-aged women, it can be a symptom of menopause, but it’s also a symptom of cancer or an infection.

Trouble swallowing: A feeling like there’s a lump in your throat is a common symptom of heartburn. Less often, when you find it hard to swallow, it can signal cancer of the esophagus.

Fever that doesn’t go away: When your temperature goes up, it’s usually a sign you’ve caught an infection. But some cancers, including lymphoma, leukemia, and kidney and liver cancers, can also make that happen. Cancer fevers often rise and fall during the day, and sometimes they peak at the same time.

Some cancer symptoms are different in men and women:

Cancer Symptoms in Men:-

Blood in urine or semen: A pink, brown, or red tinge to your pee or semen is usually nothing to panic over. Infections, kidney stones, injuries, and noncancerous prostate growth can all cause bleeding.

Lump in the testicle: A painless one is a possible warning sign of testicular cancer. Yet the bump could also be from an injury, fluid buildup, or a hernia. It’s hard to tell the cause from your symptoms alone, so go to your doctor for an exam.

Pain during ejaculation or urination: If it hurts when you pee or have an orgasm, you may have an infection or swelling of your prostate gland or urethra. There’s a chance that these symptoms might be because of prostate cancer. If the pain doesn’t improve, have your doctor take a look.

Cancer Symptoms in Women:-

Bleeding between periods or after menopause: Bleeding from the vagina during women’s reproductive years is usually their monthly period. When it happens after menopause or outside of normal periods, cervical or endometrial cancer is a possibility. Call your doctor if you have any bleeding that’s unusual for you.

Breast lump or change: Although it’s a hallmark symptom of breast cancer, most lumps aren’t cancer. They’re often fluid-filled cysts or noncancerous tumors. Still, see your doctor right away if you find any new or changing growths in your breasts, just to make sure. Also get these changes checked out:

Redness or scaling of the skin over the breast

Breast pain

Nipple changes

Lump under your arm

Fluid that isn’t breast milk leaking from the nipple

If you are noticing any of these changes or are diagnosed with cancer, feel free to reach us. We will help you get through this- Cancer Advocacy

#Cancer #cancerawareness #signs of cancer #fightcancer #cancer information

[waters82kara]

Simple Ways To Fight The Cancer Monster!

The chance of developing cancerous tumors is increased by large numbers of free radicals that are in your body. However, you probably don't know as much about treating or preventing cancer as you do about what causes it. You will discover some helpful tips and tricks in this article. To reduce your risk for various types of cancers, not smoking or using tobacco in any way is one of the best and easiest methods. Smoking has been linked not only to lunch cancer but also to lung, bladder, cervix and kidney cancer. Don't take the risk, and quit now, or don't start! Alcohol consumption is the number one cause of liver cancer. how does cancer man test you over time can damage the liver in such a way that it can no longer function. Without a transplant, most liver cancers are fatal. Reduce your risk of liver cancer by cutting down your alcohol consumption or eliminating it completely. Don't change your life drastically. It may be better if you try to maintain your lifestyle as it was while introducing necessary modifications. A big change can increase your stress level and confuse the people around you. Take every day at a time and make changes to your life as is needed. When a loved one is faced with cancer, it is important to help them with doctor appointments. Bringing along someone with a second perspective can help the patient ask the right questions when speaking to your doctor. While laughter may not be able to cure cancer, it can certainly help a little. People call laughter the best medicine for a good reason. Cancer is a very serious illness, but don't allow an overly-serious ambiance to envelop you permanently. This may inhibit some of the humor and laughter that would normally be spontaneous. Appreciating the humor in life will help you to feel a little better both physically a mentally. Certain types of fungus you eat can actually help you to prevent cancer, like the Maitake mushroom. According to research conducted by Dr. Well, a famous cancer physician and researcher, extract of the Maitake mushroom completely eliminated tumors in over 40% of all animals tested and shrunk tumor size in the other 60%. You're going to be running back and forth to the bathroom a lot as you fight with your cancer, so move into any bedroom that's closest to a bathroom. Being in close proximity to a bathroom will help to prevent accidents, and you also have quick and direct access to the shower when you need to freshen up. Know your individual risks for cancer, including your age, gender, race, and family history. These things could give you more information than you think, especially when you begin showing symptoms that otherwise could be misdiagnosed. If you are aware of an increased risk of cancer, you can target your issues appropriately with a health care professional. While chemotherapy and radiation helps in your race for a cure, it also weakens your body. Therefore, it is essential that you have a support group to help you through this time in your life. Members should include someone who can help clean your home and help with the preparation of your meals, a handyman, and someone who you can open up and talk to. If chemotherapy is part of your cancer treatment, make sure to monitor your temperature frequently. Beginning about a week after your treatment, you have a greater likelihood of getting a bacterial infection. If you notice that you have a temperature spike, go to your doctor right away to prevent a serious complication. Learn self testing methods for detecting breast cancer. Breast cancer is a leading cause of death in women of all ages, and can be identified early through regular breast exams that you can perform at home. If you are able to detect breast cancer early, you could avoid it advancing in stage to a point where your life is in danger. You should never underestimate the value of information. The more you educate yourself, the better equipped you are to deal with serious problems in your life. Remember that cancer is a serious situation, and you should treat it as such. Take in all the information in this article, and use it to help fight this horrendous disease.

#my husband misinterprets ever

[mednerds]

It’s not just the lungs: The Covid-19 virus attacks like no other ‘respiratory’ infection

Video created by: HYACINTH EMPINADO/STAT

By SHARON BEGLEY @sxbegle (STAT)

The reports seemed to take doctors by surprise: The “respiratory” virus that causes Covid-19 made some patients nauseous. It left others unable to smell. In some, it caused acute kidney injury.

As the pandemic grew from an outbreak affecting thousands in Wuhan, China, to some 10 million cases and 500,000 deaths globally as of late June, the list of symptoms has also exploded. The Centers for Disease Control and Prevention constantly scrambled to update its list in an effort to help clinicians identify likely cases, a crucial diagnostic aid at a time when swab tests were in short supply and typically took (and still take) days to return results. The loss of a sense of smell made the list only in late April.

“For many diseases, it can take years before we fully characterize the different ways that it affects people,” said nephrologist Dan Negoianu of Penn Medicine. “Even now, we are still very early in the process of understanding this disease.”

What they are understanding is that this coronavirus “has such a diversity of effects on so many different organs, it keeps us up at night,” said Thomas McGinn, deputy physician in chief at Northwell Health and director of the Feinstein Institutes for Medical Research. “It’s amazing how many different ways it affects the body.”

One early hint that that would be the case came in late January, when scientists in China identified one of the two receptors by which the coronavirus, SARS-CoV-2, enters cells. It was the same gateway, called the ACE2 receptor, that the original SARS virus used. Studies going back some two decades had mapped the body’s ACE2 receptors, showing that they’re in cells that line the insides of blood vessels — in what are called vascular endothelial cells — in cells of the kidney’s tubules, in the gastrointestinal tract, and even in the testes.

Given that, it’s not clear why the new coronavirus’ ability to wreak havoc from head to toe came as a surprise to clinicians. Since “ACE2 is also the receptor for SARS, its expression in other organs and cell types has been well-known,” said Anirban Maitra of MD Anderson Cancer Center, who led a study mapping the receptor in cells of the GI tract. (Maitra is an expert in pancreatic cancer and, like many scientists this year, added Covid-19 to his research.)

Infecting cells is only the first way SARS-CoV-2 wreaks havoc. Patients with severe Covid-19 also suffer a runaway inflammatory response and, often, clot formation, said infectious disease physician Rochelle Walensky of Massachusetts General Hospital. That can cause symptoms as different as a lack of blood flow to the intestines and the red, inflamed “Covid toe.”

“We’ve had five cases of patients who’ve had to have their gut removed,” Walensky said. “You see these cases and you say, wait a minute; the virus is doing this, too? It has definitely been keeping us on our toes.”

