To be honest, when my spouse came out to me as a woman in April 2018, I had completely forgotten about Transparent.

The shine on the former Golden Globe-winning comedy, a show I had once adored, had tarnished, dulled by time and circumstance. September 2017 had seen both the launch of the series fourth season and a #MeToo scandal surrounding star and two-time Emmy winning actor Jeffrey Tambor, relegating the Amazon Prime Video show to a bygone era, canceled by the very age of heightened diversity and equality that it helped to usher in.

When the two-hour Musicale Finale was announced in October 2018, it barely registered. My wife was still publicly closeted. We had our hands full keeping her gender identity our little secret, and tensions were high as we moved toward hormone replacement therapy and the estrogen she so desperately needed.

It wasnt until July 2019, when Amazon announced the fall premiere date for the finale just a month after my wife had come out to the world, that I realized that Id have to reckon with the show again. A show that was now my life.

RelatedRelated

My day-to-day has never resembled that of the Pfefferman clan. Maura Pfefferman was well past retirement age when she came out to her family as a trans woman, long divorced from wife Shelly, with three children mired in their 30s and 40s. The Pfeffermans were affluent Los Angeles natives, whose stories were inextricably intwined with their own complicated relationships with Judaism.

It was a world completely unfamiliar to me, a Los Angeles transplant from South Dakota, as a lapsed Methodist who met the love of her life at 18 and married at 22. In 2014, Transparent was a window into a life I could never understand and impossible for me to infiltrate.

At the time, I found it an intimate and careful series, showcasing a story that few people could imagine, and doing so with artistry and empathy.

Judith Light in Transparent: Musicale Finale

Nicole Wilder / Amazon

Nowadays, I dont know how to feel about Transparent. Rather, I feel a lot of things about Transparent, most of them in direct opposition to something else.

There are valid arguments to be made about the decision to cast a cis man as a trans woman, and legitimate complaints about how the show handled the Tambor accusations. The series absolutely is limited by being about sad rich people in a community where that is the exception and not the rule.

But I adored it because its a show that opened my heart, too. There was a moment nearly a decade ago that horrifies me to this day one of those exchanges that weighs heavy with the significance of my suspicions in retrospect when I told my wife that I could never be with her if she was a woman. It was just not something my brain had the capacity to ponder.

My life was sheltered. Homogenous. As in, I didnt meet a Jewish person until my mid-20s; that kind of sheltered. I couldnt reconcile my own sexuality until I was in my 30s. As imperfect as it was, Transparent, as did Netflixs Orange is the New Black just the year before, invited my narrow band of experience to explore a wider world.

It was a glimpse at a place that I would very soon join. Its a thesis neatly stated by Judith Lights Shelly early in Transparent Season 3: When one person in a family transitions, everyone transitions.

My wifewho is very smart and pretty wrote that Transparent was never telling Mauras story. Which is good, in a way, because Mauras story is not one that creator Jill Soloway is necessarily equipped to tell. Instead, its the story of the family as a whole.

Alexandra Billings in Transparent: Musicale Finale

Amazon Studios

So, inspired by that, heres my story:

Learning that my wife was trans felt like a chiropractic adjustment that I didnt know I needed. My life was fine. Having been together for nearly 20 years, my wife and I had developed a routine that wasnt perfect, but worked for us. Her truth hit me so hard that every bone in my body trembled. My teeth loosened. My lungs deflated.

But suddenly, I could see. I understood arguments that wed been having for eons. Issues that we could never resolve, distance that felt impenetrable, and sadness that seemed bottomless. Problems with intimacy that no amount of therapy could resolve dissipated once there was no longer a retaining wall in my wifes brain, keeping her true self locked away. Instantly, there was context for a million moments that werent strange in isolation, but in retrospect, finally made sense.

But all the hindsight in the world couldnt mend my shattered heart.

For about 36 hours, I was lost. No matter how important and valuable the discovery, her words had basically ended my life. Our life. And it took time to reconcile that.

Its difficult to remember the specifics of those moments. I know I called in sick. I know I cried. Though we were operating in the utmost secrecy, Emily knew I needed someone to talk to and immediately looped in one of our closest friends, who was invaluable both then and now.

Because while I was unsurprised by the grief, the anger, the sadness, what struck me most in the first days after the revelation was how isolated I felt. Not only because my wifes identity was the most fragile of secrets, but also because it felt as though I had lost the rights to my own narrative.

As a writer, that narrative sometimes feels like all I have. Emily being a woman, instead of the man the world presumed her to be, felt as though my editor had just sent back the last 20 years of my life for a hard rewrite. In that moment, I realized why Soloways first impulse upon their father coming out as trans was to write a TV script. If you craft a lightly fictionalized narrative onto your life, it allows you to feel like you have control in a situation in which you feel powerless.

These were the things I thought about as I stared at the ceiling, sleepless. I wondered if my life was now a lie. I wondered if our love was a lie. I relitigated every fight wed ever had. I realized that if we were going to make it through this, we would need a full reckoning of our past, with consideration for the new information that had been entered into evidence in the contentious and imaginary court proceedings that was our marriage.

