#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

[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.

[drtarunjindal]

7 Surprising Facts About Uro Oncology Problems You Must Be Aware Of

Uro-oncology, a specialized branch of medicine, focuses mainly on cancers of the urinary system and male reproductive organs. While many people are aware of common issues like prostate cancer, there are some surprising facts about uro-oncology problems that are less well-known. Here are seven that might surprise you. Go through this blog, brought to you by a renowned Uro Oncology Specialist in Kolkata.

1. Prostate Cancer is Highly Treatable

Prostate cancer, one of the most common uro-oncology problems, is often highly treatable, especially if detected early. With advanced techniques like Robotic Prostatectomy Surgery in Kolkata, patients can experience better outcomes and quicker recovery times. Also, the robotic technique allows for precision, reducing the risk of complications.

2. Bladder Cancer is More Common in Smokers

Smoking is not only a leading cause of lung cancer but also significantly increases the risk of bladder cancer. In fact, smokers are three times more likely to develop bladder cancer than non-smokers. Quitting smoking can greatly reduce this risk, emphasizing the importance of lifestyle choices in preventing uro-oncology problems.

3. Kidney Cancer Often Shows No Early Symptoms

It is important to note that kidney cancer can be a silent disease, often showing no symptoms in its early stages. It is frequently discovered incidentally during imaging tests for other conditions. Therefore, regular check-ups with a Uro Oncology Specialist in Kolkata are crucial, especially if you have risk factors like high blood pressure or a family history of kidney cancer.

4. Men Aren’t the Only Ones Affected by Uro-Oncology Problems

While prostate cancer is exclusive to men, other uro-oncology issues, such as bladder and kidney cancers, can also affect women. In fact, women are more likely to be diagnosed with bladder cancer at an advanced stage, making early detection and awareness essential.

5. Advancements in Robotic Surgery

The use of robotic surgery in uro-oncology, particularly in prostate cancer treatment, has revolutionized the field. For instance, Robotic Prostatectomy Surgery in Kolkata offers a minimally invasive option with smaller incisions, less pain, and quicker recovery compared to traditional surgery.

6. Testicular Cancer is Most Common in Young Men

Unlike most cancers that are more common in older adults, testicular cancer primarily affects younger men between the ages of 15 to 35. Fortunately, it is one of the most treatable forms of cancer, with high survival rates when detected early.

7. Lifestyle Changes Can Lower Your Risk

Healthy lifestyle choices, such as maintaining a balanced diet, exercising regularly, and avoiding tobacco, can significantly reduce the risk of developing uro-oncology problems. However, regular screenings and consultations with a Uro Oncology Specialist in Kolkata can also help in early detection and prevention. To conclude, understanding these surprising facts can empower you to take proactive steps in maintaining your uro-oncological health. Regular check-ups with a Uro Oncology Specialist in Kolkata, awareness, and embracing healthy habits are key to preventing and managing these conditions effectively.

[sa7abnews]

Dave Portnoy reveals his colonoscopy experience to the world: ‘You gotta do it’

New Post has been published on https://sa7ab.info/2024/08/09/dave-portnoy-reveals-his-colonoscopy-experience-to-the-world-you-gotta-do-it/

Dave Portnoy reveals his colonoscopy experience to the world: ‘You gotta do it’

