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Darker-skinned people urged to take extra precautions as laser hair removal industry booms

ABC News

(NEW YORK) -- For Eshanka Jayasinghe, or Eshi Jay, unwanted body hair negatively affected her self-esteem for years, so she decided to undergo laser hair removal treatments.

But the procedure left the YouTuber's body in a worse state, she said, with scarring and damage from her neck down to her arms. Jay told "Nightline" that the damage was so bad she canceled her wedding plans, has to constantly put on sunscreen because her skin is now more sensitive to the sun and had to cover up her body to hide the scars.

"I mean, it was like 70-degree weather and I was wearing long-sleeved shirts," she said.

Jay isn't alone and dermatologists warn that some patients, particularly those with darker skin tones, are at a greater risk of getting burned by improperly trained laser technicians because of the increased melanin in their skin.

"There are a lot of people that will discount coupon their health and go to laser clinics that are staffed by people that learned how to use the laser the day before and burns happen," board-certified dermatologist Dr. Jeanine Downie told "Nightline." "These machines are strong and they can do permanent damage and cause permanent scarring when in the wrong individual's hands."

Over the last few decades, experts said laser hair removal services have been on the boom as more people are looking to shed their unwanted hair.

It's estimated about a million people get laser hair removal annually, and the industry rakes in around $300 million a year, according to the American Society of Plastic Surgeons.

Downie believes that high demand for this hot venture has driven people to the industry who don't have proper training or having medical knowledge about risks to darker skin. Additionally, some people may not be using the right equipment, Downie noted.

"There are many people that share lasers and they're bounced around improperly on the backs of trucks," she said.

Early lasers in the 1990s were made for lighter skin tones, Downie said, but she added there are now specific lasers for all skin tones including darker shades. She stressed that those machines need to be properly matched with the patients.

"In some cases, estheticians or laser people, not even necessarily doctors, they will use a laser that's only intended for very light white skin, and use it on somebody that's my skin tone or darker than me and burn them because there's an increase in melanin," she said.

Some laser hair removal specialists said they are working hard to counter this deep-seated issue and provide their darker-skinned patients with the proper care.

Keisha Wagner-Gaymon, a board-certified Nurse Practitioner and the owner of PeachFuzz Laser Studio in Brooklyn, told "Nightline" that she focuses on getting people with darker skin closer to their hair removal goals.

When done correctly, laser hair removal can provide life-changing positive results, Wagner-Gaymon added.

Wagner-Gaymon said she suffered burns from a laser procedure herself and knows all too well how far an improper laser removal can go.

"It really isn't one size fits all, because dark skin can come in a variety of shades," she said.

Downie said that patients need to be mindful of the nuances in the procedure and, more importantly, providers need to be clear about the physical and mental health challenges that can come from botched laser hair removal services.

Jay said the owner of the laser removal center she visited never warned her that the procedure shouldn’t be done on people who had a lot of recent sun exposure.

During her first few treatments, Jay said everything was going as expected, until one session when she broke out into hives.

"I told her, 'Hey, is this normal?' I like pointed at it. She was like, 'Yeah, yeah, it's fine. Let's keep going to the other arm,'" Jay recalled.

Jay said that the owner later asked about Jay’s tanning and exposure to the sun while on vacation the week before her treatment session.

Jay said she ended up downplaying would downplay the pain, thinking it was all in her head.

Still, she said she felt uneasy when others, including her now-husband, looked at her skin and were noticeably shocked.

Now after two years of recovery, Jay said she is doing better, but still has to take precautions while out in the sun.

"It sounds so bizarre, but like the privilege to be out in the sun and on the beach and not super worried for my health," she said.

Jay encouraged other people who are considering laser hair removal to speak up for themselves and push their provider to be as clear and open about the risks involved.

"I think that one of the first things that I came to in that moment was blaming myself, when I was the one in excruciating pain," she said. "I think a lot of people, especially women, women of color, feel that we shouldn't be taking up space.