But what I thought about more than anything was how scared I was. No matter what I decided to do, be it move forward with Emily or leave, I would lose. It could be family or friends or opportunities, just to name a few, and more likely than not, any combination of the above. That said, if I stayed, I would keep the love of my life. And thats not nothing.

Judith Light in Transparent: Musicale Finale

Amazon Studios

The longer I sat with it, the more I realized that Emilys gender was not a disease, but a diagnosis. And there was a relatively painless cure. All we needed to do was treat her like the woman she always was. Thats it. If we did that, if we tweaked our world 15 degrees, then everything wouldnt be perfect, but it would be pretty damn close.

And I know thats a prescription that sounds so big to some people. And it is! But its also so small. It feels extremely strange to frame it in this fashion, but all things considered, our relationship was strangely primed to be able to take the transition in stride. There are plenty of significant challenges that can break relationships when a partner transitions, simply because it creates such fundamental incompatibilities that to stay together is impossible.

For instance, issues of attraction. A million years ago when we married, I was pretty sure I was straight. Rather, the part of me that was attracted to women didnt have a lot of room to explore, since I started dating my partner, like, the moment they crossed the threshold of my dorm room. By the time I realized I was, in fact, bisexual, it felt like it was too late to declare it to the world. No one cares what a long-time married white cis woman identifies as and I wasnt interested in declaring myself because the last thing I wanted to do was look like I was bandwagoning bisexuality. Emilys transition gave me license to come out publicly and, more importantly, it means that without the burden of heterosexuality, I find my wife more beautiful than ever before.

Another reality of life married to a trans woman is that the aforementioned HRT effectively sterilizes her remaining sperm. Understandably, this is heartbreaking for couples who harbor hope for biological children, potentially forcing them on a path of assisted reproduction that they never planned on.

Lucky for us, I suppose, is that our marriage had already been grappling with infertility for years. We were so far along in the IVF process, actually, that mere weeks after my wife told me she was a woman, we had our first IVF transfer. While weve yet to have success and while, honestly, we have enough to deal with right now we are already veterans of this battle.

We are privileged even beyond fundamental advantages, including insurance and steady employment in ways that not all our LGBTQ sisters and brothers are, and grateful every day that our previous paths gave us challenges that prepared us for this very unique road.

So, when I revisit Transparent now, its with jaded, yet guilty, eyes. I feel intense shame at how casually the Pfeffermans storm through the world, leaving the less fortunate in their wake, rarely taking the time or effort to clean up after themselves, literally or figuratively. And practically, it feels like no one cries enough and that Maura is looked at askance too often. The show cant ever see past the idea of Tambor in a dress and so the audience is kept at arms length, making it impossible to embrace Maura as a woman.

For better or worse, this is the world, as created by Transparent.

Transparent: Musicale Finale

Erin Simkin / Amazon

To watch the shows recent finale, is to understand that even Transparent knows that there is no place for it in 2019. Its not that the musical endeavor is a failure; its far more confusing than that. The episode picks up immediately after Mauras death and shows the family exploring their grief through song, which isnt bad, but is strange.

There are things that work, however, including Shelly attempting to launch a show about the family, going so far as to cast doppelgngers for her children and to find herself a new Maura (standout and IRL trans woman Shakina Nayfack) that helps her process her pain at the death of her ex.

As a whole, the episode is slightly cracked, garish and extreme and above all else, indulgent. But caught around the edges are hints of the subtle series that used to exist. One such moment has Shelly imagining herself and Maura as young girls taking dance together, remolding their bond into something truer to themselves and so profoundly moving that I had to pause the episode. I couldnt see through my silent sobs.

This has always been the heart of conflict for a Transparent fan. Theres so much to cringe over and nearly as much raw, real emotion.

I miss Transparent in the same way that I miss my old life. My relationship wasnt better then, but I knew what it was. It was comfortable. Its hard to woo this hot new babe when months ago you were in a genial routine and could go entire weekends in the same apartment, communicating exclusively through Slack messages. Its hard to challenge what you understand about identity, when its so much easier to fall back on what youve always known.

You could watch the Transparent finale if you want, if you feel like doing so would offer you closure. But I dont think its necessary. In fact, after rewatching three seasons of the series, Im not sure we need to revisit Transparent ever again. The series isnt somewhere weve been and its not somewhere were going. It was a conduit that brought us to where we are now. Its the bridge that brought us from the transgender experience as a punchline to realizing that transgender individuals are just people, trying their best to live happy and fulfilled lives.

We live in this beautiful, fucked-up world. Where we sit and wait to see if the U.S. Supreme Court will strip protections from LGBTQ individuals, even as television is helping to guide people about the nebulous nature of gender and love.

Im grateful for Transparent and the weight it carried. For how it paved the way for shows like Pose, and how its quality injected the trans experience into mainstream conversation, opening the eyes and hearts of people around the world, including me. But using it now to try to bolster your understanding of the world around you in 2019 is like reading a safe-sex pamphlet from 1988. Its not safe. Its not smart. It may have been the best we had available at the time, but the world has moved on.