Venky Soundararajan had a hunch that the extent of ACE2 distribution throughout the body was lying in plain sight. The co-founder and chief scientific officer of nference, which uses artificial intelligence to mine existing knowledge, he and his colleagues turned their system into a hunt for ACE2 knowledge. Combing 100 million biomedical documents from published papers to genomic and other -omics databases, they uncovered multiple tissues and cell types with ACE2 receptors, they reported last month in the journal eLife.

They also calculated what percent of each cell type expresses “reasonable amounts” of ACE2, Soundararajan said. On average, about 40% of kidney tubule cells do, and in a surprise for a “respiratory” virus, cells in the GI tract were “the strongest expressors of ACE2 receptors,” he said.

The data mining found that ACE2 is also expressed in the nose’s olfactory cells. That’s not a new finding per se — the nference system found it in existing databases, after all — but it hadn’t been appreciated by scientists or clinicians. It explains the loss or altered sense of smell that Covid-19 patients experience. Its importance became clear earlier this month, when scientists at the Mayo Clinic and reported that loss of a sense of smell is “the earliest signature of Covid-19,” appearing days before a positive swab test.

That study, using health records of 77,167 people tested for Covid-19, showed how the assumption that infection would first and foremost cause respiratory symptoms was misplaced. In the week before they were diagnosed, Covid-19 patients were 27 times more likely than people who tested negative for the virus to have lost their sense of smell. They were only 2.6 times more likely to have fever or chills, 2.2 times more likely to have trouble breathing or to be coughing, and twice as likely to have muscle aches. For months, government guidelines kept people not experiencing such typical signs of a respiratory infection from getting tested.

Faced with a disease the world had never seen before, physicians are learning as they go. By following the trail of ACE2 receptors, they are more and more prepared to look for, and treat, consequences of SARS-CoV-2 infection well beyond the obvious:

Gut: The coronavirus infects cells that line the inside of the large and small intestine, called gut enterocytes. That likely accounts for the diarrhea, nausea, and abdominal pain that about one-third of Covid-19 patients experience, said MD Anderson’s Maitra: “The GI symptoms reflect physiological [dysfunction] of cells of the lower GI tract.”

Why don’t all patients have GI symptoms — or indeed, the whole panoply of symptoms suggested by the near ubiquity of ACE2 receptors? For those with mild to moderate Covid-19, “the infectious load in the GI tract may simply not be sufficient to cause symptoms,” Maitra said.

Kidney: The cells lining the tubules that filter out toxic compounds from the blood are rife with ACE2 receptors. Last month, scientists studying 1,000 Covid-19 patients at a New York City hospital reported that 78% of those in intensive care developed acute kidney injury.

Smell: An analysis of 24 studies with data from 8,438 Covid-19 patients from 13 countries found this month that 41% had lost their sense of taste or smell, or both. That shouldn’t be surprising, said Fabio Ferreli of Humanitas University in Milan: “Perhaps the highest levels of ACE2 receptors are expressed in cells in the nasal epithelium.” The sensory loss isn’t due to nasal inflammation, swelling, or congestion, he said, “but to direct damage” to these epithelial cells. Loss of smell also impacts taste, but the virus may also have a direct effect on taste: The nference analysis found high levels of the ACE2 gene in tongue cells called keratinocytes, which contribute to the sense of taste.

There is another implication of the high expression of ACE2 in olfactory epithelium cells, scientists at Johns Hopkins concluded in a paper posted to the preprint site bioRxiv last month: ACE2 levels in the olfactory epithelium of the upper airways that are 200 to 700 times higher than in the lower airways might explain the virus’s high transmissibility. It was weeks before experts recognized that the virus could spread from person to person.

Lungs: This is where a respiratory virus should strike, and SARS-CoV-2 does. The lungs’ type II alveolar cells — among other jobs, they release a compound that allows the lungs to pass oxygen to the blood and take carbon dioxide from it — are studded with ACE2 receptors. Once infected with the coronavirus, they become dysfunctional or die, and are so swarmed by immune cells that this inflammatory response can explode into the acute respiratory distress syndrome (ARDS) that strikes many patients with severe Covid-19, Walensky said.

There is new evidence that the virus also attacks platelet-producing cells, called megakaryocytes, in the lungs. In a study published on Thursday, pathologist Amy Rapkiewicz of NYU Winthrop Hospital found something she had “never seen before”: extensive clotting in the veins and other small blood vessels of patients’ hearts, kidneys, liver, and lungs. She suspects that the platelets produced by infected megakaryocytes travel through the bloodstream to multiple organs, damaging their vasculature and producing potentially fatal clots. “You see that and you say, wow, this is not just a ‘respiratory’ virus,'” Rapkiewicz said.

Pancreas: In April, scientists in China reported that there was higher expression of the gene for ACE2 in the pancreas than in the lungs. Genetic data are an indirect measure of ACE2 receptors themselves, but could have been a tip-off to physicians to monitor patients for symptoms there. As it happens, the Chinese researchers also found blood markers for pancreas damage in Covid-19 patients, including in about 17% of those with severe disease.

Heart: Patients with severe Covid-19 have a high incidence of cardiac arrests and arrhythmias, scientists at the Perelman School of Medicine at the University of Pennsylvania recently found. That’s likely due to an extreme inflammatory response, but there might be more direct effects of the coronavirus, too. A large team of European researchers reported in April that arrhythmia (including atrial fibrillation), heart injury, and even heart failure and pulmonary embolism might reflect the fact that ACE2 receptors are highly expressed in cells along the inside walls of capillaries. When these “vascular endothelial” cells become infected, the resulting damage can cause clots, MGH’s Walensky said, which in turn can cause Covid toe, strokes, and ischemic bowel (too little blood flow to the gut). Studies from around the world suggest that 7% to 31% of Covid-19 patients experience some sort of cardiac injury.

Gallbladder: Specialized cells in this organ, too, have high levels of ACE2 receptors. Damage to the gallbladder (like the pancreas) can cause digestive symptoms.

With the number of Covid-19 patients closing in on 10 million, physicians fervently hope the virus has no more surprises in store. But they’re not counting on it.

“I’ve seen patients every day during this crisis,” said Northwell’s McGinn. “There have been times when I’ve said, wait, the virus can’t do anything new — and then there’s a young woman with a stroke or an older man with myocarditis,” inflammation of the heart muscle. “I keep thinking I’m going to run out of material” for the teaching videos he does on Covid-19, “but it hasn’t happened.”

#medicine #science #virology #sars-cov-2 #covid-19 #medblr #academia #news #ace2 receptor

[tinyshe]

[remember to save and share as this information is being suppressed and censored]

Awareness Foundation COVID-19 Roundtable

Story at-a-glance

The Awareness Foundation COVID-19 Roundtable is a sign of wakefulness and hope during times of censorship and suppression

It includes honest opinions and expertise from 14 high-profile doctors, including myself, with a focus on the potential dangers being posed by the experimental mass COVID-19 vaccination campaign

Experts discuss how COVID-19 vaccines may cause a coming tsunami of hospitalization and deaths, along with debilitating chronic disease, early signs of which are already appearing

All agree that there’s enough evidence to halt the global COVID-19 vaccination campaign, either for everyone or — particularly — for those to whom the vaccines pose the greatest risks with little to no benefit, namely children and young people, pregnant women and those who have already recovered from COVID-19

In this time of extreme censorship and suppression of scientific debate, The Awareness Foundation COVID-19 Roundtable,1 hosted by Katherine Macbean of the Awareness Foundation, is a sign of wakefulness and hope. It includes honest opinions and expertise from 14 high-profile doctors, including myself, with a focus on the potential dangers being posed by the experimental mass COVID-19 vaccination campaign.