ABC News' Lena Jakobsson and Patricia Guerra contributed to this report.

Copyright © 2023, ABC Audio. All rights reserved.

Parents warned to stop using recalled Boppy loungers linked to at least 10 infant deaths


(NEW YORK) -- Parents were advised Tuesday to stop using recalled newborn loungers from The Boppy Company that have been linked to at least 10 infant deaths.

According to The Boppy Company and the Consumer Product Safety Commission, which issued a news release Tuesday, the newborn loungers may cause infants to "suffocate if they roll, move, or are placed on the lounger in a position that obstructs breathing, or roll off the lounger onto an external surface, such as an adult pillow."

The products were first recalled two years ago and impacted by the September 2021 recall include Boppy Original Newborn Loungers, Boppy Preferred Newborn Loungers, and Pottery Barn Kids Boppy Newborn Loungers.

Although the newborn loungers can no longer be sold legally, the CPSC noted that the recalled products have still been available online through social media sites such as Facebook Marketplace.

"It is unlawful to offer for sale a CPSC recalled product on an online marketplace or to sell or donate a recalled product in any other manner," the federal agency said in its statement.

There have been at least eight infant deaths from a Boppy newborn lounger between December 2015 and June 2020, according to The Boppy Company. But after the 2021 recall, the CPSC said at least two more infants died after they were placed in Boppy newborn loungers.

"One death occurred in October 2021. In the incident, an infant was reportedly placed on the lounger for sleep and then rolled underneath a nearby adult pillow. The cause of death was positional asphyxia. In November 2021, an infant was placed on a Newborn Lounger in an adult bed with a parent and soft bedding and was later found deceased on the lounger. The cause of death was undetermined," the CPSC said.

Both the CPSC and Boppy said anyone with Boppy newborn loungers should stop using the products immediately. Customers can request instructions on how to dispose of a recalled lounger and ask for a refund from The Boppy Company through their website.

To contact The Boppy Company, customers can call 800-416-1355 from 9 a.m. to 5 p.m. ET on weekdays.

The CPSC also reminded parents to set up a safe sleep environment for children, which includes a firm and flat surface in a crib, bassinet or play yard for babies. Babies should always be placed on their backs for sleeping and soft items like blankets, pillows, padded crib bumpers "should never" be added to an infant's sleeping area, the CPSC added.

Copyright © 2023, ABC Audio. All rights reserved.

Surgeons perform kidney transplants in cats amid rising demand for advanced pet care

Dr. Chad Schmiedt performs surgery at the University of Georgia Veterinary Teaching Hospital. -- ABC News

(ATHENS, Ga.) -- Some cats battling kidney disease are getting a second chance at life, thanks to a pioneering kidney transplant program at the University of Georgia Veterinary Teaching Hospital.

Dr. Chad Schmiedt leads the initiative and is one of only a handful of surgeons who performs the procedure around the world.

“One particular thing about cats is that they are so good at hiding their disease. So, a lot of times, cats won't start showing signs of illness and owners won't pick up on signs of illness until it's quite advanced,” Schmiedt told ABC News Live. “And so that's one challenge we face in these animals, is trying to work with those very sick animals.”

It's a type of advanced veterinary care growing in demand as pet ownership has surged over the last 30 years. As of 2023, 66% of U.S. households — 86.9 million homes — own a pet, according to the American Pet Products Association's [APPA] annual survey. Millennials make up the largest percentage of current pet owners at 33%.

Around three-quarters of cat owners said they considered their pets to be a member of the family, according to the American Veterinary Medical Association's 2018 and 2022 report on U.S. pet ownership, and that could lead to increased expenses for their care. Just last year, Americans spent $136.8 billion on their pets, the APPA survey said.

“It’s considered absolutely normal behavior for people to love their animals, spend whatever it takes to fix their animals when they get sick. You have to go back to the fact that for many people, these animals are like their kids,” said Dr. James A. Serpell, professor of ethics and animal welfare at the University of Pennsylvania School of Veterinary Medicine.