We can do better. And we will. Now its on us to make reality better than that fiction.

Sign Up: Stay on top of the latest breaking film and TV news! Sign up for our Email Newsletters here.

See the original post here:
Im Married to a Trans Woman. And I Miss Transparent Like I Miss My Old Life. - IndieWire

The Government has recently imposed restrictions on the parallel export of certain drugs from the UK to the EEA. At the moment, parallel imports tend to flow into the UK, where goods can be bought inexpensively in other EU member states and resold at a higher price in the UK. As the pound continues to weaken, the tide has recently turned and we are seeing more parallel exports. As a result, and particularly in response to the ABPIs call for ministers to restrict parallel exports and attempt to stem the flow of drugs out of the UK, the Government has now announced a ban on drug exports of the medicines considered to be in shortest supply across the country. The export ban lists 24 drugs in total, including 19 hormone replacement therapy drugs, adrenaline pens for severe allergies, hepatitis B vaccines and a number of contraceptives. It is not yet clear how long this ban will stay in place for.

Currently, under EU legislation, for the UK Government to impose a temporary export ban to prevent stockpiled drugs being sold out of the UK, it would need to do so on the basis of Article 36 of the Treaty on the Functioning of the European Union (TFEU). Article 36 provides that the provisions of Articles 34 and 35 (which themselves prohibit restrictions on imports and exports between Member States) shall not preclude prohibitions or restrictions on imports, exports or goods in transit justified on grounds of the protection of health and life of humans Such prohibitions or restrictions shall not, however, constitute a means of arbitrary discrimination or a disguised restriction on trade between Member States.

Article 36 allows for a limited exception to the prohibition of any restrictions of the free movement of goods within the EU only where the public health justification is:

A number of EU Member States have applied to the Commission to restrict exports on the basis of Article 36, with varying success. For example, the Belgian Constitutional Court is currently considering the legitimacy of an amendment to the Medicines Act made earlier this year by the Belgian Parliament which sought to tackle medicines shortages in Belgian pharmacies.

Another recent example is Romania: on 13 September 2019, the Romanian Ministry of Health announced, as a result of a public consultation, that it would suspend the exportation of 127 medicines for a six month period. The targeted medicines all run an increased risk of shortage and are indicated for the treatment of cancer and transplant patients. The measure will be notified to the European Commission and is expected to be blessed given the short-term, targeted, nature of the proposed restriction.

The EU has already made clear that, if the UK leaves the EU without a deal, parallel exports into the EU would not be possible as the UK would be outside of the single market. Ahead of Brexit, any restriction imposed by the UK on exports would need to be genuine and proportionate, meaning a temporary, targeted restriction could constitute a legitimate way of preventing the drugs stockpiles in the UK from being run down ahead of Brexit. As the precise details of the Governments new ban are still to be released, in particular its duration, it is not yet clear whether it would be deemed to be genuine and proportionate for the purposes of Article 36.

Read the original post:
Brexit Healthcare blog post: Recent developments on the sale of no-deal Brexit stockpiled drugs out of the UK - Lexology

Each year over 300,000 women are diagnosed with breast cancer, making it the most common form of cancer in women. Overall, it is the second most common cause of death from cancer in women exceeded only by lung cancer. There are a number of risk factors women should be aware of for breast cancer.

Aging: The aging process is the greatest risk factor for developing breast cancer. Two-thirds of all cases of invasive breast cancer occur in women over the age of 55 years. Only 12.5% of cases occur in women below the age of 45 years. So as women age, the importance of regular breast self-examinations and mammograms increases in importance.

Family History: Having one first-degree female relative (mother, sister or daughter) with breast cancer doubles your risk for developing breast cancer. Having two first-degree female relatives with breast cancer increases your risk 5-fold. Around 5% to 10% of breast cancers are due to the inheritance of abnormal genes. These genes include BRCA1, BRCA2 and CHEK2. If you have a female relative with breast cancer you should ask them if they were tested for the presence of these genes.

Body Weight: Being overweight increases your risk for developing breast cancer. If you already have had breast cancer, it increases your risk of recurrence. The increased risk is especially seen after menopause. The excess fat cells make the hormone estrogen which can encourage breast cancers to develop and grow. Eating a plant-based, whole foods diet (consisting of fresh or frozen fruits and vegetables instead of processed foods) helps to decrease the risk of breast cancer. Also, there is a lower rate of breast cancer in countries where women consume lower fat diets.

Exercise: Exercising 35-60 minutes each day reduces the risk of breast cancer. Exercise also improves survival among women who have breast cancer. Consult with your medical provider and a physical trainer on how best to start an appropriate exercise program.

Alcohol: Consuming three alcoholic beverages per week increases the risk of breast cancer by 15%. Each additional drink added to this average increases the risk by another 10% e.g. 4 drinks per week is associated with a 25% increase in risk. Alcohol raises estrogen levels and can potentially damage DNA both of which contribute to the risk of cancer.