Each has faced censorship when speaking out, and though there are some differing viewpoints, all agree that there’s enough evidence to halt the global COVID-19 vaccination campaign, either for everyone or — particularly — for those to whom the vaccines pose the greatest risks with little to no benefit. This includes children and young people, pregnant women and those who have already recovered from COVID-19.

I highly recommend setting aside two hours to watch this roundtable discussion in full — it’s a rarity in the present day to hear such candor and open debate. However, I’ve also compiled some of the highlights below, which include warnings about the dangers these experimental vaccines may pose to society.

A Tsunami of Chronic Disease and Death

Will COVID-19 vaccines cause a coming tsunami of hospitalization and deaths, along with debilitating chronic disease? One expert on the panel, Dr. Peter McCullough, an internist, cardiologist, epidemiologist and full professor of medicine at Texas A&M College of Medicine in Dallas with a master's degree in public health, said he’s focused more on the short-term adverse effects from the shot. These nonfatal injuries fall into four major categories:

Neurologic

Immunologic

Hematologic

Cardiac

“What I'm seeing is just the late emergence of various neurologic syndromes. And it probably depends on where the seeding occurs of, uh, of, you know, the uptake of the genetic material in the brain or support cells in the brain, but there's a whole variety of cerebral, cerebellar, even peripheral nervous system abnormalities,” McCullough said, adding:2

“I've seen it in my clinic and they seem to be emerging three, four or five, six months later after vaccination … So I'm getting increasingly alarmed here that this is not just a simple one- or two-day problem. And so there's great concern, particularly in younger kids that over a course of three or six or nine months, they'll end up with heart failure or cardiac death.

… What I see is, potentially from these signals, not mass death, but just a large number of Americans and people around the world with a new chronic disease of some sort of neurodegenerative disease or cardiac disease. The patients that I'm aware of, these problems seem to be quite disabling.”

Another panel member, Dr. Vladimir Zelenko, who has treated thousands of COVID-19 patients using hydroxychloroquine (HCQ), azithromycin and zinc sulfate,3 with great success, has a different take. He believes there is a very distinct possibility that everyone who receives the COVID jab may die from complications in the next two to three years:4

“I'm just going to give you the perspective of a clinician who deals with people that are dying … 4 million dead people can testify to the unique clinical syndrome to put them there. Basically, a natural animal virus was changed to infect humans, and then its lethality was augmented to cause blood clots and lung damage.

And in concept here, we're dealing with a Hitler/Stalin type of mentality with weapons of mass destruction and the way to win this war — and it's very winnable — is in the following manner. It's a narrative war. So we need to spread the following two ideas … Don't give into the fear and choose to destroy yourself, No. 1. No. 2, treat your problem early. If these two ideas could penetrate the fixed calls of humanity, then it's really the end of this crisis.”

Dr. Tess Lawrie, whose company The Evidence-Based Medicine Consultancy has worked with the World Health Organization, agreed that the vaccines are unsafe for children and adults alike:5

“They're actually not safe for anybody, and it's clear. The databases are screaming. The databases are early warning systems, and the databases around the world are screaming that we are facing a tsunami of chronic disease.”

Inflammatory Disorders, Cancer Markers on the Rise

Dr. Richard Urso, an ophthalmologist in Houston, Texas, is also concerned:6

“Early on, we were seeing things, mostly thrombotic, but later, as we get into two and three months [after vaccination], we’re seeing a lot of inflammatory issues. I’ve had a host of people with inflammatory ocular disorders, as well as having orbital inflammatory diseases.

I typically don’t see this rash number of people. For people who don’t know, my clinical practice is probably one of the largest in the United States, if not the largest, and we get a tremendous number, in volume, of patients who come through our office. And I’m seeing late inflammatory disease, and it responds quite well to inflammatory medicines.”

Some have brushed off the notion that the virus could be a bioweapon because it didn’t cause sudden, mass deaths. But this is a misconception. A successful bioweapon can be something that causes long-term, progressive, chronic-type diseases, noted Dr. Richard Fleming, a physicist, nuclear cardiologist and attorney.

In 1994, Fleming introduced the theory of inflammation and vascular disease, which explains why these inflammable thrombotic diseases, and the causes, including viruses like SARS-CoV-2, produce disease states like COVID-19.

“As I laid out in the theory in 1994,” Fleming said, “you're going to see an inflammable thrombotic response. That’s the primary thing that people are noticing, be that heart disease or retinol disease.” The other factor is a prion component of this virus, “which is also a chronic smoldering disease.” Fleming noted:7

“If you're going to actually develop something that's going to have a massive effect on your ‘enemy,’ your goal isn't to kill the enemy any more than it was the goal of the United States in Vietnam to kill the enemy.

The goal was to maim the enemy so that more of the enemy would be taken off the field. What we've seen is something that's been implemented that is an ideal by a weapon designed to demoralize and to feed people the enemy, and to cause a slow smoldering process.”

Fleming cited data from Pfizer that showed in the 12 to 14 days following the second injection of the Pfizer mRNA vaccine, elderly individuals had a 2.6-fold increase in symptoms of Alzheimer’s disease. “This is an inflammable thrombotic process affecting every organ system and prion diseases that not only affect the brain, but also affect the heart and other vital organs of the body.”8

Dr. Ryan Cole, a Mayo Clinic-trained, triple-boarded pathologist, also said that he’s seeing potential cancer-causing changes, including decreases in receptors that keep cancer in check, and other adverse events post-vaccine:9

“I’m seeing countless adverse reactions … it's really post-vaccine immunodeficiency syndrome … I'm seeing a marked increase in herpetic family viruses, human papilloma viruses in the post-vaccinated. I'm seeing a marked uptick in a laboratory setting from what I see year over year of an increase of usually quiescent diseases.

In addition to that — and correlation is not causation — but in the last six months I have seen — you know, I read a fair amount of women's health biopsies — about a 10- to 20-fold increase of uterine cancer compared to what I see on an annual basis. Now we know that the CD8 cells are one of our T-cells to keep our cancers in check.

I am seeing early signals … what I'm seeing is an early signal in the laboratory setting that post-vaccinated patients are having diseases that we normally don't see at rates that are already early considerably alarming.”

Do the Vaccinated Pose a Risk to the Unvaccinated?

Sherri Tenpenny has heard thousands of anecdotal reports that something is being transmitted from the vaccinated to the unvaccinated:10

“We're injecting a synthetically made messenger RNA and strips of synthetically made double-stranded DNA by different mechanisms, and if that transmission goes to the other person, they don't get COVID, they don't get COVID symptoms that we typically recognize as COVID. They get bleeding, they get blood clots, they get headaches, they get heart disease, they get all of these different things.”

Dr. Robert Malone, the inventor of the mRNA and DNA vaccine core platform technology,11 doesn’t agree that anything is being “passed” from vaccinated people to others, adding that while it may be possible for mRNA to be shed through breast milk to nursing infants, possibly causing gastrointestinal symptoms, anything else is just speculation.

Others suggest it could be more of a hormonal or pheromonal issue than some type of “shedding,” which may help explain why women are also reporting abnormalities with their menstrual cycles following vaccination. Dr. Lee Merritt, an orthopedic and spinal surgeon, brought up a 2015 report by the U.S. Food and Drug Administration, which looked at “shedding” in mRNA vaccines, which they call gene therapies.12 She explained:13

“They talk about, they're very concerned about the shedding — and they do call it shedding, whether that's technically correct … And they tell you in this thing who to protect, they tell you to protect neonates, immunocompromised people and elderly with bad immune systems.

They also say, we don't know what's being shed. They say it could be genetic material. It could be activated viruses and it could be a recombinant product. This is what's in the FDA data.”

Immediately Halt the Vaccine Program

All of the experts agreed that evidence suggests the mass COVID-19 vaccination program should be halted. “There is enough evidence now just from the European Medicines Agency alone, 1.7 million in reported adverse events and 17,000 deaths that the four clinical trials should be stopped,” said Dolores Cahill, a professor at the school of medicine at the University College Dublin.

