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Category Archives: Hormone Replacement Therapy

Osteoporosis Care for RA Patients Found Suboptimal, Declining – MedPage Today

Posted: August 14, 2017 at 3:47 am

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Fewer than half of rheumatoid arthritis (RA) patients at a risk of fracture sufficient to warrant guideline-recommended osteoporosis treatment received appropriate care, according to a large study of U.S. osteoarthritis (OA) and RA patients.

The study, published online in Arthritis Care & Research, found that despite a higher risk of osteoporosis and fracture, RA patients were no more likely than OA patients to be treated or screened for osteoporosis according to the management recommendations of the American College of Rheumatology (ACR) 2010 guidelines on the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) or the broader guidelines of the National Osteoporosis Foundation (NOF), which target all risk groups regardless of steroid use.

“Besides this suboptimal osteoporosis care, we also showed that the relative risk of undergoing osteoporosis treatment or [bone mineral density] screening has been decreasing since 2008 in RA and OA patients,” wrote Kaleb Michaud, PhD, of the University of Nebraska Medical Center in Omaha, and colleagues. They noted that RA is associated with double the risk of osteoporosis, even at younger ages, thanks to accelerated aging, hormonal changes, physical disability, and inflammation-associated osteoclast activation.

Michaud has previously reported on this continuing treatment gap despite frequent recommendations over the past two decades that rheumatologists assess bone mineral density in at-risk patients. “With reduction in steroid use, we hope to see a reduction in fracture and osteoporosis risk, but there is still an inherent increase in risk that comes from having RA,” he told MedPage Today. “As in many other conditions, screening can create uncertainty about who is responsible for ensuring this screening is done — i.e., the rheumatologist, primary care physician, or other specialist. We hope the study’s findings will help in the ongoing conversation about these roles for best clinical care of patients with RA.”

The observational study followed osteoporosis care in 11,669 RA and 2,829 OA patients registered in the Wichita-based National Data Bank (NDB) of Rheumatic Diseases longitudinal study during 2003-2014. The mean age and gender composition in the RA group were 59.3 years and 80.4%, respectively, and in the OA group, 65.8 years and 82.6%. In the RA group, 66.3% of the patients had used glucocorticosteroids, versus 25.7% in the OA group.

With care defined as drug therapy (excluding calcium/vitamin D) or screening (OPTS, osteoporosis treatment or screening); treatment was assessed at enrollment and every six months and included bisphosphonates, raloxifene, teriparatide, and hormone-replacement therapy. The 10-year major fracture probability was assessed by FRAX, an approach based on demographic and clinical risk factors but without reference to bone mineral density.

During a median 5.5 years of follow-up, OPTS was reported in 67.4% of RA and 64.6% of OA patients overall. But of those requiring treatment according to the ACR 2010 GIOP guidelines, only about 55% overall reported osteoporosis medication use 48.4% of RA patients and 17.6% of OA patients.

And although at greater risk, RA patients were no more likely to undergo OPTS than OA patients were: hazard ratio of 1.04 (95% CI 0.94-1.15). Adjusted models showed a significant downward trend for OPTS after 2008 in both groups of patients. Factors associated with receiving osteoporosis care in RA patients included older age, postmenopausal status, previous fragility fracture or diagnosis of osteoporosis, any duration of glucocorticoid treatment, and biologic use.

“Despite the importance of implementing GIOP guideline recommendations, our findings suggest that focusing only on glucocorticoid-receiving RA patients would overlook nearly 1 of every 5 patients not treated with glucocorticoids but also deemed to be high-risk and for whom osteoporosis treatment would be indicated based on the 2014 NOF guideline,” Michaud and colleagues wrote.

Interestingly, RA patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs) were more likely to be tested for bone mineral density but not more likely to be treated for osteoporosis: “These patients might have higher disease activities and more glucocorticoid-exposure prior to bDMARDs, which may explain the better screening,” the investigators wrote.

They pointed to the need to clarify patient- and provider-related factors driving suboptimal management and develop effective interventions and reduce the burden of osteoporotic fractures. “Considering the increased osteoporosis and fracture risk in RA patients regardless of glucocorticoid use, development of an RA-specific osteoporosis prevention and management guideline might be helpful in covering all high-risk groups, optimizing the care and decreasing the health impact of osteoporosis complications in RA.”

Regarding study limitations, the authors cited the voluntary recruitment of patients and physicians to the NDB, and hence the potential for reduced generalizability to all RA patients owing to participation bias created by a better-educated and disease-conscious sample. Another limitation was the self-reporting of fractures and trauma, opening the door to misclassification errors. Michaud et al also cautioned that the ACR’s 2010 GIOP guidelines did not cover certain glucocorticoid-using risk and age groups, and even the expanded 2017 guidelines are not as extensive as their NOF counterparts, which are applicable to all fracture risk groups beyond users of glucocorticoids.

Funding for the study was partly provided by a Rheumatology Research Foundation Investigator Award to Michaud. One of the co-authors reported receiving support from a VA Merit Award and the National Institutes of Health. No conflicts of interest were reported.

2017-08-13T12:00:00-0400

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Biz Buzz: Health and wellness medical spa opens in Short Pump – Richmond.com

Posted: at 3:47 am

Erasing facial wrinkles and lines with Botox and plumping up lips and cheeks with products such as Juvederm and Radiesse is big business.

Spending on facial injectables topped more than $2 billion in the U.S. in 2015, according to one report.

Betting on that trend, Dominion Womens Health & Wellness Med Spa moved into larger quarters in June.

Formerly located in a 500-square-foot space in Mechanicsville, the medical spa moved to a 2,600-square-foot space at 11739 W. Broad St. in The Shoppes at Westgate in Short Pump. The space was previously occupied by Jingles Bridal Salon, which closed in 2015 when the owner retired.

The medical spa is a division of Dominion Womens Health Inc., an obstetrics and womens health practice with medical offices in Chesterfield, Hanover and Henrico counties and Tappahannock.

We offer a pretty progressive menu of treatments, said Badeha Hamze, spa director and a master esthetician. We do all sorts of facials and waxing like a normal spa would.

In addition, spa staff procedures include facial chemical peels, microdermabrasion, dermaplaning, microneedling, permanent hair reduction, laser resurfacing for scars, and laser liposis body contouring.

Our vision has always been the integration of beauty and medicine, and now with our expanded location in Short Pump, we can offer a more complete array of services, including bio-identical (hormone replacement therapy), in a convenient location, said Dr. Danny Shaban, founder of Dominion Womens Health and medical director at DWH Health & Wellness Med Spa.