That was the case five years ago for Franklin, Tennessee, resident Greg Norwicki, whose beloved cat Tucker was diagnosed with kidney failure after routine blood work showed slightly elevated creatinine and blood urea nitrogen – indicators for kidney disease. Tucker’s levels continued to rise over the following months, then Norwicki learned Tucker may be a candidate for a kidney transplant.

The transplant was a success, and Tucker is still alive — and thriving.

“We don’t realize how sick our animals are until you see an animal bounce back,” Norwicki said.

At the University of Georgia, the surgery costs around $20,000 for both the recipient and donor cat, Schmiedt said. There are also recurrent costs -- it’s estimated owners can expect to spend anywhere between $1,500 to $4,000 per year on medication, tests and veterinary visits.

Donor cats come from a variety of places, including other cats owned by the family of the recipient. The donor cats are always adopted by the family of the recipient, Schmiedt said.

“To the best of our knowledge, they go on and live a normal life,” Schmiedt said.

Still, some have raised ethical concerns about the program, arguing that unlike humans, cats can’t give consent to have their organs donated.

“Those donor cats don't come along and say, ‘Yes, please take my kidney.’ The argument that is used is that most of those donor cats are coming from shelters. They might not have found a home. They might have been euthanized in the shelter. So donating a kidney to another cat is preferable to that, especially if the recipient household of that new kidney is willing to adopt the donor,” Serpell said.

In Norwicki’s case, Charlie, the donor cat for Tucker, was previously used for research and was adopted by the family after the procedure.

“So as I say, you know, we saved [Charlie’s] life, too,” Norwicki said.

Copyright © 2023, ABC Audio. All rights reserved.

Toxic smoke from Canadian wildfires could impact health of millions in the US

Brais Seara/Getty Images

(NEW YORK) -- Wildfires across the United States and Canada -- fueled by record heat and dry conditions -- could severely impact the health of millions of people.

Smoke from wildfires in several Canadian provinces, including Ontario, Quebec and Nova Scotia, led to air quality alerts throughout several states in the Midwest, mid-Atlantic and Northeast. Additionally, fires in Michigan and New Jersey have created dense fog and heavy smoke.

Inhaling toxic smoke and ash from wildfires could cause damage to the body -- including the lungs and heart -- and even weaken our immune systems, experts said.

"Wildfire smoke itself is quite a complex mixture and it's made up of fine particles … and a number of other gases, which are toxic, mainly due to the fact that wildfires burn everything so more toxic than household fires because everything has been burned," Dr. Kimberly Humphrey, a climate change and human health fellow at the Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health, told ABC News.

Fine particulate matter known as PM2.5, which is 30 times smaller in diameter than a human hair, is of particular concern.

Because these particles are too small to be seen with the naked eye, they can easily enter the nose and throat and can travel to the lungs, with some of the smallest particles even circulating in the bloodstream, according to the Environmental Protection Agency.

"The top offender here is these fine particles," Dr. Vijay Limaye, a climate and health scientist at the National Resources Defense Council, told ABC News. "That size is really important because can penetrate really deeply and wreak havoc on the body."

PM2.5 can cause both short-term health effects, even for healthy people, including irritation of the eyes, nose and throat; coughing, sneezing; and shortness of breath and long-term effects such as worsening of conditions such as asthma and heart disease.

This is especially concerning for vulnerable groups including children, pregnant people, older adults and those who are immunocompromised or having pre-existing conditions.

"Lower socioeconomic neighborhoods are at a higher risk as well," Humphrey said. "Often they don't have the ability for financial reasons, predominantly, and also social reasons to get away from wildfire smoke, they may not be able to shelter inside, they may not be able to afford the equipment to protect their lungs from the smoke."

Not all PM2.5 particles are the same. One study from California in 2021 found that those from wildfires can be up to 10 times more harmful than the same type of air pollution coming from combustion activity.

Being exposed to smoke can cause lung inflammation and could make it harder to remove inhaled foreign materials and bacteria, potentially increasing the susceptibility to respiratory infections, including COVID-19, according to the Centers for Disease Control and Prevention.