Barstool Sports founder Dave Portnoy is sharing his cancer prevention journey with the world.Portnoy, 47, had a colonoscopy on July 31 and documented the experience on social media for his fans.The CEO announced in a video on X, formerly Twitter, on July 29 that he was preparing for the procedure in Boston, as part of what he jokingly called the “Dave is getting old checklist.”ASPIRIN MAY BE LINKED TO LOWER RISK OF COLORECTAL CANCER, NEW STUDY SUGGESTSBefore beginning his fasting and prep, Portnoy said he ate “seven f***in’ dinners from Giacomo’s.”While he expressed that he was dreading the procedure, he emphasized the importance of men getting screened, saying, “You gotta do it.”Colon cancer “is the second leading killer of men,” Portnoy said in the video. “It can be treated if you catch it early.”(Updated statistics from the American Cancer Society show that colorectal cancer is the third-deadliest cancer for men, after lung cancer and prostate cancer.)FDA APPROVES NEW BLOOD TEST FOR COLON CANCER SCREENING: ‘EARLY DETECTION IS CRITICAL’Portnoy said he has partnered with the Washington, D.C.-based nonprofit Lead From Behind to help raise awareness of colorectal cancer.”I’m a captain, that’s what captains do — they lead the ship,” he said.On July 30, Portnoy jokingly posted, “I’m starving. May not make it.”The next morning, at 5:48 a.m, he posted, “Rise and shine, it’s colonoscopy time!”He then shared a video of himself upon arrival at the facility, joking that no one was available to check him in even though he’d been instructed to show up an hour early.At 7:18 a.m., after he’d been checked in and changed into a gown, Portnoy shared a selfie with the caption, “Locked and loaded.”WHAT IS COLORECTAL CANCER? SIGNS, SYMPTOMS, RISKS AND MORE OF THE GLOBAL HEALTH CONCERNIt appeared that the procedure went smoothly, as his next post was a short video taken afterward, showing him a bit loopy from the anesthetic.Later that day, he posted photos of his post-colonoscopy “refill meal.” Fox News Digital reached out to Portnoy and Lead From Behind for comment.Portnoy has previously been open about his health issues.In June, the social media personality revealed on his podcast, “The BFFs Pod,” that he had been diagnosed with skin cancer, which was surgically removed from his neck.The condition was caused by “lying in the sun all day with no sunscreen,” Portnoy said.”I went to a doctor, did a skin thing, they scrape it, and one of them came back cancerous; got to take it out,” he added.Portnoy then said on X that the cancer “wasn’t the serious kind, thank god.”Portnoy isn’t the first public figure to be open about having a colonoscopy.CLICK HERE TO SIGN UP FOR OUR HEALTH NEWSLETTERIn 1997, journalist Katie Couric — then a host on the “Today” show — received her first colonoscopy on-air, in an effort to raise awareness and encourage others to get screened.Shortly before her procedure, Couric lost her first husband to the disease. In 2021, the U.S. Preventive Services Task Force updated its guidelines to recommend that adults begin regular screenings for colorectal cancer at 45 years old.For more Health articles, visit www.foxnews/healthLead From Behind — which states on its website that it’s “on a mission to make colon cancer famous” — launched in 2022 to help raise awareness of colon cancer prevention.Actor Ryan Reynolds and football player Dak Prescott have also partnered with the organization to boost colon cancer awareness, according to the Lead From Behind website.

[drchandrakant01]

Understanding Early Stage DVT: Leg Symptoms and How to Treat Them Effectively — Dr Chandrakant

Deep vein thrombosis, commonly known as DVT, is a condition where a blood clot forms in a deep vein, usually in the legs. While it may sound alarming, recognizing early stage DVT symptoms and knowing how to treat them can make a significant difference. This blog aims to provide an easy-to-understand guide on identifying the early signs of DVT in your legs and the effective treatments available.

What is Deep Vein Thrombosis (DVT)?

DVT occurs when a blood clot forms in one of the deep veins in your body, typically in the lower leg or thigh. These clots can cause serious health problems if they break loose and travel through the bloodstream to the lungs, causing a pulmonary embolism. Early detection and treatment are crucial to prevent complications.

Early Stage DVT Symptoms

Recognizing the symptoms of early stage DVT can be challenging because they can be subtle and similar to other conditions. However, paying attention to the following signs can help you identify the condition early:

Swelling in One Leg: One of the most common symptoms of DVT is swelling in one leg. The swelling usually occurs below the knee and may come on suddenly.

Leg Pain: DVT-related pain often starts in the calf and can feel like cramping or soreness. This pain may worsen when standing or walking.

Red or Discolored Skin: The skin around the affected area may turn red or have a bluish tint. This discoloration is a sign that something is wrong with the blood flow.

Warmth in the Affected Leg: The area around the blood clot may feel warmer than the rest of your leg. This warmth is due to increased blood flow trying to bypass the clot.

Visible Veins: In some cases, the veins near the surface of the skin may become more visible or bulge out.

Causes and Risk Factors of DVT

Several factors can increase your risk of developing DVT, including:

Prolonged Immobility: Sitting or lying down for long periods, such as during long flights or bed rest, can slow blood flow and lead to clot formation.

Injury or Surgery: Injuries to the veins or surgeries, particularly on the legs or abdomen, can increase the risk of clots.

Medical Conditions: Certain conditions, such as cancer, heart disease, and inflammatory bowel disease, can raise the risk of DVT.

Hormone Therapy: Hormone replacement therapy and birth control pills can increase the risk of blood clots.

Genetics: A family history of DVT or clotting disorders can make you more susceptible.