“They are detailed in the classifications, cardiac related immune, uh neuropathological and fertility associated.

So I think we all have duties as doctors and scientists to say, if something is causing more harm than good, which this clearly is, we should, I think, unify and called for a stop to the clinical trials worldwide, and also that any individual prime ministers and regulators that continue the trial would have to be liable for any adverse events.”

Malone believes that the vaccines have merit for certain populations, namely the elderly, but is advocating for prohibition on vaccination for infants and newborns, through young adults up to ages 30 to 35. “And specifically,” he said, “I'm trying to stop this crazy effort to force universities and schools to have universal vaccination.” In addition, he added:

“We can argue about risk-benefit for elderly, but the risk-benefit ratio for newborns through young adults is explicitly clear. It is upside down. It's not subtle there. You're going to kill more. And, and personally, I also feel that we can dig in really hard on the reproductive health in pregnancy, in women, that there just aren't data to support the use of this product because of the potential female reproductive health consequences.”

Dr. Urso added the other significant population that has far more to risk than gain from vaccination: the COVID-recovered. “The immune status should be more important than the vaccination status,” he said.

“So I think there's three groups that are easily winnable arguments [to avoid vaccination]: pregnant women, the young and … the COVID recovered … I mean, that's a, that's a lousy thing to do to get all these people that are COVID recovered, good immune status and give them a vaccination for something they don't need.”

How to End Fear and Optimize Your Immune System

The roundtable participants are planning to continue their discussion offline to formally request an end to mass COVID-19 vaccination for the mentioned groups as well as create a statement to end government interference with the practice of medicine. Many physicians have had their hands tied when it comes to prescribing early treatments for COVID-19, like ivermectin. As Fleming noted:

“… The reason why people die with COVID is because they're not receiving treatment, so I would argue that we need to make certain that people, the physicians, are allowed to treat without government interference and that we put a hold on the dissemination of the vaccines at this point in time, until we can further investigate them safely.”

Dr. Sam White, whose reputation has been under attack since he released a video on social media detailing his concerns about the suppression of the science around therapeutics in the U.K., added:

“We could end the fear overnight by allowing access to therapeutics and changing the mainstream media narrative that there's no need for masks. There's no need for lock downs. This is more treatable than flu, as far as I'm concerned, we're just not allowed to do any treatment. If the public knew that it changes the narrative overnight.”

While we work on changing the narrative, or at least opening up discussions of science outside of the narrative, it’s always a good idea to optimize your immune system.

Toward this end, I recommend optimizing your vitamin D levels to 60 to 80 nanograms per milliliter and improving your metabolic flexibility so your body can seamlessly transition between burning fats and glucose as your primary fuel. One way to do this is to condense your eating window to about six to eight hours a day.

Even without changing your calories, this can make a profound difference, but from a perspective of choosing the right foods, one of the most important strategies that I’ve learned over my four decades of studying this is to avoid processed foods, nearly all of which are loaded with vegetable, or seed, oils.

These oils have a high content of linoleic acid, which contributes to mitochondrial instability and increases susceptibility to oxidative stress. This, in turn, increases immune dysfunction and mitochondrial dysfunction. These are simple strategies I recommend, as they're useful to improve your overall health and resiliency to fight any infection.

As mentioned, I highly recommend listening to the discussion in full to get all of the details that weren’t included here. At the next meeting, the group plans to discuss how to move forward to challenge the narrative in greater detail, including fighting back against the organizations, such as the Wellcome Trust and the Bill & Melinda Gates Foundation, that are heavily investing in this.

[acgmedicalsupplysblog]

Deep vein thrombosis (DVT)

What is deep vein thrombosis?

Deep vein thrombosis (DVT) is a serious condition in which a blood clot forms in one or more of the deep veins. What causes DVT?

Deep vein thrombosis is usually caused by a combination of different underlying conditions:

Restricted movement

Blood flow in the veins is slowed down because of restricted movement for a long period of time (illness, after surgery, long-distance traveling).

Blood clots form more easily than normal

The risk of getting DVT is increased with a condition that causes blood to clot (coagulate) more easily than normal. Some of these conditions include:

cancer and cancer treatments

heart disease and lung disease

thrombophilia, a genetic condition where the blood has an increased tendency to clot

Infections or inflammation

Infections or inflammation can promote thrombus formation by affecting the lining surface of the vein, e.g. through vessel wall damage and increased coagulability.

Damaged blood vessels

If the wall of a blood vessel is damaged, it may become narrowed or blocked, which can cause a blood clot to form. Blood vessels can be damaged by injuries such as broken bones or severe muscle damage.

Pregnancy

DVTs are rare in pregnancy, although pregnant women are 3 to 4 times more likely to develop thrombosis than non-pregnant women of the same age. A clot can form at any stage of pregnancy and up to six weeks after giving birth.

In addition, several risk factors for the development of DVT exist.

What are some potential complications of DVT?

About one of every two to three patients with previous DVT will develop a long-term complication known as post-thrombotic syndrome (PTS), despite optimal anticoagulant treatment. PTS is a progressive disease and it can show up as chronic pain, swelling, and discoloration of the leg and, in late stages, as open leg ulcers.

The likelihood of another clot forming is high once you have had aDVT event. The effects of PTS are long lasting and can lessen your quality of life substantially.

Another complication of DVT is a condition known as pulmonary embolism (PE) which occurs when a blood clot breaks loose and travels through the vessel to the lungs. A pulmonary embolism can be fatal if the blood clot significantly blocks blood flow through the lungs.

What are the symptoms of a DVT?

Nearly 50% of all DVT cases have no noticeable symptoms. If symptoms are present, they can include leg pain and tenderness, swelling in the calf muscle, ankle, foot, or thigh – usually in one leg only. At times, the skin feels warm and is reddened. Am I at risk for developing a DVT?

Are you over 60? Are you traveling long distances, thereby sitting for prolonged time withrestricted mobility? Are you overweight and/or lead a sedentary lifestyle? If you answered yes to any of these questions, you may be at risk for developing DVT.

Other risk factors include:

Surgery (especially orthopedic) or major injury

Smoking

Varicose veins

High levels of estrogen, such as during pregnancy or when using birth control pills (hormonal contraception)

Cancer

Prolonged bed rest or immobility, e.g. during hospitalization

How is DVT diagnosed?

Diagnosis of DVT can be made quickly with a simple ultrasound scan that is painless and risk-free. A specific blood test may be performed to measure the level of “D-dimers” which is a sign of recent clotting. Early diagnosis and treatment greatly reduce your risk of serious complications.

There are other tests that your physician may recommend depending on your medical history.

“More than two million Americans are affected by blood clots every year.”

Did you know?

74% of adults have little to no awareness of DVT.

A pregnant woman is 5 to 6 times more likely to develop a DVT than a non-pregnant woman.

40% of patients with an existing DVT will experience a further DVT within 1 to 2 years.

Wearing compression stockings or socks reduces the risk to develop DVT and associated complications.

Summary

Deep vein thrombosis (DVT) is classified as an acute venous disorder.

Basic medical knowledge on venous disorders

With the term Chronic Venous Disorder (CVD) we describe a long-standing condition involving impaired venous return.

If vein valves don’t close properly, a reflux results: the blood leaks downwards and stagnates in the vein, thereby leading to venous hypertension. This condition is known as chronic venous insufficiency (CVI) which may cause edema, skin change, and, in some cases, ulcerations.

If left untreated, chronic venous insufficiency can result in the formation of serious disorders, including phlebitis and pulmonary embolism. To distinguish the different manifestations of CVD, the CEAP classification system is used.

Acute venous disorders usually occur without pre-existing conditions, but they can also be triggered by chronic venous disorders. In any case, medical treatment is immediately required. Acute venous disorders include superficial thrombophlebitis, deep vein thrombosis (DVT), pulmonary embolism, post-thrombotic syndrome, and variceal bleeding.