The interior design for the new space was done by Gaylin Vandenbroucke. Henrico County-based Freeman Morgan Architects did the architecture work, and MGT Construction was contractor for the renovations, which cost an estimated $425,000.

Need some junk lugged away?

Businessman Andy Taylor has opened a local franchise of The Junkluggers moving company, which bills itself as an eco-friendly junk hauling service.

Our mission is to give these items that are no longer wanted or needed a second use or second home, Taylor said.

Whatever we cant donate, we recycle through about a dozen different partners in the area we work with. Our whole guise is not to put things in the landfill, he said.

The Junkluggers of Central Virginia at 12104 Washington Highway, Unit 7, in Ashland opened in July. Taylor, who said he has two employees, opened the franchise after taking a buyout from his previous employer, a media solutions company that was a division of Texas-based Harland Clarke.

We spent about four months looking for opportunities, said Taylor, referring to himself and his wife, Melody Taylor.

The cost to have The Junkluggers haul away depends on how much room items take up in The Junkluggers truck. Taylor said there is a minimum $60 fee for a job, and estimates are available at no charge.

In cases where the collected items are donated to charities, customers receive a tax-deductible receipt for the item, Taylor said.

The Junkluggers company started in 2004 and is based in Stamford, Conn. The company started offering franchises in 2013. According to the company website, the franchise fee is $35,000.

2nd Beef Jerky Outlet opens in Hanover

Craving some chewy, spicy slivers of dried meat?

A second Beef Jerky Outlet has opened in Hanover County.

Jeff and Debbie Gelzinis and son Nick are owners of the franchise at 6493 Mechanicsville Turnpike, Unit B, near the intersection of Jackson Arch Drive.

Jerky is a high-protein, easy-to-carry-around snack popular among people on the go, such as hunters and other outdoorsy types. Beef, turkey, bacon, kangaroo, alligator, venison, elk and salmon are some of the types of jerky available.

The Beef Jerky Outlet in Mechanicsville is the chains second area location.

A Beef Jerky Outlet that opened in 2012 at 11670 Lakeridge Parkway, next to Bass Pro Shops, in Hanover County is operated by husband-and-wife team Allen and Kelly Musick.

Tennessee-based Beef Jerky Outlet was founded in 2010. The company operates six founder-owned stores and has more than 100 franchise locations.

Tidewater Physical Therapy firm acquired

Maryland-based Pivot Physical Therapy acquired Tidewater Physical Therapy, which operated locations in Hampton Roads and Richmond.

The acquisition was completed last year but only recently announced by the company.

Prior to the purchase, Newport News-based Tidewater Physical Therapy had more than 360 employees at 34 clinics and three performance centers from Virginia Beach to Richmond.

With the acquisition, Pivot Physical Therapy has more than 50 locations in Virginia and nearly 250 locations along the East Coast. There are 15 locations in the Richmond region, including former ProCare physical therapy practices that were part of another Pivot acquisition.

Of the companys 2,400 employees, 384 are in Virginia, including 120 in the Richmond area.

The Restroom Kit earns $10,000 prize

Former Richmond-area resident Bill Massey took home the $10,000 top prize on reality TV show Steve Harveys Funderdome on Aug. 6.

The show features entrepreneurs and their new products competing for investment money.

Masseys product, The Restroom Kit, contains a toilet seat cover, toilet paper and sanitary wipes everything you need when using a public restroom.

Massey and his wife, Sonia, were on the show. He said they may use the prize money for marketing, office space and paying off business debt.

Since were a product development company, the money could be used for new product design, Massey said. We could definitely use the funds for more inventory, and moving the business from our home into a office space/warehouse would be great.

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What’s the Cultural Impact of Transgender Characters on TV? – Newsweek

Posted: August 12, 2017 at 10:45 pm

This article originally appeared on The Conversation.

In 2014, Time magazine declared American culture had reached a transgender tipping point, with transgender people achieving unprecedented media visibility.

However, in light of recent policy shifts such as the White Housesrollback of federal guidelines that supported transgender studentsand Trumps July 26Twitter pronouncementthat the U.S. military will no longer allow transgender service members some have questioned whether this visibility has actually meant greater acceptance of trans people.

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The cast of ‘Transparent,’ the acclaimed Amazon original series. Transparent/Amazon Prime

Studies have shown thatentertainment has the powerto shape attitudes on health and social issues, fromorgan donationto thedeath penalty. But little research has explored the impact of portrayals of transgender people.

For this reason, we wanted to see how transgender TV characters might influence the attitudes of viewers. Specifically,we testedwhether political ideology plays a role in how audiences respond to these potentially polarizing depictions.

Transgender Media Visibility

Times transgender tipping point from a few years ago was attributed to fictional trans characters in shows like Transparentand Orange Is the New Blackandnews coverageof controversial policy issues, such asdiscrimination lawsuitsabout school bathrooms. In April 2015,nearly 17 million peoplewatched Caitlyn Jenner come out as transgender on 20/20.

It was in this context that the USA Network drama Royal Painsincluded a storyline about a fictional transgender teen named Anna who experiences complications while transitioning from male to female. Although Annas subplot lasted only 11 minutes, it grappled with numerous issues: the medical professions historical treatment of transgender individuals as mentally ill, parental rights regarding adolescent transitions and the risks of hormone replacement therapy.

Actress Laverne Cox, left, and writer Janet Mock embrace each other at the 23rd annual Gay and Lesbian Alliance Against Defamation (GLAAD) Media Awards in New York March 24, 2012. Andrew Kelly/Reuters

We first learned of the upcoming Royal Painsstoryline in early 2015, when the shows writers contacted Hollywood, Health & Society (HH&S), a USC Annenberg-affiliated program that gives entertainment industry professionals accurate and timely information for storylines on health, safety and national security. (Erica is a researcher at HH&S.)

HH&S facilitated conversations between the writers and an expert in the medical treatment of transgender youth. The resulting June 23, 2015 episode, “The Prince of Nucleotides, receiveda 2016 GLAAD Media Award, with transgender activistNicole Mainesmaking her acting debut as Anna.

Media Bubbles

Before we could study the impact of Annas storyline, we wanted to make sure that the audience was mixed in its views on transgender rights in other words, that the show wouldnt simply be preaching to the choir.

Since the 2016 U.S. election,countlessstorieshave explored the media bubbles in which Americans live. This trend toward fragmentation permeates news, social media andentertainment. TV shows with broad audience appeal tend to address hot-button social issues relatively infrequently andsuperficially. Regular viewers of boundary-pushing series, on the other hand, may alreadybe left-leaning.