Lifestyle Factors: Smoking, obesity, and a sedentary lifestyle can all contribute to the risk of developing DVT.

Diagnosing DVT

If you suspect you have DVT, it’s important to seek medical attention promptly. A healthcare professional will perform a physical examination and may order tests to confirm the diagnosis, such as:

Ultrasound: This non-invasive test uses sound waves to create images of the blood flow in your veins and detect clots.

D-dimer Test: This blood test measures a substance released when a blood clot breaks up. High levels of D-dimer may indicate the presence of an abnormal blood clot.

Venography: In this test, a contrast dye is injected into a large vein in your foot or ankle. X-rays are then taken to show the veins and any clots present.

Effective Treatments for Early Stage DVT

Once diagnosed, treating DVT promptly is essential to prevent complications. Here are the common treatment options for early stage DVT:

1. Anticoagulant Medications

Anticoagulants, also known as blood thinners, are the most common treatment for DVT. These medications prevent the clot from growing larger and reduce the risk of new clots forming. Common anticoagulants include:

Heparin: Often given as an injection, heparin works quickly to thin the blood.

Warfarin (Coumadin): Taken as a pill, warfarin requires regular blood tests to monitor its effects.

Direct Oral Anticoagulants (DOACs): These newer medications, such as rivaroxaban (Xarelto) and apixaban (Eliquis), are taken orally and don’t require frequent blood tests.

2. Compression Stockings

Compression stockings help reduce swelling and prevent blood from pooling in the legs. They are worn on the affected leg and can be particularly helpful during long periods of immobility.

3. Thrombolytic Therapy

In severe cases of DVT, thrombolytic therapy may be used. This treatment involves injecting clot-dissolving medications directly into the clot. While effective, it carries a higher risk of bleeding and is typically reserved for life-threatening cases.

4. Filters

For patients who cannot take anticoagulants, a filter may be placed in the inferior vena cava (the large vein that carries blood from the lower body to the heart). This filter catches clots before they can travel to the lungs.

5. Lifestyle Changes

Making certain lifestyle changes can help manage DVT and prevent future clots:

Stay Active: Regular exercise, such as walking, can improve blood flow and reduce the risk of clots.

Maintain a Healthy Weight: Losing excess weight can decrease the pressure on your veins and improve circulation.

Quit Smoking: Smoking increases the risk of blood clots, so quitting can significantly reduce your risk.

Stay Hydrated: Drinking plenty of water helps keep your blood flowing smoothly.

Move During Travel: If you’re on a long flight or car ride, take breaks to stand up and move around every couple of hours.

Preventing DVT

Prevention is always better than cure. Here are some tips to help prevent DVT:

Move Regularly: If you have a sedentary job or are traveling long distances, make sure to move around regularly. Simple leg exercises, such as ankle circles and leg lifts, can keep your blood flowing.

Wear Compression Stockings: If you’re at high risk for DVT, wearing compression stockings can help prevent blood from pooling in your legs.

Follow Medical Advice: If you’re prescribed anticoagulants or other medications, take them as directed.

Stay Informed: Knowing the risk factors and symptoms of DVT can help you stay vigilant and seek prompt medical attention if needed.

Conclusion

Understanding early stage DVT and recognizing its symptoms is crucial for timely treatment and preventing serious complications. If you notice any signs of DVT, such as swelling, pain, redness, or warmth in your leg, seek medical advice immediately. With prompt diagnosis and effective treatment, you can manage DVT and reduce the risk of severe outcomes. By adopting healthy lifestyle habits and following your doctor’s recommendations, you can protect yourself from this potentially dangerous condition.

Dr. Chandrakant emphasizes the importance of early detection and treatment in managing DVT effectively. Stay informed, stay active, and take the necessary steps to maintain your vascular health.

[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.

[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

[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.

[mednerds]

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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.”

[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.

[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.

[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.

[sophieellisbextorarchives]

Lockdown's dancing queen: Sophie Ellis Bextor explains how she's survived with five sons while performing web concerts from her kitchen - and owes her life to the NHS after almost dying during childbirth

SOURCE: https://www.dailymail.co.uk/news/article-8371137/Sophie-Ellis-Bextor-talks-surviving-lockdown-five-sons-performing-concerts-kitchen.html

Any mother of five who is still sane after two-and-a-half months of lockdown will surely have some survival tips for the rest of us. And Sophie Ellis-Bextor does indeed have advice.

Come Friday night, when the textbooks have been flung in a corner and you've finished screeching at the kids, you should dig out your heels and put on your sparkliest hot pants, she says.