#acgmedicalsupply #medicial #medical health #medicalservice #medicalcare #medicare #medicine #medicinestore #medicalsupplystore #healthy #health claim #health blog #handwash #healthylifestyle #healthlifestyle

[didanawisgi]

2020 Yale-G’s Monthly Clinical Updates According to www.uptodate.com

(As of 2020-11-12, updated in Yale-G’s 6th-Ed Kindle Version; will be emailed to buyers of Ed6 paper books)

       Chapter 1: Infectious Diseases

Special Viruses: Coronaviruses

     Coronaviruses are important human and animal pathogens, accounting for 5-10% community-acquired URIs in adults and probably also playing a role in severe LRIs, particularly in immunocompromised patients and primarily in the winter. Virology: Medium-sized enveloped positive-stranded RNA viruses as a family within the Nidovirales order, further classified into four genera (alpha, beta, gamma, delta), encoding 4-5 structural proteins, S, M, N, HE, and E; severe types: severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and novel coronavirus (2019-nCoV, which causes COVID-19). Routes of transmission: Similar to that of rhinoviruses, via direct contact with infected secretions or large aerosol droplets. Immunity develops soon after infection but wanes gradually over time. Reinfection is common. Clinical manifestations: 1. Coronaviruses mostly cause respiratory symptoms (nasal congestion, rhinorrhea, and cough) and influenza-like symptoms (fever, headache). 2. Severe types (2019-nCoV, MERS-CoV, and SARS-CoV): Typically with pneumonia–fever, cough, dyspnea, and bilateral infiltrates on chest imaging, and sometimes enterocolitis (diarrhea), particularly in immunocompromised hosts (HIV+, elders, children). 3. Most community-acquired coronavirus infections are diagnosed clinically, although RT-PCR applied to respiratory secretions is the diagnostic test of choice.              

Treatment: 1. Mainly consists of ensuring appropriate infection control and supportive care for sepsis and acute respiratory distress syndrome. 2. In study: Chloroquine showed activity against the SARS-CoV, HCoV-229E, and HCoV-OC43 and remdesivir against 2019-nCoV. Dexamethasone may have clinical benefit.

Prevention: 1. For most coronaviruses: The same as for rhinovirus infections, which consist of handwashing and the careful disposal of materials infected with nasal sec retions. 2. For novel coronavirus (2019-nCoV), MERS-CoV, and SARS-CoV: (1) Preventing exposure by diligent hand washing, respiratory hygiene, and avoiding close contact with live or dead animals and ill individuals. (2) Infection control for suspected or confirmed cases: Wear a medical mask to contain their respiratory secretions and seek medical attention; standard contact and airborne precautions, with eye protection.

      Hepatitis A: HAV vaccine is newly recommended to adults at increased risk for HAV infection (substance use treatment centers, group homes, and day care facilities for disabled persons), and to all children and adolescents aged 2 to 18 years who have not previously received HAV vaccine.

      Hepatitis C: 8-week glecaprevir-pibrentasvir is recommended for chronic HCV infection in treatment-naive patients. In addition to the new broad one-time HCV screening (17-79 y/a), a repeated screening in individuals with ongoing risk factors is suggested.

      New: Lefamulin is active against many common community-acquired pneumonia pathogens, including S. pneumoniae, Hib, M. catarrhalis, S. aureus, and atypical pathogens.  

      New: Cefiderocol is a novel parenteral cephalosporin that has activity against multidrug-resistant gram-negative bacteria, including carbapenemase-producing organisms and Pseudomonas aeruginosa resistant to other beta-lactams. It’s reserved for infections for which there are no alternative options.

      New: Novel macrolide fidaxomicin is reserved for treating the second or greater recurrence of C. difficile infection in children.       Vitamin C is not beneficial in adults with sepsis and ARDS.    

      Chapter 2: CVD

      AF: Catheter ablation is recommended to some drug-refractory, paroxysmal AF to decrease symptom burden. In study: Renal nerve denervation has been proposed as an adjunctive therapy to catheter ablation in hypertensive patients with AF. Alcohol abstinence lowers the risk of recurrent atrial fibrillation among regular drinkers.

VF: For nonshockable rhythms, epinephrine is given as soon as feasible during CPR, while for shockable rhythms epinephrine is given after initial defibrillation attempts are unsuccessful. Avoid vasopressin use.

All patients with an acute coronary syndrome (ACS) should receive a P2Y12 inhibitor. For patients undergoing an invasive approach, either prasugrel or ticagrelor has been preferred to clopidogrel. Long-term antithrombotic therapy in patients with stable CAD and AF has newly been modified as either anticoagulant (AC) monotherapy or AC plus a single antiplatelet agent.

      Long-term antithrombotic therapy (rivaroxaban +/- aspirin) is recommended for patients with AF and stable CAD. Ticagrelor plus aspirin is recommended for some patients with CAD and diabetes.

VTE (venous thromboembolism): LMW heparin or oral anticoagulant edoxaban is the first-line anticoagulants in patients with cancer-associated VTE.

Dosing of warfarin for VTE prophylaxis in patients undergoing total hip or total knee arthroplasty should continue to target an INR of 2.5.

     Chapter 3: Resp. Disorders

Asthma: Benralizumab is an IL-5 receptor antibody that is used as add-on therapy for patients with severe asthma and high blood eosinophil counts.

Recombinant GM-CSF is still reserved for patients who cannot undergo, or who have failed, whole lung lavage.

Pulmonary embolism (PE): PE response teams (PERT, with specialists from vascular surgery, critical care, interventional radiology, emergency medicine, cardiac surgery, and cardiology) are being increasingly used in management of patients with intermediate and high-risk PE.

Although high-sensitivity D-dimer testing is preferred, protocols that use D-dimer levels adjusted for pretest probability may be an alternative to unadjusted D-dimer in patients with a low pretest probability for PE.

     Non-small cell lung cancer (NSCLC): Newly approved capmatinib is for advanced NSCLC associated with a MET mutation, and selpercatinib for those with advanced RET fusion-positive. Atezolizumab was newly approved for PD-L1 high NSCLC.

Circulating tumor DNA tests for cancers such as NSCLC are increasingly used as “liquid biopsy”. Due to its limited sensitivity, NSCLC patients who test (-) for the biomarkers should undergo tissue biopsy.

Cystic Fibrosis (CF): Tx: CFTR modulator therapy (elexacaftor-tezacaftor-ivacaftor) is recommended for patients ≥12 years with the F508del variant.

Vitamin E acetate has been implicated in the development of electronic-cigarette, or vaping, product use associated lung injury.

     Chapter 4: Digestive and Nutritional Disorders

     Comparison of Primary Biliary Cholangitis (PBC) and Primary Sclerosing Cholangitis (PSC):

     Common: They are two major types of chronic cholestatic liver disease, with fatigue, pruritus, obstructive jaundice, similar biochemical tests of copper metabolism, overlapped histology (which is not diagnostic), destructive cholangitis, and both ultimately result in cirrhosis and hepatic failure. (1) PBC: Mainly in middle-aged women, with keratoconjunctivitis sicca, hyperpigmentation, and high titer of antimitochondrial Ab (which is negative for PSC). (2) PSC: Primarily in middle-aged men, with chronic ulcerative colitis (80%), irregular intra- and extra-hepatic bile ducts, and anti-centromere Ab (+).

      CRC: Patients with colorectal adenomas at high risk for subsequent colorectal cancer (CRC) (≥3 adenomas, villous type with high-grade dysplasia, or ≥10 mm in diameter) are advised short follow-up intervals for CRC surveillance. Pembrolizumab was approved for the first-line treatment of patients with unresectable or metastatic DNA mismatch repair (dMMR) CRC.

      UC and CRC: Patients with extensive colitis (not proctitis or left-sided colitis) have increased CRC risk.