Research by GLAAD (the Gay & Lesbian Alliance Against Defamation) indicates that transgender characters have appeared primarily on streaming platforms and premium cable channels, while broadcast network showswhich have larger audiencestend to feature transgender characters only in brief storylines, if at all.

This means viewers disinclined to watch a show like Transparent,which features several trans characters, might still encounter such characters in minor storylines in mainstream programs.

Royal Pains(2009-2016) was about as mainstream as TV gets today. The show had no real history of addressing LGBTQ issues, so Annas episode was unlikely to attract a particularly trans-supportive audience. For us, this made it the ideal show to study transgender portrayals and how they might influence viewers across the ideological spectrum.

Do Minor Subplots Make a Difference?

Because HH&S had consulted on the storyline, the members of USA Networks social media team were open to helping us with our study. They posted links to our survey on the shows official Facebook and Twitter accounts following the episode. We supplemented this sample by recruiting Royal Painsviewers from market research panels. Only those who had seen the episode or one of the two prior episodes were eligible. Of the 488 viewers in our study, 391 had seen Annas episode.

Because there were several different shows at the time featuring transgender characters, we asked viewers which of these they had seen. We also measured their exposure to transgender issues in the news, including the unfolding Caitlyn Jenner story.

Finally, we examined several important variables that are known to impact viewers. These includeidentificationwith main characters, a sense of being drawn into the world of the story (what media scholars call transportation) and theemotions evokedby the storyline.

We foundthat Royal Painsviewers who saw Annas story had more supportive attitudes toward transgender people and policies, and we found a cumulative effect of exposure to transgender entertainment narratives. The more portrayals viewers saw, the more supportive their attitudes. Neither exposure to such issues in the news nor Caitlyn Jenners story had any effect on attitudes. In other words, the fictional stories we examined were more influential than events in the news.

Consistent withprevious research, in our data, political conservatism strongly predicted negative attitudes toward transgender people and lower support for policies that benefit transgender people. However, exposure to two or more transgender storylines cut the strength of this link in half. That is, politically conservative viewers who saw multiple shows featuring transgender characters had more positive attitudes toward trans people than those who saw just one.

Political ideology also shaped viewers responses to the Royal Painsnarrative. Those who were politically liberal were more likely to feel hope or identify with Anna, whereas those who were politically conservative were more likely to react with disgust.

Beyond the Bubble

Hollywood is not a panacea for healing our nations deep partisan and ideological divisions. To influence attitudes on a broad scale, entertainment storylines must first reach audiences outside cloistered media bubbles.

However, our research suggests nuanced portrayals of transgender individualsparticularly in mainstream forms of entertainmentcan break down ideological barriers in a way that news stories may not. Cumulative exposure across multiple shows had the greatest impact on attitudes, but even a relatively brief storyline had a powerful effect too. While politically conservative viewers were more likely to react with disgust, such reactions were tempered by seeing trans characters on a variety of shows.

At a recent GLAAD-sponsored panel,trans actress and activist Laverne Cox noted:

Weve got to tell these stories better because lives are on the line. Trans people are being murdered, are being denied health care, access to bathrooms and employment and housing because of all of thesemisconceptions that people have about who we really are.

As the future ofthousands of active duty service membershangs in the balance, its more imperative than ever to understand how the public responds to media representations of transgender people.

Erica L. Rosenthal is a Senior Research Associate, Hollywood, Health & Society, University of Southern California.

Traci Gillig is a PhD Candidate in Communication, University of Southern California, Annenberg School for Communication and Journalism.

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Md. Medicaid should cover trans-specific care – Baltimore Sun

Posted: at 10:45 pm

The 45th presidents recent tweets banning transgender people from serving in the military because of their potential medical costs underscores the difficulties the transgender community faces in accessing quality health care. They often face stigma and discrimination by health professionals, and even if they have insurance, they may not have coverage for gender affirming procedures like hormone replacement therapy (HRT) or sex affirming surgery (SAS).

On some insurance plans, including Maryland Medicaid, prior authorization is required for someone who is transgender to receive HRT or SAS. Prior authorization is typically used to confirm that extraordinary requests are medically necessary, like transplants or cosmetic surgery. The transgender community shouldnt have to ask permission and submit claims before receiving life-affirming care.

According to the World Professional Association for Transgender Health, the standards of care for the transgender community include psychotherapy, HRT, changes in gender expression and SAS. Individuals may choose to use all, some or none of these in their health management of gender expression. These are particular therapeutic needs for this population. Although there may be some overlap with cisgender people (those whose personal gender identity corresponds with their birth sex) like psychotherapy, prostate exams and mammograms it is unethical to require preauthorization for other care that is specific to a community because it is different from the majority.

Currently the Affordable Care Act does not exclude the transgender population from some medically necessary care based on gender identity. This means a man can get insurance coverage for a pap smear, but not HRT. The language in the act is ciscentric, and wasnt specific enough to make insurance companies provide coverage for HRT and SAS. Even the quality metrics Maryland uses for its insurance plans do not include sexual orientation and gender identity information. So people in the community who are shopping for private insurance have no way of knowing if their care is covered in benefit plans. Transgender people have not been given a seat at the table in health care decision-making.

Fortunately, as a state, we can shift insurance coverage to include transgender specific care starting with Medicaid. Coverage under Medicaid would give the most vulnerable population access to quality care: 26 percent of the transgender population lives under the federal poverty line ($12,060 for individuals per year). Poverty in this community leaves people susceptible to violence, drug abuse and depression. Providing this population with access to life affirming care through Medicaid would set an example for private insurance plans to start allowing trans-specific health coverage.

This small step toward transgender insurance parity under Medicaid offers huge opportunities for the community in the health care field and beyond. There would be more understanding of hormone therapy and its side effects, long-term effects and dosing. Visibility in the health care arena can transition bias and discrimination among providers to compassion and understanding. Shifts in provider perception will result in the quality care needed to address the mental illnesses, housing instability and drug abuse that runs in the community. The increased demand to address those needs could transform into a specialized field of transgender health. The possibilities are endless.

California already mandates insurance coverage for life-affirming care in the transgender community. No significant changes were made to their budget for the accommodation, and insurance surcharges on private insurances were actually dropped because there was no significant cost for adding trans-specific care to their benefits.

Every year the transgender community becomes more and more visible; we are doing them a great disservice by ignoring their needs for health care specific to their community. We can take these steps of social progress and apply it on a national level and provide access to quality health care to all Americans.

Chigo Oguh ([email protected]) is a graduate student at the University of Maryland, Baltimore.