'If you don't own a sequined one-piece, you should get one,' the singer insists. 'They make you feel like a disco superhero!'

She would also recommend a glitterball to hang in the kitchen. It will distract from the dirty dishes, she says.

Tidying the kitchen is optional, though: 'I do try to but if there's the odd dish in the sink, who cares?'

When the history of the great British lockdown is written, there will be villains (take a bow, Dominic Cummings) and heroes.

And Sophie Ellis-Bextor will surely be in line for a medal, for services to the national dancefloor (kitchen disco division).

Every Friday night for ten weeks she has donned her own glad rags and, via the magic of social media, invited us all to a disco round at hers.

She has been in charge of the mic, singing her own hits (with tweaks) and cover versions of some of her other favourites (speaking of favourite things, she even does a mean Julie Andrews).

Each week she has changed the lyrics of one of her biggest hits, Take Me Home, to the lockdown-friendly Stay At Home. We cheered. We heeded. 'Well, most people did,' she says.

Lots of entertainers have been doing their stuff in lockdown. Few of them have done so with five children in tow, though, and with such pizzazz.

You'd never guess it from the size of her waist but 41-year-old Sophie — whose mother is former Blue Peter presenter Janet Ellis — has five sons, aged from 16 down to 16 months. Her family life has never really been a part of her work.

But at the start of lockdown, something changed and she decided to stop being so precious about the work/home life divide.

'I've always been quite private, never showing the kids' faces, that sort of thing,' she says.

'But suddenly it all felt totally irrelevant. I just had this desire to sort of connect with people, to have fun and do something that just distracted us all — and for me, as an entertainer, that meant getting up and putting on a show.

'If it was going to be a show in my own house, the kids had to be involved as we're all locked down together. That overwhelmed any other emotion, really.

'I said to them, 'We're going to have a party. Do you want to come? What do you want to wear?'

'We pulled out all manner of sequined things we already had. They got out costumes, hats, whatever. There were no rules. They could be in their pyjamas if they wanted, because they often are.

'At the end of the first one, I remember making a joke like, 'This could be the end of my career.' '

In another time, it could have been. What too-cool-for-school singer sashays around the Lego, for goodness' sake? And what pop star hoicks a baby onto her hip, limbos around the lightsabers or attempts some sexy strutting when there is a pint-sized Superman in the way?

'It has been quite surreal, hasn't it?' she says with a laugh. 'But this whole situation is surreal, so I guess it has been fitting.

'We've had all sorts — the kids joining in, or sitting there bored with it all as I dance around them. We've had the baby crawling across the floor, trying to pull the plug out of the router. It's not stuff you normally have to contend with when you go on stage.'

And the performances have been all the more magical for it, I suggest. Her kitchen discos have been in keeping with the national mood, which lurches between delirium and despair and involves much trying to get on with the day job, with the kids at our feet.

All our kids are represented in hers, too. There is Sonny, 16 and a typical teenager, who mostly rolls his eyes at the idea of being in his mum's disco 'but actually he's invaluable because he helps with the baby so I can relax'.

Kit, 11, has 'kind of dipped in and out of the discos. He has missed a few. Sometimes he'd just rather do something else'.

Ray, eight, and Jesse, four, are generally game for anything — but if the children all join in at the same time, while wearing masks, the potential for chaos is high.

Last is baby Mickey, who likes to reach for bright lights. And cables. And sparkly shoes.

'I think what has kept some people tuning in is the music, but others are only watching to see if any of my kids injure themselves,' Sophie says.

People may also be tuning in to see her game attempts at making the most inappropriate songs kid-friendly. Her new repertoire includes the highly suggestive Prince song Gett Off. If the kids ask, it's a song about getting off the climbing frame, she explains.

When we speak, Sophie is preparing for — sob! — the last lockdown disco. Kitchen Disco No 10 will finish with a rousing rendition of the Madness hit Our House, which contains the lines 'Our house it has a crowd/ There's always something happening/ And it's usually quite loud'.

How apt. That sums up family life in all its messy glory.

It will be the end of a very weird chapter for Sophie.

'We could keep going but I'm getting the feeling that lockdown is being eased. There is a different feel, so it's time to stop. Although I'm bad at saying 'never again'.'

It has been a blast — and Sophie admits she has benefited herself.

'The discos have done my soul and my spirit the world of good. I've always turned to music anyway when anything has been happening in my life, good or bad, but I don't know what shape the past few months would have taken without this outlet.