      Eradication of H. pylori: adding bismuth to clarithromycin-based triple therapy for patients with risk factors for macrolide resistance.

      Thromboelastography and rotational thromboelastometry are bedside tests recommended for patients with cirrhosis and bleeding.

      Pancreatic cancer: Screening for patients at risk for hereditary pancreatic cancer (PC): Individuals with mutations in the ataxia-telangiectasia mutated gene and one first-degree relative with PC can be screened with endoscopic ultrasound and/or MRI/magnetic retrograde cholangiopancreatography.

      Olaparib is recommended for BRCA-mutated advanced pancreatic cancer after 16 weeks of initial platinum-containing therapy.

      HCC (unresectable): New first-line therapy is a TKI (sorafenib or sunitinib) or immune checkpoint inhibitor atezolizumab plus bevacizumab, +/- doxorubicin. Monitor kidney toxicity for these drugs.

      UC: Ustekinumab (-umab) anti-interleukin 12/23 antibody, is newly approved for the treatment of UC.

      Crohn disease: The combination of partial enteral nutrition with the specific Crohn disease exclusion diet is a valuable alternative to exclusive enteral nutrition for induction of remission.

      Obesity: Lorcaserin, a 5HT2C agonist that can reduce food intake, has been discontinued in the treatment of obesity due to increased malignancies (including colorectal, pancreatic, and lung cancers).

      Diet and cancer deaths: A low-fat diet rich in vegetables, fruits, and grains experienced fewer deaths resulted from many types of cancer.

      Note that H2-blockers (-tidines) are no longer recommended due to the associated carcinogenic N-nitrosodimethylamine.

      Gastrointestinal Stromal Tumors (GIST):

      GIST is a rare type of tumor that occurs in the GI tract, mostly in the stomach (50%) or small intestine. As a sarcoma, it’s the #1 common in the GI tract. It is considered to grow from specialized cells in the GI tract called interstitial cells of Cajal, associated with high rates of malignant transformation.

Clinical features and diagnosis: Most GISTs are asymptomatic. Nausea, early satiety, bloating, weight loss, and signs of anemia may develop, depending on the location, size, and pattern of growth of the tumor. They are best diagnosed by CT scan and mostly positive staining for CD117 (C-Kit), CD34, and/or DOG-1.

Treatment: Approaches include resection of primary low-risk tumors, resection of high-risk primary or metastatic tumors with a tyrosine kinase inhibitor (TKI) imatinib for 12 months, or if the tumor is unresectable, neoadjuvant imatinib followed by resection. Radiofrequency ablation has shown to be effective when surgery is not suitable. Newer therapies of ipilimumab, nivolumab, and endoscopic ultrasound alcohol ablation have shown promising results. Avapritinib or ripretinib (new TKI) is recommended for advanced unresectable or metastatic GIST with PDGFRA mutations.

      Anal Cancer:

Anal cancer is uncommon and more similar to a genital cancer than it is to a GI malignancy by etiology. By histology, it is divided into SCC (#1 common) and adenocarcinoma. Anal cancer (particularly SCC among women) has increased fast over the last 30 years and may surpass cervical cancer to become the leading HPV-linked cancer in older women. A higher incidence has been associated with HPV/HIV infection, multiple sexual partners, genital warts, receptive anal intercourse, and cigarette smoking. SCCs that arise in the rectum are treated as anal canal SCCs.

Clinical features and diagnosis: 1. Bleeding (#1) and itching (often mistaken as hemorrhoids). Later on, patients may develop focal pain or pressure, unusual discharges, and lump near the anus, and changes in bowel habits. 2. Diagnosis is made by a routine digital rectal exam, anoscopy/proctoscopy plus biopsy, +/- endorectal ultrasound.

Treatment: Anal cancer is primarily treated with a combination of radiation, chemotherapy, and surgery—especially for patients failing the above therapy or for true perianal skin cancers.

     Chapter 5: Endocrinology

      Diabetes (DM):       Liraglutide can be added as a second agent for type-2 DM patients who fail monotherapy with metformin or as a third agent for those who fail combination therapy with metformin and insulin.       Metformin is suggested to prevent type 2 DM in high-risk patients in whom lifestyle interventions fail to improve glycemic indices.       Metabolic (bariatric) surgery improves glucose control in obese patients with type 2 DM and also reduce diabetes-related complications, such as CVD.       Teprotumumab, an insulin-like growth factor 1 receptor inhibitor, can be used for Graves’ orbitopathy if corticosteroids are not effective. Subclinical hypothyroidism should not be routinely treated (with T4) in older adults with TSH <10 mU/L.

        Chapter 6: Hematology & Immunology

       Anticoagulants: Apixaban is preferred to warfarin for atrial fibrillation with osteoporosis because it lowers the risk of fracture. Rivaroxaban is inferior to warfarin for antiphospholipid syndrome.

      Cancer-associated VTE: LMW heparin or oral edoxaban is the first-line anticoagulant prophylaxis.

      NH-Lymphoma Tx: New suggestion is four cycles of R(rituximab)-CHOP for limited stage (stage I or II) diffuse large B cell non-Hodgkin lymphoma (DLBCL) without adverse features. New suggestions: selinexor is for patients with ≥2 relapses of DLBCL, and tafasitamab plus lenalidomide is for patients with r/r DLBCL who are not eligible for autologous HCT.

      Chimeric antigen receptor (CAR)-T (NK) immunotherapy is newly suggested for refractory lymphoid malignancies, with less toxicity than CAR-T therapy. Polatuzumab + bendamustine + rituximab (PBR) is an alternative to CAR-T, allogeneic HCT, etc. for multiply relapsed diffuse large B-C NHL.

      Refractory classic Hodgkin lymphoma (r/r cHL) is responsive to immune checkpoint inhibition with pembrolizumab or nivolumab, including those previously treated with brentuximab vedotin or autologous transplantation.

      Mantle cell lymphoma: Induction therapy is bendamustine + rituximab or other conventional chemoimmunotherapy rather than more intensive approaches. CAR-T cell therapy is for refractory mantle cell lymphoma.

      AML: Gilteritinib is a new alternative to intensive chemotherapy for patients with FLT3-mutated r/r AML.

      Oral decitabine plus cedazuridine is suggested for MDS and chronic myelomonocytic leukemia.  

      Multiple myeloma (MM): Levofloxacin prophylaxis is suggested for patients with newly diagnosed MM during the first three months of treatment. For relapsed MM: Three-drug regimens (daratumumab, carfilzomib, and dexamethasone) are newly recommended.

      Transplantation: As the transplant waitlist continues to grow, there may be an increasing need of HIV-positive to HIV-positive transplants.

      Porphyria:       Porphyria is a group of disorders (mostly inherited) caused by an overaccumulation of porphyrin, which results in hemoglobin and neurovisceral dysfunctions, and skin lesions.       Clinical types, features, and diagnosis:  I. Acute porphyrias: 1. Acute intermittent porphyria: Increased porphobilinogen (PBG) causes attacks of abdominal pain (90%), neurologic dysfunction (tetraparesis, limb pain and weakness), psychosis, and constipation, but no rash. Discolored urine is common. 2. ALA (aminolevulinic acid) dehydratase deficiency porphyria (Doss porphyria): Sensorimotor neuropathy and cutaneous photosensitivity. 3. Hereditary coproporphyria: Abdominal pain, constipation, neuropathies, and skin rash. 4. Variegate porphyria: Cutaneous photosensitivity and neuropathies.  II. Chronic porphyrias: 1. Erythropoietic porphyria: Deficient uroporphyrinogen III synthase leads to cutaneous photosensitivity characterized by blisters, erosions, and scarring of light-exposed skin. Hemolytic anemia, splenomegaly, and osseous fragility may occur. 2. Cutaneous porphyrias–porphyria cutanea tarda: Skin fragility, photosensitivity, and blistering; the liver and nervous system may or may not be involved.  III. Lab diagnosis: Significantly increased ALA and PBG levels in urine have 100% specificity for most acute porphyrias. Normal PBG levels in urine can exclude acute porphyria.       Treatment: 1. Acute episodes: Parenteral narcotics are indicated for pain relief. Hemin (plasma-derived intravenous heme) is the definitive treatment and mainstay of management. 2. Avoidance of sunlight is the key in treating cutaneous porphyrias. Afamelanotide may permit increased duration of sun exposure in patients with erythropoietic protoporphyria.