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Niwot author pioneers interventions for Autoimmune Disease – Left Hand Valley Courier

Posted: at 10:45 pm

Along with the growing stressors of modern life, theres been a corresponding dependence on fatigue fighters such as energy drinks, triple-shot lattes and Mountain Dew. We take supplements to re-charge our metabolic systems, often reaching for quick-fix solutions when what we really need is to rest and recharge. But then, whos got the time?

But without time spent each day in an anabolic state, or what Niwot author and pharmacist Dr. Izabella Wentz calls a state of rest and digest, were basically telling our bodies that were unsafea situation that, over a sustained period, triggers biologic responses that can lead to autoimmune conditions.

At 27, Wentz was diagnosed with Hashimotos disease, also known as hypothyroidism, an autoimmune condition that results in an underactive thyroid gland. Wentz often felt cold, with other symptoms including hair loss, acid reflux, fatigue and depression. Like many autoimmune sufferers, she was told by doctors that her symptoms were just in her head.

One doctor told her she was experiencing the normal signs of aging, she said. That was her wake-up call. From then on Wentz took a more active role in figuring out her own road back to health.

That plan led to remission, and her recovery eventually led to the publication of her latest New York Times bestseller, Hashimotos Protocol: a 90-day plan for reversing thyroid symptoms and getting your life back, which released on March 28, 2017.

The condition runs in Wentzs family, and she attributes her mother as the force behind the book, urging her to write so that my cousins in Poland would start feeling better too, she said.

The thyroid is a small, butterfly-shaped gland that produces hormones such as thyroxine (T4) and triiodothyronine (T3), which stimulate vital processes throughout the body. Not coincidentally, thyroid hormones impact the proper functioning of the bodys heat production, its ability to make use of vitamins, proteins, carbohydrates and fats, along with fertility and growth. In hypothyroidism, the bodys immune system attacks its own cells, and if not caught in its early stages, the gland can become permanently damaged.

Hormone replacement therapy is the first step on the road to recovery, but because Hashimotos is so complex, Wentz recommends several dietary and lifestyle changes as well.

Gluten seems to be a major trigger for producing an autoimmune response. Cardiologist and author, Dr. William Davis, argues in his 2011 book, Wheat Belly: Lose the Wheat, Lose the Weight, that genetically altered Frankenwheat has been imposed on the public by agricultural geneticists and agribusinesses to disastrous results for the collective gut.

But whatever the cause of the populations prevalent wheat sensitivities, Wentzs protocol encourages a 90-day abstinence from flare-up triggers such as wheat, alcohol and caffeine, and recommends that anyone diagnosed with Hashimotos to remain gluten-free indefinitely.

An estimated 20 million Americans suffer from some form of thyroid disease, according to the American Thyroid Association. And though theres a disproportionate number of women hit with thyroid conditions, theres no known reason why. But Wentz offers some theories, which include exposure to toxins in personal care products, along with pregnancy, genetics and culture.

Women often put themselves last, she said. Theres a stigma attached to women who demand attention or have too many needstheyre considered high maintenance.

In addition, [Women] jump from one activity to the next, from school to work, to childrens sports, to homework to dinner. Were rushed in the mornings, we eat in the carour time is overly scheduled.

For every one man, she said, five to eight women are diagnosed with a thyroid condition.

Hashimotos triggers also include nutrient depletions, food sensitivities and intestinal permeability (also known as leaky gut), among others. So it makes sense that treatment includes changes in eating and other lifestyle behaviors.

Taking probiotics helps to balance gut flora, and the removal of triggering foods from the diet can make huge changes in an autoimmune sufferers sense of well-being. But the biggest impact, for Wentz, happened when she started taking a thiamine supplementsimple vitamin B1.

Youll know in five days if its going to help, she said. It helped resolve her fatigue issues. Another easy solution with a huge payoff came over-the-counter as well: digestive enzymes. Other recommendations include gut-healing nutrients, such as Omega-3s, zinc, L-glutamine and bone broth.

Stress causes the adrenal glands to pump out extra hormones, shifting the body from a relaxing, digesting and healing state, to a fight-or-flight response state. To promote the rest-and-digest state, Wentz suggests introducing more self-care activities. Sipping hot lemon water in the mornings for its liver-supporting properties while enjoying a warm water foot soak will give the metabolism a boost.

You can add lavender or other essential oils to the water, [and] set your intentions for the day, she said.

She also recommends spending an hour every day reading inspirational or spiritual books, Whatever you find uplifting, she said. Journaling can also be helpful. You can make a list of your health goals and journal about it. Then check in with yourself.

She also suggests celebrating small successes. Maybe your hair has stopped falling out (though maybe it hasnt grown back yet), but stillits progress, she said. Listen to your body, she continued. If youre tired, take a nap. If youre taking a lot of Maalox, eat less acid-forming foods, such as fresh vegetables, and avoid sugar, caffeine and alcohol. You can do anything for 90 days. The results may just be worth it.

Wentz has a Facebook community where people with Hashimotos write in with questions ranging from how to combat a vitamin B12 deficiency (she recommends sublingual tablets), to whether or not sufferers should stop dyeing their hair (yes). Visit her at Facebook.com/thyroidlifestyle. Hashimotos Protocol, and Wentzs first book, Hashimotos Thyroiditis, are available at most major book retailers.

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Transitioning: Controversy, corrections and new-found peace, Misty Lane is finally finding happiness with herself – Douglas Budget

Posted: at 10:45 pm

The camper was never meant to be anyones home, but the 120-acre spread it sits on is the closest thing to a home the tenant has ever known. More importantly, it marks the place where one way of life ends, andanother begins. In most cases, a name doesnt matter.

For this story, its critical.

Start with Mark.

For the first 20 years of his life, he was a tattooed, muscled roughneck who worked oil rigs, collected muscle cars and raced mud bog trucks; a real self-described Wyoming redneck. When Mark was 21, he legally changed his name to Misty. And for the first time in his life, Mark felt he was who he is supposed to be a woman. Mark, now Misty, puts on eye shadow, wears frilly shirts and dons tennis shoes with pink laces when she climbs under the car to change the oil.

Misty is very much a mans man. In this regard, her gender identity is still at odds with her sex in that shes still very much a guy when it comes to her interests, including her preference for dating women. Ironically, the more comfortable she feels in her female body with breast implants and hormone therapy, the more ostracized she becomes in the community.

Life would be easier if Misty left Wyoming.

But just as her personal interests havent changed, she loves everything shes always loved about living out West. She doesnt expect people to understand, nor does she blame anyone for their reaction, particularly given where they live. Wyoming isnt exactly open-minded when it comes to homosexuals and transgenders. The Code of the West is pretty straightforward when it comes to gender: guys are guys.