Smoking: This increases the risk of breast cancer especially among younger, pre-menopausal women. Even second-hand smoke exposure has been associated with an increased risk of breast cancer.

Oral Contraceptive Use: Any use results in a 7% overall increase in risk. Current use causes a 24% increase in the risk of breast cancer. After a woman has been off the oral contraceptive for 10 years, the increased risk had resolved. Similarly the use of hormone replacement therapy also increases the risk of breast cancer due to the ongoing exposure of the breasts to estrogen. You should consult with your health care provider is you are considering hormone replacement therapy after menopause to assess the risks and benefits of this therapy.

Dr. Samuel Abbate has a practice in Wasilla.

Go here to see the original:
Steps women can take to prevent breast cancer - Mat-Su Valley Frontiersman

In 2009, Connecticut was the first state to pass a law that requires radiologists to notify women who have had screening mammograms if they have dense breasts. Since then, more than 30 states, including New York, have followed suit. Breast density has to do with the amount of fibrous and glandular tissues that a woman has in her breasts compared with the amount of fat. Having dense breasts is a risk factor for breast cancer. Below, Sandra Brennan, M.D., Director of Radiology at Memorial Sloan Kettering (MSK) Westchester, explains what doctors know about breast density and what steps women with dense breasts can take to increase the likelihood that any cancer they might develop is detected early.

Having dense breasts is relatively common and makes it more difficult for cancer to be picked up by a mammogram. The dense tissue looks white on the image, and that can obscure cancerous masses.

Women with dense breasts also have an elevated risk of breast cancer. The 10 percent of women who have the most-dense tissue have a risk that's four to six times higher compared with those whose breasts are the least dense. This is because glandular tissue is more likely to become cancerous. But even women with breasts that are mostly fatty can develop breast cancer.

Mostly it's just part of the body's natural makeup. Density is affected by age and hormones. Taking hormone replacement therapy will increase breast density. Conversely, taking an estrogen-receptor drug to treat breast cancer will decrease it. A woman's breasts may become less dense as she ages, but that doesn't always happen. Some women may have changes in the amount of fat in their breasts if they lose or gain weight. Women with a low body mass index tend to have dense breasts.

Tomosynthesis, also known as 3-D mammography, is better at detecting masses in dense breasts than traditional 2-D mammography. This is because it looks at the breasts in visual slices and removes some of the masking effect of the overlying dense tissue. We offer 3-D mammograms as an option for women who get screened at any of MSK's locations, including MSK Westchester.

Women with dense breasts should discuss with their doctor whether they should have supplemental screening with ultrasound. It can pick up cancers that we might not see on a mammogram in women with dense breasts.

We offer 2-D and 3-D mammography, and screening breast ultrasounds. For women at a higher breast cancer risk unrelated to their breast density, we offer breast MRIs, which can detect small tumors that are not seen on a mammogram.

For those who need a breast biopsy, we perform a number of nonsurgical procedures at MSK Westchester. These include percutaneous ultrasound-guided core biopsies, fine-needle aspirations, stereotactic breast biopsies and MRI-guided biopsies. People who are having surgery at MSK in Manhattan can have their preoperative seed localizations and sentinel node injections done at MSK Westchester.

We also offer contrast-enhanced digital mammography (CEDM) at MSK Westchester. This advanced breast-imaging technique creates a vascular map of the breast, similar to an MRI. It's a specialized procedure that highlights areas of increased blood flow that can be associated with tumor growth. MSK research has shown that CEDM is as sensitive in detecting breast cancer as breast MRI when both were compared with standard mammograms. MSK is unique among breast-screening facilities in Westchester County in offering CEDM, which is not widely available.

Read the original:
What Women Should Know About Breast Density And Cancer Risk - Patch.com

WASHINGTON None of us know when a medical emergency will affect us, Senator Bernie Sanders wrote in a tweet from Desert Springs Hospital Medical Center on Wednesday, hours after the 78-year-old Democratic candidate for president experienced one.

Mr. Sanderss emergency the sudden onset of chest pain known as angina is one that thousands of other Americans experience each year. Mr. Sanderss discomfort occurred at a campaign event on Tuesday night. Because it signaled acute heart trouble, the senator went to the hospital where doctors implanted two stents in one of the coronary arteries that nourish the heart.

Doctors often release patients who undergo such procedures in a day or two. Mr. Sanders remained in the hospital until Friday evening, when after three days of revealing few details about his condition his campaign confirmed that Mr. Sanders had suffered a heart attack.

Until then, Mr. Sanders had not disclosed whether blood and electrocardiogram tests showed he had a heart attack. The senator and his campaign have not allowed reporters to interview his doctors, though advisers have said that Mr. Sanders would be able to appear in the next Democratic debate on Oct. 15.