 Chapter 7: Renal & UG

Membranous nephropathy (MN): Rituximab is a first-line therapy in patients with high or moderate risk of progressive disease and requiring immunosuppressive therapy.

      Diabetes Insipidus (DI): Arginine-stimulated plasma copeptin assays are newly used to diagnose central DI and primary polydipsia, often alleviating the need for water restriction, hypertonic saline, and exogenous desmopressin.

      Prostate cancer: Enzalutamide (new androgen blocker) is available for metastatic castration-sensitive prostate cancer. Cabazitaxel, despite its great toxicity, is suggested as third-line agent for metastatic prostate cancer. Either early salvage RT or adjuvant RT is acceptable after radical prostatectomy for high-risk disease.

      UG cancers: Nivolumab plus ipilimumab is suggested in metastatic renal cell carcinoma for long-term survival.

      Enfortumab vedotin is suggested in locally advanced or metastatic urothelial carcinoma. Maintenance avelumab is recommended with other chemotherapy in advanced urothelial bladder cancer. Pyelocalyceal mitomycin is suggested for low-grade upper tract urothelial carcinomas.

Chapter 8: Rheumatology

Janus kinase (JAK) inhibitors (upadacitinib, filgotinib) are new options for active, resistant RA and ankylosing spondylitis.

Graves’ orbitopathy: new therapy–teprotumumab, an insulin-like growth factor 1 receptor inhibitor.

Chapter 9: Neurology & Special Senses

Epilepsy: Cenobamate, a novel tetrazole alkyl carbamate derivative that inhibits Na-channels, provides a new treatment option for patients with drug-resistant focal epilepsy. A benzodiazepine plus either fosphenytoin, valproate, or levetiracetam is recommended as the initial treatment of generalized convulsive status epilepticus.

Migraine: Lasmiditan is a selective 5H1F receptor agonist that lacks vasoconstrictor activity, new therapy for patients with relative contraindications to triptans due to cardiovascular risk factors.

      Stroke: New recommendation for cerebellar hemorrhages >3 cm in diameter is surgical evacuation.       TBI: Antifibrolytic agent tranexamic acid is newly recommended for moderate and severe acute traumatic brain injury (TBI).

      Ofatumumab is a new agent that may delay progression of MS.

 Chapter 10: Dermatology

 Minocycline foam is a new topical drug option for moderate to severe acne vulgaris.

       Melanloma: Nivolumab plus ipilimumab in metastatic melanoma has confirmed long-term survival. With sun-protective behavior, melanoma incidence is decreasing.

       New: Tazemetostat is suggested in patients with locally advanced or metastatic epithelioid sarcoma (rare and aggressive) ineligible for complete surgical resection.

       Psoriasis: New therapies for severe psoriasis and psoriatic arthritis: a TNF-alpha inhibitor (infliximab or adalimumab, golimumab) or IL-inhibitor (etanercept or ustekinumab) is effective. Ixekizumab is a newly approved monoclonal antibody against IL-17A. Clinical data support vigilance for signs of symptoms of malignancy in patients with psoriasis.

     Chapter 11: GYH

      Breast cancer:        Although combined CDK 4/6 and aromatase inhibition is an effective strategy in older adults with advanced receptor-positive, HER2-negative breast cancer, toxicities (myelosuppression, diarrhea, and increased creatinine) should be carefully monitored. SC trastuzumab and pertuzumab is newly recommended for HER2-positive breast cancer.

      Whole breast irradiation is suggested for most early-stage breast cancers treated with lumpectomy. Accelerated partial breast irradiation can be an alternative for women ≥50 years old with small (≤2 cm), hormone receptor-positive, node-negative tumors.

      Endocrine therapy is recommended for breast cancer prevention in high-risk postmenopausal women.

      Uterine fibroids: Elagolix (oral gonadotropin-releasing hormone antagonist) in combination with estradiol and norethindrone is for treatment of heavy menstrual bleeding (HMB) due to uterine fibroids.

      Chapter 12: OB

      Table 12-6: Active labor can start after OS > 4cm, and 6cm is relatively more acceptable but not a strict number.

      Table 12-7: Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria, or of hypertension and significant end-organ dysfunction with or without proteinuria, in the last half of pregnancy or postpartum. Once a diagnosis of preeclampsia is established, testing for proteinuria is no longerdiagnostic or prognostic. “proteinuria>5g/24hours” may only indicate the severity.

      Mole: For partial moles, obtain a confirmatory hCG level one month after normalization; for complete moles, reduce monitoring from 6 to 3 months post-normalization.

      Chapter 14: EM

SHOCK RESUSCITATION

Emergency treatment—critical care!

“A-B-C”: Breathing: …In mechanically ventilated adults with critical illness in ICU, intermittent sedative-analgesic medications (morphine, propofol, midazolam) are recommended.

 Chapter 15: Surgery

      Surgery and Geriatrics: Hemiarthroplasty is a suitable option for patients who sustain a displaced femoral neck fracture.

    Chapter 16: Psychiatry

     Depression: Both short-term and maintenance therapies with esketamine are beneficial for treatment-resistant depression.

Schizophrenia: Long-term antipsychotics may decrease long-term suicide mortality.

Narcolepsy: Pitolisant is a novel oral histamine H3 receptor inverse agonist used in narcolepsy patients with poor response or tolerate to other medications. Oxybate salts, a lower sodium mixed-salt formulation of gamma hydroxybutyrate is for treatment of narcolepsy with cataplexy.

     Chapter 17: Last Chapter

PEARLS—Table 17-9:  Important Immunization Schedules for All (2020, USA)

Vaccine                 Birth       2M          4M          6M          12-15M                 2Y          4-6Y       11-12Y       Sum

HAV                                                                                       1st                          2nd (2-18Y)                            2 doses

HBV                      1st           2nd                        3rd (6-12M)                                                                             3 doses

DTaP                                    1st            2nd         3rd          4th (15-18M)                        5th                             + Td per 10Y

IPV                                       1st           2nd         3rd (6-18M)                                         4th                             4 doses

Rotavirus                            1st           2nd                                                                                                         2 doses

Hib                                       1st           2nd         (3rd)       (3-4th)                                                                    3-4 doses

MMR                                                                                    1st                                         2nd                              2 doses

Varicella                                                                              1st                                         2nd                        + Shingles at 60Y

Influenza                                                            1st (IIV: 6-12Y; LAIV: >2Y                (2nd dose)               1-2 doses annually

PCV                                     1st           2nd         3rd          4th                                                                        PCV13+PPSV at 65Y

MCV (Men A, B)                                                                                                                                1st         Booster at 16Y

HPV                      9-12Y starting: <15Y: 2 doses (0, 6-12M); >15Y or immunosuppression: 3 doses (0, 2, 6M).

Chapter 17 HYQ answer 22: No routine prostate cancer screening (including PSA) is recommended and answer “G” is still correct–PSA

screening among healthy men is not routinely done but should be indicated in a patient with two risk factors.

#medical school #Resources

[demigodsanswer]

Out of curiosity, any headcanons on Clarisse's backstory?

I do! I’ve written about some of these before, so some might be repeats. 

Her mom (Madeline) was a dancer with the Paris Opera ballet when she met Ares. She was 29. They only spent the night together. He had told her that he was a god, but she thought it was some bad pick up line. 

When they were done, he made some comment about her having his baby, and she realized that he had lied about using protection. She was so angry (she’s a very angry person) that she stabbed him with one of her kitchen knives, which, of course, did nothing. 