Despite all masculine traits to the contrary, she identifies female, which she realizes is hard to explain to someone who was born with the correct body.

I dont think its an issue of want. You have to, she says, biting a corner of her blunt thumbnail. Essentially, you have the base knowledge that somethings not right. Eventually, it eats away at you like a cancer. But its not eating away at your body, its eating away at your soul.

The reverberation in her Pops garage is squint-worthy. A lit Marlboro dangling from one corner of her mouth and mirror Raybans pushed back on the top of her head, Misty smiles through the windshield of her vintage Camero and gives it another rev.

Its an original SS, she screams over the roar, rattling off a list of bits and pieces that apparently make it faster and louder. Under the white-striped ebony hood, the engine screams.

She jumps out to show off some of the original components underneath the hood, struggling with one hand to release the latch. The other hand rests idly at her side like an inflated surgical glove, swollen with a staph infection that wont seem to go away, despite the daily trips to Casper for antibiotics.

She slammed her hand under the hood of her truck last week.

This is where Misty and Mark begin to diverge. Despite the long hair and frosty pink eye shadow, her hands still belong to Mark. Thick-knuckled with half moons of grease under the nails, these are hands used to doing dirty work.

This has always been her passion. Shes a certified mechanic and, as Mark, had worked for years in the trade, even owning her own shop.

Now, as Misty, its much harder to find work. People arent exactly clamoring to hire a former man who now identifies as a female. The trouble is that though her genders changed, her skills havent.

Doors dont exactly open to a man wearing make up and pink shoelaces and introducing herself with a girls name. Usually, the employer says that she doesnt fit their company image or says there are no openings. Sometimes shes just met with abject stares and smirks.

Its funny people will hire ex-cons no problem, Misty says, flicking an ash on the ground after a deep inhale, but forget about hiring a transgender.

Unfortunately for Misty, she falls into both categories. Worse, she bears the label of a registered sex offender given that she went to jail after a lusty night of heavy petting with a 14 year old an encounter that landed her two years in prison and another year of probation. Shes been out for less than 10 months.

Misty is stoic when it comes to defending that charge. She screwed up, plain and simple. The girl lied about her age, Misty says, and she didnt think to check her ID.

Thats completely on me and Ive served my time.

Misty shrugs. Shit happens.

I may have a shitty reputation as a person, she says, squinting as she tightens a bolt, but Im a damned good mechanic.

Smart, too, she adds, not afraid to admit she has an IQ of 142. She loves working on cars and would prefer spending her days in a garage away from people. Cars make sense to her, people dont.

That includes herself.

All her life she felt that something wasnt quite right but it took her years to realize that it was her gender.

Shed always felt more comfortable as a female, beginning with her earliest memory of her sister and cousin dressing her up in their clothing, but how, as a boy, do you admit that out loud? Especially when its clear your parents disapprove. Misty remembers being confused when her father beat the hell out of her after finding Mark wearing a dress, berating his sisters for trying to turn him into some kind of sissy.

Clothing plays a big part in Marks gender identity, both as a haven and a form of torture. She prefers feminine clothing and always has. Mistys worst childhood memories revolve around holidays and being forced to wear suits and ties. She had no idea why it made her miserable.

Her confusion, too, was compounded as a teenager, when she went to see the doctor about a bladder infection, and according to Misty, found out she also had a uterus and was therefore considered innersex, the term for a person born with the sexual or reproductive anatomy of both a female and male. Oddly, innersex births are more common that one might think. According to the Intersex Society of North America, it occurs in nearly one in every 2,000 births.

The fact that she had a uterus didnt exactly make the situation any better.

How do you approach a person with that statement, Misty laughs, bitterly. She didnt have anyone to talk to about this when she was younger, so she just tried to live with it and do her best to fit in.

Trying to do anything outside of the social norm as a teenager is hard enough, she says. It doesnt matter what it is. Its not met well.

This grin-and-bear-it strategy didnt work, however, and after two suicide attempts in her early twenties, she realized she only had one choice: Become a woman or die.

Theres no way to explain how it feels to be born with the wrong body. You either get it or you dont. What Misty can tell you, however, is that the day she buried Mark and became Misty was the moment she realized what it felt like to breathe.

First the name change, then came breast implants, hormone replacement therapy, make up and female clothing.

Its hard to explain, Misty says, but when you start to transform physically, the mental follows. These thoughts and feelings have always been inside her but up until now shes worked hard to hide it. With every step toward transition, she feels a weight being lifted.

Its kinda like being on deadline, Misty pauses. Like theres so much stress and pressure trying to get the work done, but the second that you meet that deadline, you instantly feel a sense of relief.

There are a lot of people who dont get what it means to be transgender, she adds. People think its some kind of fetish, guys who like to put on make up and dresses and pretend to be a girl.

For Misty, it means living in a body where she feels she finally belongs. Its real. The make up and clothing reinforce her sense of femininity. Shes not doing this for attention.

Believe her. Theres nothing fun about being stared at or having obscenities yelled at you or otherwise being treated like some kind of freak, especially here.

Look around you, she shrugs. Lets face it, Wyoming hasnt exactly evolved a lot. If you want to experience the old West, just go outside.

Regardless of geography, Misty chooses to live as a woman with the goal of saving enough money to have gender reassignment surgery, a procedure that involves turning her penis into a vagina. The hefty price tag$22,000 just for the surgery alonekeeps it a faraway dream, but shes determined to make it happen. Shes met the criteria, talked to several doctors and has done the research. Now, its just a matter of when.

Im not going to cave, Misty says, slamming the hood as she reaches into her back pocket for another smoke. Its not in my nature. Id be more afraid of meeting my maker and telling him why I didnt have the courage to do what I needed to do.

Theres an official process involved when it comes to switching genders. In order to officially become a woman, surgically speaking, Misty had to first prove she has lived in a female role for over a year and had to do so many months of hormone therapy replacement treatment. She also had to have a psychological evaluation that validated, that yes, she identified as a female.

That part, logistically speaking, was easy.

The harder part comes now as she leaves Marks world behind in order to become Misty. One doesnt ever get to easily dispose of a body, even if just in name only.

First there are a few demons to exorcise, starting with teenage Mark, a tough guy with a chip on his shoulder.

I wasnt a very nice person back then, Misty says, shrugging.

And those who knew him in high school, like Maria Bromley, would agree. Though Maria hated Mark in high school, shes since fallen in love with Misty, who shes learned to see in an entirely new light.

He was pretty much a total a**hole, Maria says, cuddling now against Mistys shoulder.