With respect to release of health information, President Trump has not had a medical emergency while running for or serving in office, but he disclosed few specific laboratory test results initially in his 2016 campaign. He issued a four-paragraph letter from his personal physician stating that Mr. Trump would be the healthiest individual ever elected to the presidency. Closer to the 2016 election date, Mr. Trumps doctor offered a more conventional letter that still omitted a number of details that would be part of a customary summary of a patients health.

In 2018, the doctor, Harold N. Bornstein, said that Trump aides had raided his office a year earlier and taken the presidents medical files after The Times reported that the president had taken a drug for hair growth. And this year, the White House physician pronounced Mr. Trump in very good health although the president had gained weight and is now officially obese.

The health questions hang over Mr. Sanders in part because he would become the nations oldest president by far if elected. Also, given that implanting two stents in one coronary artery is a very common procedure in American hospitals, it was puzzling that for several days he did not release more details. Mr. Sanders is a private person, no doubt, but most modern-day presidents and serious candidates for the presidency have put forward details to inform the electorate after emergency health issues.

Normally, recovery from stent placement is very quick, and patients usually go home a day or two after the procedure, said Dr. Jonathan S. Reiner, a cardiologist at George Washington University Hospital in Washington, D.C. who treated former Vice President Dick Cheney for serious heart disease for many years before, during and after his two terms of office. Dr. Reiner is not involved in Mr. Sanderss care.

Older patients and those who experience complications like heart rhythm abnormalities, heart attacks or heart failure may remain in the hospital longer. A patients condition usually determines the length of stay.

In the 2016 presidential campaign, Mr. Sanderss doctor said that the senator was in overall very good health. His ailments included gout; a mild elevation of cholesterol; an inflammation of out-pouches in the bowel known as diverticulitis; and hormone replacement therapy for an underactive thyroid gland. He had no reported history of heart disease. Tuesdays episode of angina appears to be his first such incident.

In cases like Mr. Sanderss, doctors perform a standard procedure known as cardiac catheterization. In it, they thread thin tubes into chambers of the heart and inject a radio-opaque dye to produce X-rays outlining the coronary arteries. For Mr. Sanders, the procedure revealed blockage in one artery; he has not said which artery. Doctors would then remove the blockage, which is usually caused by deposits of fatty substances, by inflating a tiny balloon in a tube to squash them. Implanting the stents aims at preventing development of scar tissue and recurrence of the blockage.

All presidential hopefuls strive to portray themselves in good health. When a medical event occurs, candidates and their aides, who usually have had little if any medical knowledge, often scurry to play it down to prevent damage to the leaders image.

Mr. Sanderss event is likely to renew pressure on his rivals to release their health information in a timely fashion. Although some have made pledges, they have not done so.

In recent years, most candidates have released their personal health information in statements from their doctors or through interviews. The practice grew out of retrospective analyses of the health of presidents that document how some presidents hid or lied about their health problems, often aided by their doctors. Occasionally, White House doctors have misdiagnosed a presidents heart and vascular problems.

Experts believe that President Warren Harding died of a heart attack that his doctor did not detect. Toward the end of President Franklin D. Roosevelts third term and until his death in his fourth term, his White House doctor withheld the fact that he had serious heart failure. President Dwight D. Eisenhower suffered a heart attack near the end of his first term. Examination of his older medical records has provided strong clues that he had a heart attack before he ran for president.

In 1999, former Senator Bill Bradley of New Jersey damaged his presidential campaign by not disclosing that he had a number of episodes of atrial fibrillation (a heart rhythm abnormality) before he experienced one while campaigning and had to rush to a hospital in the Bay Area with reporters trailing him.

Among the current candidates, Joseph R. Biden Jr. underwent emergency surgery in 1988 for a near-fatal ruptured berry aneurysm of an artery in his brain. He also underwent surgery to remove a second berry aneurysm. New cerebral aneurysms can develop years later in a tiny percentage of individuals who have survived one. In 2008, Mr. Bidens doctor said that he had recovered fully, and that he did not need further tests to detect a new berry aneurysm because he had done well for 20 years.

Modern medicine has enabled many individuals with heart disease and other chronic ailments to successfully run for office and fulfill their duties. Nevertheless, Mr. Sanderss stent episode is likely to renew a measure of voter interest in the health of its 2020 presidential candidates. Two other leading Democratic hopefuls are in their 70s and President Trump is 73. All of them, as well as Mr. Sanders, may well be medically fit to serve, but Americans have never faced the prospects or consequences of so many top candidates who were past the official retirement age.

Read the original:
Sanders Said He Had a Common Heart Procedure. So Why the Mystery? - The New York Times

This transcript has been edited for clarity.

Thomas Allison, PhD: Greetings! I'm Tom Allison, cardiovascular specialist at Mayo Clinic. During today's roundtable, we'll be discussing lipoprotein(a). I'm joined by my colleague, Dr Steve Kopecky, who specializes in this area. Steve, what is lipoprotein(a) and why do we have it? What role does it play?

Stephen L. Kopecky, MD: Lipoprotein(a) is a combination of a couple of standard molecules that we all know about. One is an LDL cholesterol-type molecule or low-density lipoprotein. The second is an apolipoprotein(a) which is bound to the LDL-like molecule at the ApoB receptor with a disulfide bond. Now, what does that mean? Lp(a) is a cholesterol-type molecule, basically.