Ares just smiled and took the knife from her, before handing her a celestial bronze knife. He said “This is the only thing that will protect your son. Hold onto it,” 

So she stabbed him with that knife. This time, it did something. Still, he just smiled and handed the knife back to her, and said “This bodes well for me. Your son’ll be fierce,” 

“How do you even know I’ll get pregnant? How do you even know it’ll be a boy?” 

“Just do,” 

Five months later, she smiled when she found out it was a girl. 

Madeline wasn’t from France. Her family was distantly French, but they had lived in America for 400 years. Her parents were from Phoenix. She moved to Paris for dance training when she was 15. 

Madeline never wanted to be a mother. She wasn’t a bad mother, but she wasn’t a great mother either. She spent a lot of Clarisse’s childhood focusing on her career instead of Clarisse. 

She also made Clarisse take dance as early as three. Which wasn’t really surprising to anyone, considering Clarisse was basically raised in ballet studios. 

When Clarisse was six month old, Madeline started dating another man in the company (Jean). They were together for seven years, and Clarisse grew up believing he was her real father. He treated her like she was his daughter and loved her fiercely. He was planning on adopting her when he and Madeline got married. 

Madeline swears she didn’t know that Clarisse thought Jean was her birth father, but Clarisse think’s that’s just impossible. 

But when Clarisse was seven, Madeline got a call that her mother had stage-four lung cancer. Her father asked her to come home (”You’re 37. Your dance career is almost over anyway,”) to help take care of her. 

Madeline agreed to go home until her mother passed. No one expected her to live for more than a year. So she and Jean put their engagement on pause and she moved back to Arizona with Clarisse. 

Her mother lived for another two and a half years. 

After the first year, Madeline decided to call off the engagement when Jean offered to move to Arizona to be with them. He was only 32 and still had years of dancing left and he was from France. Madeline didn’t want him leaving France to be with her when she didn’t know how long they would be there or if she would ever come back. 

When she told Clarisse, Clarisse got angry and yelled and asked to move back to France to live with her dad. Madeline ended up shouting back at Clarisse until ran off to her room. Madeline went to her room and cried too, and wished her mom would just die so that her life could get back to normal. She knew it wasn’t the right thing to think, but she couldn’t help it. Everything had been going so well, and now she was stuck back in a city she hated, taking care of her aging parents, and a child she never wanted and didn’t understand. 

Her relationship with Clarisse was never very good after that. 

When her mother lived another year, Clarisse finally called Jean and said that she didn’t expect to ever move back to Paris - Clarisse had settled into Arizona life, and she couldn’t uproot her daughter’s life again, even if her mother passed away soon. 

Her mom passed away six months later, and at the funeral, Clarisse asked if they would move back to Paris. 

“Do you want to?” 

“Yes, I hate it here,” 

“What about your soccer team?” 

“They play soccer in France,” 

“What about poppop?” 

“He can come,” 

Madeline smiled, thinking that maybe they could move back to France. 

Before any serious moves could be made in that direction, though, they discovered that her father had dementia. He’d had symptoms for the last two years, but they went unnoticed because of his wife’s cancer. Madeline couldn’t leave him alone or uproot him to move to Paris. 

This sparked another fight between her and Clarisse. 

“You said we were moving back to Paris!” 

“That was before we knew that poppop was sick! We can’t just leave him!” 

“But you promised!” 

“You think I don’t hate it here too? You think I don’t miss Paris every day? But your grandfather needs our help right now! And we can’t just abandon our family!” 

“What about papa? We abandoned him! We haven’t seen him in three years!” 

“Jean isn’t family!” Madeline yelled. 

Clarisse looked so angry, like if she were any taller or stronger she would start hitting her mom. “How can you say that! He’s my father!” 

Madeline realized then that Clarisse thought Jean was her birth father. She sat Clarisse down and explained that she had already been six months old when they’d started dating. Madeline expected Clarisse to ask questions about her birth father, but she didn’t. When Madeline finally looked at her daughter, she expected her to be angry, to start yelling, but she was just staring at the floor and crying. 

Madeline tried to reach over to comfort her, but Clarisse just looked at her and said, “I hate you. I wish papa had adopted me so that I didn’t have to live with you anymore,” and then she took herself to her room. 

After an hour, Madeline went to check on her and found her sitting in her bed looking at old photos from Paris. 

“Can I come in?” she asked. Clarisse nodded without looking at her. She made her way into the room and sat next to her on the bed, pulling her daughter in for a hug, who accepted it without resistance. “Are you okay?” 

Clarisse shook her head no. “I just still feel like he’s my dad,” she started crying again, and Madeline held her tighter, “and now I won’t ever get to see him again,” 

“I miss him too,” she said. “And I’m sorry. I would have told you sooner if I had realized,” 

They spend a decent amount of time talking, and Madeline orders them a pizza. She decided that she and Clarisse would play hookie the next day and get ice cream and hang out around town. 

The next morning, they’re enjoying a late breakfast, when someone knocked on the door. Madeline recognizes the man immediately. He had introduced himself to her a few weeks ago as Coach Hedge, when he’d explained who he was and why he was there, and that he was watching Clarisse. “She’ll have to leave soon,” he’d told her. 

“You want my ten-year-old to leave with a goat-man to go across the country to be trained by a magic horse?”

“It sounds insane when you put it that way, but yes. She needs to be trained,” 

“She is a child!” She yelled at him. “She needs her mom,” 

“If she stays here she could be killed. Now, I don’t know how long it’ll be before they start coming for her, but I can tell that she’s strong. If I know she’s here, it won’t be long before they know it too,” 

And now he was there, in her doorway with a backpack and a baseball bat. 

“Please, no, not today,” she said before saying anything else. 

“We need to leave today. They aren’t far. We need as much of a head start as we can get,” 

(Cut to the story I wrote yesterday for how the rest of that went) 

When she got to camp, Luke showed her around. She got a spot on the Hermes cabin floor next to Chris, who was excited to have another kid at camp around his age. 

“Do you like Star Wars?” 

“No,”

“Do you like soccer?”

“Yeah!” 

They become very fast friends, but Luke does have to move them to different parts of the floor because they kept staying up late talking. 

It takes about a month for her to be claimed, but no one is surprised when it happens. She was claimed after a spar with Annabeth. She was using a sword, and Annabeth was using her knife, but Clarisse had her dad’s knife hidden in her pocket. When Annabeth thought she had won, Clarisse pulled out her own knife and ended up winning. 

This starts their constant rivalry at camp. 

She doesn’t meet her dad until the Winter Solstice when Luke steals the lighting bolt. 

She introduces herself to her father, and he claimed he didn’t remember her mother, so she reminded him. “She stabbed you,” she said, “and that didn’t work, so you gave her this knife,” she pulled out the knife, “and then she stabbed you again,” 

She didn’t mean to be insolent or insubordinate, but that’s how her father took it. He slapped her across the face. Hard. 

She looked at him, shocked at what had happened. He looked back like he was waiting for her to say or do something. 

She looked him in the eye and said, “My mother hits harder.” That time, she had meant to be insubordinate and insolent. She was also a liar. Her mother had never hit her. 

Ares just smirked. “You need a better weapon that some stupid knife. They’re good when you need them, but you can’t do much damage with just that,” 

“I use a sword too,” she said. 

“You should use a spear, like your older brothers. I’ll send one to camp for you,”

She smiled, “Thank you, sir,” 

“One last thing, kid,” he towered over her. He seemed like he was seven feet tall. He might be, Clarisse realized, he’s a god. “I don’t have many daughters. I prefer it that way. They tend to be disappointing. I hope you don’t disappoint me,” 

Clarisse nodded. “I won’t, sir,” she promised.

#heres all the headcanons for a fic i will probably never get around to writing #clarisse la rue #chris Rodriguez #aquaeclipse