Its fair to say I wasnt a very nice person, Misty says with a tight-lipped grin. As Misty, shes still trying to get used to pubic affection and other social niceties like smiling.

You think? Maria jokes. Mark pretty much told you exactly what he thought.

Back then Mark was pumped up with muscles and enjoyed going to school drunk and doing everything he could to mess with teachers.

He was also pretty violent. A lot of this anger stemmed from hating his life and his circumstances.

Its hard to be happy when you feel like every part of your life is a lie, Misty says, staring through the kitchen window. Outside, the finger-like branches of a maple tree bend in the gusty wind as if clenching together in a fist.

Marks also left behind some causalities, including three daughters from two different women from relationships in his late teens. Misty doesnt have too many good things to say about one of the moms, Katie, who cleared out his checking account one day while he was at work and refuses to let her see her girls, despite the fact they have joint custody.

Mistys youngest girl was given up for adoption when Misty was working out of the country on a drilling rig. Misty didnt know the daughter was hers until a year after she returned.

Nonetheless, its a sore spot.

My children mean everything to me, Misty says defiantly, when pressed to remember the last time shes seen or talked to any of them.

Shes vague about their lives. Misty repeats how much she loves them. Marks oldest daughter picked her new name Misty, she quietly recalls.

She has no idea when shell see them again.

This is a common refrain in Mistys life: people who have wronged her or dislike her leaving unseen emotional scars.

Nonetheless, Misty makes it clear that she doesnt put up with anyones crap or abuse.

She tells a story about an elderly woman who lived in a trailer park near her years ago and how this woman would always complain about Mistys truck being too loud. So Misty checked the local noise ordinance and set her engine to two decibels below the max. When she worked on her truck, it sounded like a drag strip. The woman called the police who came out to test the decibel levels, which were always within the legal range. The woman finally sold her trailer and moved, Misty says, smiling.

The lesson is clear: hurt me, and Ill hurt you. Leave me alone, and Ill be cool to you.

Shes still dealing with a lot of anger, Misty confesses. Its going to take some time.

Maria needs a cigarette.

Theyre in my purse, babe, Misty says, twisting in her chair to grab a small glittery bag off the floor near Marias feet.

The door shuts behind Maria and soon a cloud of smoke fills the window behind Mistys head.

They are in her grandfather Gale Lane, or Pops, kitchen, the one home where Mistys always been welcome. For the past decade, Pops has been slowly declining with Alzheimers and at present has little recollection of his earlier life.

Pops and Bonnie, Marks step-grandmother, have been the only people in her life who have half-way understood, or at least accepted Misty, no matter what. For that, she loves them deeply.

Theres a lot of pain in Mistys past, starting with Marks relationship with his dad, which deteriorated even more when he began dressing in his sisters clothes.

Picture a six-foot something mans man, Misty describes her father. The fact that Misty mainly takes after her motherwho left the family when Mark was 9was another sore point for her father. Basically, my dad had a lot of reasons for beating the shit out of me.

That was just the start of Marks problems, which culminated in him getting into lots of trouble at school, and, finally, for reasons Misty refuses to disclose, eventually landed Mark in a juvenile facility at age 13.

After shuffling throughout several facilities throughout the state, he ended up in a group home in Douglas, which left some good memories. The woman who ran the place was kind, Misty says. Life there wasnt too bad.

Eventually, Mark graduated from high school, enrolled in college, then headed to the oil field. Misty got a commercial drivers license and went to mechanic school.

The door opens and Maria is back. She wants to clear the air about Marks violent past. Mark was dealing with a lot of anger because he couldnt be the person he needed to become, she insists.

Maria likens it to being in an abusive relationship. Her voice gets soft as she describes how that life becomes your reality and when youre stuck in the middle of it, you know that anything you do can never be right because youll never be able to please that person. You become somebody youre not.

Thats how Misty felt, she says. She couldnt find any glimmer of happiness in herself, so how on earth could she find happiness anywhere else?

The waitress at the Village Inn does a double take when Misty, in a male voice, orders a double cheeseburger and a Coke with fries. Up until that point, Misty and Maria had been just two more attractive blonde women in a morning when she already seen plenty. Now, the waitress takes a closer look at the woman with the male voice.

Sometimes, Misty softens her voice to blend in, but only when she wants to.

A couple of middle-aged cowboys at a nearby table swivel in their seats to eyeball Misty with prolonged stares. Blondes always turn a few heads, but theres something about her face that doesnt quite fit. Much like a face can either look 20 or 50, gender too is revealed in the bones. The men smirk.

This is typical of the range of reactions Misty gets in public: stares, smirks, double takes, name calling, or, conversely, the conscious effort to pretend that shes not transgender.

The waitress immediately falls into the latter, overdoing the pronouns with too many self-conscious references to ladies and girls, even joking with Maria about Mistys ability to eat like a man without putting on weight.

Shes a skinny bitch, Maria laughs, playfully slapping Misty.

Right? the waitress answers, joking at how just looking at Mistys lunch makes her fat.

Misty smiles indulgently before lifting her burger in both hands and taking a big bite. She cant control the way people react to her, nor does she care. She doesnt expect people to understand.

And though people in Wyoming are less open to diversity, they tend to be pretty laid back when it comes to minding their own business. And while in the urban circles of the hyper-politically correct, transgenders are fighting for pronoun equalitypreferring to be referred to in the third-person as them and they in effort to embrace both sides of their sexMisty isnt carrying any flags.

That said, shes less sympathetic to the name-calling and blatant attempts to pick a fight. She willand hasfought back.

I always tell them that I may look silly but theyre going to look even sillier when they get their ass kicked by a tranny.

Misty, unlike Mark, stays out of the bars. That helps avoid fights, though not entirely.

Misty doesnt exactly mince words. Social skills in general can be a problem for her, she concedes. She blames her Aspergers Syndrome for being too blunt. She sees things as strictly black or white, very little gray; success or failure, nothing in-between.

Misty drops a pen on the table, then lifts it in the air. You either have the ability to pick up or not, she says.

Maria covers her face and shakes her head. Trying means nothing?

Nope.

Maria gives up.

Misty rubs her thumb over a clump of mascara thats fallen under Marias left eye. She holds her chin and rubs gently.

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Transitioning: Controversy, corrections and new-found peace, Misty Lane is finally finding happiness with herself – Douglas Budget

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Top five misconceptions about menopause – Starts at 60

Posted: at 10:45 pm

Going through menopause is usually a difficult time for women and there are a lot of physical changes that take place. So often we hear about the hot flushes, sleepless nights and lowered libido. But is it really that bad and what actually happens? Specialist Clinics of Australia owner and clinical director Dr Garry Cussell debunks the top five myths of menopause and sheds light on how to make this time of transition as easy and as possible.