Allison: I understand that there are different sizes of these Lp(a)s.

Kopecky: Yes, there are different sizes because the apolipoprotein portion can have different kringles. Some are very big, some are very small. The smaller ones seem to be more atherogenic or cause more problems.

Allison: Like the small dense LDL.

Kopecky: Like the small dense LDL. One question that comes up is, why do we even have this molecule? It seems to promote clotting, which may not be a good thing, although years ago if you had trauma, it may have helped with wound healing or clotting. It may have helped prevent excessive bleeding in childbirth, so there may be a reason why we have it in our bloodstream.

Allison: What evidence do we have that this causes heart disease or contributes to our risk for heart disease? And I presume that we're talking about coronary artery disease, right?

Kopecky: Ischemic stroke also could be involved.

First, what is it about this molecule that may be causing problems? The LDL particle can actually promote atherosclerosis. We also know that the apolipoprotein particle is similar to plasminogen, so it can promote clotting. It inhibits fibrinolysis. And the third factor is that it is an inflammatory molecule.

So it does three things: causes atherosclerosis, causes the plaque rupture with inflammation, and then causes clotting at the site of plaque rupture. Large observational studies, such as the INTERHEART study, which involved many nations, show that individuals with elevated lipoprotein(a) have an increased risk for myocardial infarction (MI).[1]Mendelian randomization studies in large numbers of patients/subjects suggest that if you have an elevated lipoprotein(a), you also have an increased risk for MI and stroke.[2]

Allison: Am I correct that some recent trials have shown that the on-treatment level of Lp(a) in a clinical trial actually correlates with the event risk?

Kopecky: Yes. If you look at LDL cholesterol trials where they gave statins to control LDL, the best predictor at that point of recurrent events was actually the lipoprotein(a) level, not the LDL level.[3,4]

Allison: What is the cut point? At what level do we see the increased risk? I know there's some controversy about what the cut point is.

Kopecky: Yes, because a lot of it's observational, and [approximately] 80% of individuals globally have normal levels of less than 50 mg/dL. In the US, we have an average of about 20 mg/dL. If you look at certain ethnic groups, Asians and Caucasians are very similar; African Americans and Arabs also have higher levels, maybe two or three times higher. The question is, how much of that goes into risk? And that's not quite clear. Is an African American's risk higher because they have a higher Lp(a)? That has not been worked out.

Allison: So 50 mg/dLis that the number?

Kopecky: In general, the average number is 20 mg/dL. Over 50 mg/dL, we start to call it increased risk; that's what most guidelines have said. If you're using nmol/L, 100 or 125 is elevated risk.

Allison: In the prevention clinic at Mayo, do you measure Lp(a) on everybody, or are there specific groups for whom you think it's more important?

Kopecky: People have said that we should measure it in everybody. I don't think we're quite there, mainly because we don't have a treatment yet. But also because the people who may benefit the most are the ones who come in with early atherosclerosis or they have a family history, and they say, "My older brother just had a heart attack at age 48." That may be a good time to check it.

Patients who have recurrent atherosclerotic events in spite of optimal treatmenta case has been made to check those patients. And then there are patients who have FH, familial hypercholesterolemia. About 1 in 5 people (or 1 in 3) with FH have elevated lipoprotein(a). It increases risk, so we check.

The last group is aortic stenosis; bicuspid aortic valve is probably the prototype of that. There's evidence that individuals with elevated lipoprotein(a) and bicuspid aortic valve have more rapid progression of aortic stenosis.

Allison: That's new, right?

Kopecky: That's fairly new. We're starting to think of that when we look at patients with the bicuspid aortic valve.

Allison: So now you have lipoprotein(a) and it's over 50. What do you do?

Kopecky: First off, you make sure that when we're talking about over 50, we're talking about over 50 mg/dL versus like 125 nmol/L. The reason why that's important to differentiate is because the mg/dL is the mass concentration whereas nmol/L is the particle concentration. And as you implied, the particles are different sizes, so we can't convert one to the other like we can with LDL or HDL. It has to be a completely different measurement. There's a push right now to have a single way of measuringthe nmol/L, which would take into account the particle size.

Allison: And that's 125 nmol/L.

Kopecky: It would be like 125 nmol/L. So if it's high, what do we do? Well, lifestyle is always very important, although 80%-90% of your Lp(a) level is genetically determined. It's a codominant inheritance, meaning you can get a gene from each parent, and both will raise it more.

You can give things like niacin or hormone replacement therapy. We know that can lower it, but it doesn't lower events; in fact, it may increase cardiovascular events, so it's not recommended. Statins don't affect it. The PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors lower it by maybe 25%, but they're not indicated for high lipoprotein(a).

Lipoprotein apheresis can be helpful in a very small percentage of patients. So we have some treatments, the PCSK9 inhibitor, but it's not yet indicated for lowering it.