'I've been doing cover versions of songs and they have all basically been like love letters to people I can't see any more.'

Lockdown came earlier for this household than for most of us. One of the children showed symptoms even before the schools closed, so they all isolated early.

That Sophie's stepfather — Janet's husband, John Leach — was having chemotherapy as part of his cancer treatment made the situation even more serious.

They are a close family. Janet, who lives only a few streets away in West London, is used to popping in and out, and provides childcare once a week. Any contact at all between them stopped overnight, as it did for so many families.

'I haven't hugged my mum since I don't remember when,' Sophie says. 'They couldn't leave their house at all at the beginning, so it was a case of leaving some groceries on the doorstep. My stepfather has Stage Four lung cancer and was in the middle of chemo, which had to stop.

'Now, thankfully, it has restarted but it has been a terrible time — devastating, really. For so many families the world has just tilted.' The older children understand why they can't see their grandparents, the little ones less so.

This is a united family (Sophie's mum split from her father, film and television producer Robin Bextor, but they are all on good terms), yet not necessarily one that ever did things by the rulebook.

Many will recall the furore when Janet — then the nation's darling, as many Blue Peter presenters were — fell pregnant with Sophie's brother Jackson. She was unmarried at the time and it was a national scandal.

It sounds as if Janet was the sort of mother Sophie has become — old-fashioned about some things (table manners, eating together) but more relaxed about others. And Mum having a slightly crazy day job was par for the course.

'I remember going with her when she did a skydive. She was in the Guinness Book of Records at one point for the highest-altitude jump for a female. At the time it was just normal.'

Janet didn't mind when Sophie decided she would not go to university because she wanted to join a band. 'Many parents would have said, 'No, we have paid for this private education. You will go,' but they never did. They were completely supportive.'

And of course, it worked out. Sophie started to get attention in the industry in the Nineties with indie band Theaudience — but in 2000 her career went mainstream thanks to a feature spot on the song Groovejet (If This Ain't Love) by Spiller.

Further hits followed. Then, in 2013, she went even more mainstream, signing up for Strictly Come Dancing. Her Charleston was a thing of wonder but she lost in the final to Abbey Clancy.

She knew her husband, The Feeling bassist Richard Jones, for a year before they started dating. When they did, it was something of a whirlwind and she discovered she was pregnant within weeks.

'Sonny was premature, so he was actually born eight months after we got together. Weird maths.'

Then, finding that it was rather fun, they kept having children. 'In a way I think it sort of set the tone, having Sonny so early. We've never really known what it is to be just the two of us.'

Juggling a pop career with five children can't have been easy, but her laid-back approach must help.

Some aspects of her parenting style have come in handy in lockdown, she says. 'I try to get up and dressed myself, but I'm not bothered if they want to stay in their pyjamas,' she admits.

Other aspects of lockdown have been hard. She admits she is not a natural home schooler.

'With five, it has been really difficult keeping up with the school stuff. I think their teachers do a brilliant job and I can't compare.

'At the start I did try hard, but to be honest I was feeling a lot of pressure to be running the home and making them emotionally happy. I quit quite early, realising it was making me really tense and really unhappy.

'We've kept the eldest two doing more formal work (Sonny is in his GCSE year, she explains) but with the little ones it's more about projects they can do.'

She says it isn't practical — or even desirable — to turn their home into a school. 'I'm hoping that home is where they learn to interact with each other, where they learn how to be happy, how to be kind.'

They have all been clapping on the doorstep on a Thursday night, too, aware of the debt they owe the NHS.

Sophie's life was saved by doctors when she suffered from complications during her first two pregnancies and gave birth prematurely both times. Kit weighed just 2 lb 6 oz.

'Anyone who has ever had a loved one's life in the hands of hospital staff knows what it is to feel that gratitude,' Sophie says.

'If it wasn't for them, I wouldn't be here and neither would my first two.

'I'll never forget their faces, the doctors and nurses who treated us in the neonatal unit. You don't, because you owe them everything.'

To be a singer in this climate is perhaps to feel a little superfluous, but Sophie says the only things she can do are sing and dance. The reaction from the wider world to her 'little discos' has been heartwarming.

'If you can make people smile and laugh at how daft it all is, then you make a connection that is actually quite special.'

We are getting all wistful now, when I suggest that her sons will grow up knowing they were a part of something magical. She laughs.

'They are more likely to roll their eyes at their crazy mum dancing around and tell me to keep the noise down!'