Whilst the average age that women hit menopause is 51 to 52 years old, it can in fact happen to women in their 40s (early menopause) or even younger (premature menopause). Surgery or medical treatments that affect hormones such as chemotherapy and radiation therapy can bring on early menopause or premature menopause. Genetic factors also play a role in determining the age a woman will hit menopause but every woman has her own moment, says Dr Cussell.

Lack of estrogen can cause symptoms such as itchiness, decreased lubrication, and pain during sexual intercourse and incontinence of urine. These symptoms generally appear a few years after the onset of menopause and affect up to 50% of post-menopausal women. Many women believe that the only way to treat these symptoms is with invasive surgery or Hormone Replacement Therapy but these days there are a lot of safe alternatives out there. GynaeLase is a quick, non-invasive and relatively painless laser procedure that relieves these symptoms without surgery or HRT. It encourages renewed functional activity in the treated sections of tissue through a special heat effect. Optimum results are usually achieved after three treatments as the process of collagen neogenesis takes time to develop, with the effect of tissue tightening and collagen build-up increasing after each treatment.

Laxity and atrophy can be bothersome conditions and impact on happiness and sexual function. Even the healthiest of women will experience the natural process of laxity, and this can be exacerbated by child birth or weight gain. GynaeLase helps treat these symptoms and the vast majority of patients at Specialist Clinics of Australia who have undergone the treatment have reported improved sexual activity.

Although hot flushes are one of the most common symptoms experienced by women going through menopause, not all women get them. Its still not clear exactly what actually causes hot flushes but its estimated that four out of five postmenopausal women will experience them. The usual treatment for these is using oestrogen tablets and patches, however these have potential side effects and there are alternative treatments.

Decreased oestrogen levels can impact on your bodys metabolic rate but this doesnt necessarily mean youll gain weight post-menopause. Keeping a balanced diet and exercising regularly will help you manage your weight. If you notice a sudden change in your weight, despite maintaining a healthy lifestyle, talk to your doctor.

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I was an intersex child who had surgery. Don’t put other kids through this. – kgw.com

Posted: August 9, 2017 at 3:43 pm

Kimberly Mascott Zieselman, Opinion contributor , TEGNA 9:10 AM. PDT August 09, 2017

Kimberly Mascott Zieselman, months after her intersex surgery, in Concord, Mass., in 1983. (Photo: Family Photo)

I was born with typically male XY chromosomes and internal testes instead of ovaries and a uterus, but my body developed to appear typically female.

My intersex condition was invisible until I reached puberty and failed to menstruate like other girls. On the advice of doctors at a major hospital, my parents agreed that I should have surgery to remove my healthy gonads, without my knowledge or consent.

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My natural hormone production ceased, and I was forced onto hormone replacement therapy for the rest of my life. I was just 15. Doctors also recommended to my parents that I receive invasive surgery to create a more typically sized vagina thankfully, my parents refused. I didnt find out about any of this until I was 41 years old.

Intersex people like me up to1.7% of the population are born with sex characteristics that do not fit typical definitions of male or female. I haveandrogen insensitivity syndrome. Because my body was resistant to androgens, including testosterone, in the womb, my natural hormones automatically converted into estrogen through a process calledaromatization.

Intersex people have been the last bastion of dont ask, dont tell, with doctors commonly telling parents for many years that the best thing they could do for their children was to have surgery done, even when they are infants, so they can grow up normal.

These and other surgeries have been commonly performed on intersex children in the USAsince the 1960s. But in the 1990s, intersexadults began speaking outagainst these non-consensual and medically unnecessary procedures because of their lifelong physical and psychological consequences.

Despite decades of controversy over the procedures, doctors continue to operate on childrens gonads, internal sex organsand genitals when the kids are too young to participate in the decision even though thesurgeries are dangerousand could be safely deferred. Its rare that urgent health considerations require immediate surgical intervention. The results of these cosmetic surgeries are often catastrophicand the supposed benefits largely unproven.

As executive director ofinterACT, the nations only organization dedicated exclusively to protecting the legal and human rights of intersex youth, I am thrilled that since interACTs founding in 2006, we have seen progress frommedical associations but not enough, and not nearly quickly enough.

Its not time for more data collection or dialogue;its time for these surgeries to stop.

I know firsthand the devastating impact they can have,not just on our bodiesbut on our souls.We are erasedbefore we can even tell our doctors who we are. Every human rights organization that has considered this practice has condemned it, some even to the point of recognizing it asakin totorture.

We know that most physicians want to do the right thing for their patients, just as parents want to do the right thing for their children. The right thing, unequivocally, is to wait until an intersex person can participate in these life-altering decisions. The right thing is to afford them the same dignity and autonomy that is due to everyone and refrain from inflicting irreversible harm solely because of a discomfort with difference.

The fewdoctors who refuse to bring their practices in line with human rights standards tell us there is a silent majority of patients who are happy they had their childhood surgeries, but they have been unable to produce those happy patients for us to talk to.Wedohear from people who are extremely grateful they were spared surgery, as well as parents of intersex children who are growing up just fine without medical intervention.

Some doctors have dismissed us as angry activists, but our position has support from theUnited Nations, theWorld Health Organization,Amnesty International, theState Department, everymajorLGBTQ rightsorganization in the United States, three formerU.S. surgeons generaland almost every intersex organization in the world.Now, interACT and Human Rights Watch have published anew reportechoing those calls for a ban.

These institutionsare not just angry activists. They areprincipled human rights defenders drawing on data, laws and the medical ethics concept of do no harm.

Most important, intersex children and adults are telling us that they want the freedom to make decisions about their own lives and bodies.

Working with intersex youth every day, I can tell you these kids are perfect as they are and they are telling us that their bodies aren’t shameful and dont need to be fixed.

Kimberly Mascott Zieselman is executive director ofinterACT, an organization that advocates for intersex youth.

You can read diverse opinions from ourBoard of Contributorsand other writers on theOpinion front page, on [email protected] in our dailyOpinion newsletter. To respond to a column, submit a comment to [email protected].

2017 USATODAY.COM

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I was an intersex child who had surgery. Don’t put other kids through this. – kgw.com

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Perimenopause Problems: How Changing Hormones Exacerbate ADHD Symptoms – ADDitude

Posted: at 3:43 pm

An ADDitude reader wrote: I am a 42-year-old business executive diagnosed with ADHD. I have a confession to make. Lately, I dont like calling people on the phone or returning calls. I think perimenopause may be causing this glitch. I also find myself getting confused and shutting down when confronted with a bunch of projects at work all at once. I need more time to process things. I know I have ADHD, and I know my hormone profile is changing. I take medication, but what strategies do you have to ease this collision course between diagnosis and hormones? What can I do to make things easier on myself?