Allison: Am I correct that there is a new drug under development that was presented at the American Heart Association scientific sessions, that has shown a significant (ie, 80%) lowering effect, but it's not available? Is that right?

Kopecky: Right. It's an antisense oligonucleotide that actually lowers Lp(a) significantly. It's undergoing clinical studies and we don't know the outcomes yet. It sounds like it's a good idea, but we would need the outcome studies to show that it benefits patients.

Allison: No dietary therapies?

Kopecky: Lifestyle is important, but it doesn't lower your lipoprotein(a). It lowers your risk, but that's separate from the Lp(a).

Allison: Steve, any other points we should make about this?

Kopecky: It's always good to look at the guidelines. The recent ACC/AHA lipid guidelines say you should consider lipoprotein(a) over 50 mg/dL or 125 nmol/L as a risk enhancer ,so be a little more aggressive in treating those patients.[5]

It may be the risk enhancer you use with some patients in primary or secondary prevention, and it's something worth checking, especially if you have patients who have recurrent events or early events, or a family history of early events, because it helps you be more aggressive in treating the patients.

Allison: Do you ever bring in a patient's family members and check them? If, for example, you're 40 years old and you have an MI, should your brother and your kids get checked?

Kopecky: The cascade screening. Yes, we actually have a letter that we give patients. Once we check them and it's elevated, we say, "Give this letter to your first-degree relatives. You don't have to talk to them; the letter explains everything." It says the patient had this elevated lipoprotein(a), which can be associated with increased risk for heart disease, and the relative should take this letter to their primary care provider to check [lipoprotein(a)].

Allison: Steve, thanks for this update and for your insights. I want to thank everyone for joining us on the heart.org | Medscape Cardiology.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

Excerpt from:
The Lowdown on Lipoprotein(a) - Medscape

Talking points

The podcast boom continues apace, with an impressive number of people in the UK listening to an audio show each week according to new figures. Ofcoms latest report shows around 7.1 million of us or one in eight people are tuning into pods, a 24% rise on last year. Its unsurprising given the big investments currently being made in the medium (more on that here).

Meanwhile, its five years this week since Serial restarted the podcast movement, making amateur sleuths of its listeners. While not without its ethical controversies, like much true crime, this early hit remains a truly impressive feat of storytelling.

Dear Joan and JerichaJulia Davis and Vicki Pepperdines judgmental, disgusting and thoroughly convincing agony aunts return for another series of the hilarious podcast. Cringe-inducing wisdom is the core of their business, whether theyre telling women over 35 not to have wrinkly babies or warning them to tend to their husbands physical needs. The chat veers from the absurd to the filthy, all perfectly delivered in the prim way of two know-it-alls who are qualified in psycho-genital counselling and sports journalism. HV

Youre Dead to Me

This amusing new podcast follows TV outings such as Drunk History and Horrible Histories in making the past that bit more exciting. Historian Greg Jenner, who helped to make the latter show, hosts alongside experts including Dr Helen Castor, a medieval historian who helps to explain the remarkable story of Joan of Arc. Of course, there are comedians, too among them Suzi Ruffell, who considers her own identity as a gay woman as they assess the continuing arc of LGBT history. HJD

As part of the Guardians ongoing campaign on menopause awareness, last weeks Science Weekly podcast revealed the exciting new insights scientists have uncovered when it comes to hot flushes insights that could one day give women a much-needed alternative to hormone replacement therapy. As Hannah Devlin finds out, the menopause has historically been a mystery for scientists but could this all be about to change? Max Sanderson

Chosen by David Waters

Calling someone a master of radio, you can be accused of hyperbole. But in the case of superproducer Cathy FitzGerald the self-described caretaker of the Strange & Charmed school for audio storytellers, which is churning out a new generation of fellow superproducers that is literally the case.

Her latest documentary is an explosion of sound and joy from the very first minute. Were immediately transported to the Brooklyn Superhero Supply Company which, it turns out, is part of an American non-profit company (826 National) that uses various cover stories across the US to capture the imaginations of children. From pirates in San Francisco to ghosts in New Orleans and robots in Detroit, various tropes are deployed by the organisations nationwide chapters. And once under their spell, children can access free tutoring and homework help plus workshops for budding authors. Like FitzGeralds own audio school, 826 National is more than just education: its about confidence, creativity and empowering people to tell stories.

Original post:
Everyone's favourite filthy agony aunts are back! Podcasts of the week - The Guardian

Hypothyroidism patients are more likely to develop sleep apnea, according to new research.

To understand the potential link between hypothyroidism and sleep apnea, a team from Texas Tech University Health Sciences Center (TTUHSC) embarked upon new research using data mined from the National Health and Nutrition Examination Survey (NHANES). Their study, Hypothyroidism and its Association with Sleep Apnea Among Adults in the United States: NHANES 2007-2008, was published in July by theJournal of Clinical Endocrinology & Metabolism.