ADHD symptoms change as we age, and as life circumstances become more complicated and stressful. Hormones, in particular, often exacerbate ADHD symptoms as women edge closer to menopause. In fact, as youve pointed out in your question, this worsening of symptoms may occur during perimenopause, when estrogen levels begin to drop.

We know that when estrogen levels decrease, cognition suffers. Women struggle with memory, word retrieval, and other cognitive activities. In fact, for some, the change in cognitive function is so drastic that some think they are developing dementia or Alzheimers. Lower levels of estrogen may cause depression. During this time of hormonal fluctuations, we find that ADHD medication and strategies for managing ADHD symptoms may not work as effectively as they once did.

[Self-Test: Could You (or Your Daughter) Have ADHD?]

Your new difficulty in dealing with phone calls and feeling overwhelmed when faced with multiple projects may be due to your estrogen deficits. Changing hormone levels, combined with ADHD, creates a tough situation for a lot of women in the workplace.

The first thing I suggest is to discuss these new challenges with your physician or medical provider. Look back and think if these struggles have been there all along, or if they are worse since perimenopause. Youll want to also rule out any other reason for your current challenges outside of the ADHD/hormone connection thyroid disease, allergies, and so on.

If your medical provider gives you a clean bill of health, discuss your situation with your prescribing doctor. Many doctors make the mistake of increasing stimulant medication for women whose hormonal changes are causing the kinds of challenges you describe. Patricia Quinn, M.D., an expert on ADHD and hormones, suggests that this may not be the best solution. She suggests discussing possible hormone replacement therapy with the doctor.

Another possible explanation for your difficulties is additional stress in your life. Is your boss demanding more of you lately? Are there other things going on in your life that are challenging you mentally?

[ADHD Is Not a Males-Only Diagnosis]

Here are some strategies women can use when, like you, they feel overwhelmed at work. The first step, always, is to identify the problems.

>You say that you hate calling people on the phone. One way around this is to schedule your calls early in the day, so you dont think about them very long. Try making calls first thing in the morning, when not a lot is going on, and check them off your to-do list.

Make calls first thing in the a.m. and cross them off your list.

Is there someone at work who can take some of the phone calls off your plate? Maybe trade tasks do something a colleague hates to do in exchange for her making some of the phone calls. Bartering chores is a great way to deal with difficult tasks.

>If thats not possible, identify what exactly makes you hate the phone calls so much. Do you get bored? Do you feel anxious? Are you afraid you might forget what to say? Do you hate the prep or follow-up involved?

[How Your Hormones Affect and Worsen Your ADHD]

>If you get distracted on the phone, playing with fidgets and doodling on a piece of paper can keep you focused. I stayed focused on lectures in college by doodling in the margins of my notebooks.

>Instead of phone calls, encourage clients or other business contacts to email or send text messages to you.

As we age, we not only deal with hormonal changes, but with an aging brain as well. As a result, we are more easily overwhelmed. It can become harder to juggle all the things thrown at us.

>Bring in more support, if possible. If you have assistants, hand off more responsibilities to them. Many with ADHD have a terrible time delegating, partly because it can trigger a sense of perceived failure (I should be able to do it all myself). Help them to help you by working together on setting up systems that work, starting with a schedule.

>Stop taking everything on. Learn to say no (when appropriate). Negotiate extra time for getting tasks done.

>Write it down. When you begin to feel overwhelmed, analyze what is upsetting you. Perhaps you feel you dont have enough time to take on all the projects that have landed on your desk. Try whittling down larger projects into mini-tasks. One way to do that is to write an outline:

Writing things down reduces stress on the ADHD brain. Some people find that using a voice recorder to break down a task can be helpful, too.

>If you wait until the last minute to finish a project a common problem for people with ADHD set up a schedule to divide the project into parts, and assign each part a day and a time. For instance:

Monday9 a.m.: phone calls to xyz11 a.m.: Spend a half hour working on reportNoon: lunch1 p.m.: Write the first paragraph of the analysis report

Use visuals to avoid taxing your brain.

>Many people are overwhelmed when a boss spits out orders or expectations, especially verbal commands. If your boss does that, get in the habit of carrying a pad and taking notes as you discuss new assignments, or ask him or her to write down the specifics of what you need to do. Say that this is the best way for you to get the job done, as it gives you the opportunity to re-read the plan. Again, having your boss email you the assignment in detail is an excellent way to deal with his demands when your brain is already tired.

>Working with professionals familiar with ADHD can bring tremendous relief to someone who doesnt feel up to a task. In your case, it may be working with an ADHD coach who can help you set up systems at work, and hold you accountable for getting things done. The job of a coach is to encourage you and work with your strengths. You can find an ADHD coach in the ADDitude Directory.

>Another option is to work with a professional organizer, who can de-clutter and organize your office with you. Make sure the person you hire understands ADHD-related challenges, so he or she is not judging you as you organize your office.

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Parents and Doctors, Hold Off on This ‘Devastating’ Surgery – Newser

Posted: at 3:43 pm

(Newser) When Kimberly Mascott Zieselman was 15, she had surgery she now says caused “irreversible harm” due to others’ “discomfort with difference.” In her op-ed for USA Today, Zieselman explains how, as a young teen, she didn’t get her period like other girls, and when her parents took her to get examined, doctors made a surprising discovery: She was intersex, meaning a person born with both male and female characteristics. In Zieselman’s case, that meant that even though on the outside she appeared female, she had male XY chromosomes and testes (instead of ovaries and a uterus) inside her body. She had androgen insensitivity syndrome, so that her body resisted male sex hormones called androgens and led to an external appearance of being female.

She says her parents agreed, per physician advice, to have her “healthy gonads” taken out, “without my knowledge or consent.” She was also placed on a lifelong hormone replacement therapy, as her natural hormones had halted. She says these types of “non-consensual and medically unnecessary procedures” on intersex kids have been common since the ’60s, with “often catastrophic” results and “largely unproven” benefits. “We are erased before we can even tell our doctors who we are,” she writes. Zieselman believes most doctors and parents think they’re doing the right thingbut she notes the “devastating impact” on patients and says “every human rights organization that has considered this practice has condemned it.” “The right thing is to wait until an intersex person can participate in these life-altering decisions,” she writes. Read the full piece.

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