The NHANES is a biennial survey conducted by the Centers of Disease Control and Prevention to generally evaluate the health of children and adults in the US. In addition to providing a significantly larger sample size, the NHANES provides a cross-sectional sample of the non-institutionalized US adult population. It includes a detailed demographic and behavioral questionnaire, a physical examination, laboratory testing and a list of all prescription medications used by the respondent.

Study coauthors internal medicine resident Subhanudh Thavaraputta, MD; Jeff Dennis, PhD, an assistant professor for TTUHSCs Department of Public Health,looked a the2007-2008 NHANES because it tested respondents for thyroid stimulating hormone (TSH) levels and included a detailed sleep questionnaire.

We had to use those two years to get the exact data points that we wanted, Dennis says in a statement. I always use the most current data when we can, but we were somewhat constrained here, and this is the one NHANES where we could see both TSH levels and sleep disorder information in the same place. We dont have any reason to think that would have changed drastically between the 2007-2008 NHANES and now. What we found should be reasonably consistent over time.

Thavaraputta, the studys lead author, says responses from 5,515 of the 10,000 respondents who participated in the 2007-2008 NHANES were ultimately included in the TTUHSC research. After analyzing those results, he and Dennis estimate that the prevalence for hypothyroidism among US adults is 9.47%, which represents approximately 19.6 million people.

The results also indicate that individuals diagnosed with hypothyroidism are 1.88 times more likely to develop sleep apnea. Hypothyroid patients who were undergoing hormone replacement therapy at the time of the NHANES evaluation were estimated to be 2.51 times more likely to have a sleep apnea diagnosis, regardless of their TSH level.

We hope that our findings will raise awareness and concern among physicians regarding this association, Thavaraputta says. In the future, if this relationship is established, assessing the sleep qualities/problems in hypothyroid patients might be beneficial to improve the patients standard of care, quality of life and treatment outcomes.

View original post here:
Study: What is the Connection Between Hypothyroidism and Sleep Apnea? - Sleep Review

Hilary Swift for The New York Times Senator Bernie Sanders spoke to voters in Davenport, Iowa, last week before his heart attack.

BURLINGTON, Vt. Senator Bernie Sanders, a week after suffering a heart attack in Las Vegas, said on Tuesday that he planned to slow down his pace on the campaign trail and acknowledged that voters would likely consider his health when deciding whether to vote for him.

Speaking to reporters outside his home in Burlington, following a visit with a local cardiologist, Mr. Sanders gave no indication he was planning to drop out of the race and said he would continue to campaign actively.

Sign Up For the Morning Briefing Newsletter

We were doing, you know, in some cases five or six meetings a day, three or four rallies and town meetings and meeting with groups of people, Mr. Sanders said. I dont think Im going to do that.

I think were going to change the nature of the campaign a bit, he added. Make sure that I have the strength to do what I have to do.

Asked to clarify what he meant when he said the campaign would change, he replied: Probably not doing four rallies a day.

Standing next to his wife, Jane, Mr. Sanders, 78, also acknowledged that his heart attack could be a factor for voters considering whether to support him.

Everything that happens everyday weighs on how people feel about you, he said. And my own view is that and I think its the voters view you look at the totality of who a candidate is. You look at what that candidate stands for, the integrity of that candidate, the history of that candidate.

Mr. Sanders returned to Burlington over the weekend after being hospitalized in Las Vegas for three days last week, recovering from a heart attack. His campaign said he felt chest pains during events last Tuesday, and he was taken to the hospital, where two stents were inserted into an artery.

Since then, his campaign has insisted that Mr. Sanders does not intend to drop out of the race. During a telephone call with staff members on Monday, Mr. Sanders said he felt more strongly about the need for a political revolution today than I did when I began this campaign.

On Tuesday, Jane Sanders downplayed the decision to slow the campaigns pace down, saying it was something that the entire campaign, and especially me, have been saying for months not for his health but for the ability to keep up that kind of a pace for everybody else, too.

Known for keeping a grueling schedule on the campaign trail, Mr. Sanders will often criss-cross a state with multiple stops for big rallies and smaller town hall-style events and gatherings.

In a Democratic primary where the three leading candidates are in their 70s, Mr. Sanderss health issue has intensified the scrutiny on age as a factor in running for president. Many Democratic voters have said they worried about nominating a septuagenarian candidate.

Mr. Sanders, who finished second to Hillary Clinton in the 2016 primary, has been among the top three Democratic contenders since he entered the race in February. But in recent weeks has been passed by Elizabeth Warren in national polls and polls of early nominating states like Iowa and New Hampshire.

Still, he remains a formidable challenger; just last week he announced a third-quarter fund-raising total of $25.3 million, the largest in the Democratic field.

In the 2016 presidential campaign, Mr. Sanderss doctor said that the senator was in overall very good health. His ailments included gout; a mild elevation of cholesterol; an inflammation of out-pouches in the bowel known as diverticulitis; and hormone replacement therapy for an underactive thyroid gland. He had no reported history of heart disease.

Here is the original post:
Sanders Says He Will 'Change the Nature' of His Campaign After Heart Attack - msnNOW