Depending upon the length and amount of exposure, prolonged lung inflammation could result in impaired lung function that lasts long after the wildfire has ended.

Additionally, studies have shown a link between poor air quality -- which these fires have caused -- and cardiovascular disease, including strokes, heart attacks, heart failure and atrial fibrillation.

Because of climate change, there will not only be more record-setting wildfires but also more people at risk of inhaling toxic smoke as well, the experts said.

"It's clear that the climate change problem is essentially creating conditions that make the fire problem and the smoke problem worse," Limaye said. "So, we're talking about, hotter days, longer wildfire, seasons, drier conditions, spring snowmelt that essentially, put more wildfire fuel in play earlier -- all these kinds of converging factors."

He added, "And I think it's reasonable to expect that wildfire smoke is going to grow as a public health concern in the coming years."

Humphrey recommends that people stay aware of their local air quality and, if it reaches unhealthy levels, to wear a mask, ideally an N95.

Copyright © 2023, ABC Audio. All rights reserved.

Noom joins Weight Watchers in offering medications like Wegovy for weight loss: What to know

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(NEW YORK) -- As the popularity of drugs like Wegovy and Ozempic used for weight loss continues to rise, another weight loss-focused company is jumping into the market.

Noom, an app that helps people track their eating and exercise habits, will now offer prescriptions through a new telehealth platform known as Noom Med.

The company said Noom Med will be available to people who meet certain requirements -- such as a BMI of 30 or higher -- and who are members of Noom Weight, its $42 per month program that offers psychological tips to help with weight loss.

The cost of Noom Med will be $49 per month and includes "interactive patient education, a psychologically-aware curriculum, and a suite of comprehensive nutrition & exercise tools," according to the company.

Users who qualify can be prescribed weight loss medications after undergoing "comprehensive lab work" and a "health evaluation by a board-certified physician or a physician-supervised nurse," according to Noom.

Noom's entry into the medication market comes three months after WW, formerly known as Weight Watchers, made the same move.

In March, WW announced it had acquired Sequence, a subscription-based telehealth platform that provides telemedicine appointments with doctors who can prescribe popular medications like Ozempic and Wegovy.

"These companies are profit-driven," Maya Feller, a New York-based registered dietitian nutritionist, told ABC News' Good Morning America. "And if people want to lose weight and they center that as the thing that's valuable, we're going to see more companies jump on the bandwagon and start to use these GLP-1s."

Ozempic and Wegovy are part of a class of drugs called GLP-1 RAs that help people produce insulin and lower the amount of sugar in the blood. The drugs slow down movement of food through the stomach, curbing appetite and leading to weight loss.

Both drugs are made from a compound called semaglutide, which works by helping the pancreas release insulin to move sugar from the blood into body tissues.

A third popular drug now being used for weight loss is Mounjaro, whose active ingredient, tirzepatide, works by activating two naturally produced hormones in the body: glucagon-like peptide-1, known as GLP-1, and glucose-dependent insulinotropic polypeptide, or GIP.

The combination is said to slow the emptying of the stomach by making people feel full longer, suppress appetite by slowing hunger signals to the brain, and help reduce blood sugar.

Mounjaro is currently approved by the U.S. Food and Drug Administration to treat Type 2 diabetes. The drug's maker, Eli Lilly, announced in April that it expects an additional version of the medication could be approved by the FDA for weight loss as early as the end of the year.

The FDA approved Ozempic in 2017 as a treatment for Type 2 diabetes alongside diet and exercise if other medications cannot control blood sugar levels well enough. Although Ozempic is not explicitly approved for chronic weight management, it can be prescribed off-label and used for people who are obese.

Wegovy is essentially the same injectable drug as Ozempic, prescribed at a higher dosage. The FDA has specifically approved Wegovy for patients with severe obesity, or who are overweight and have one or more weight-associated conditions like high blood pressure or high cholesterol.

Without insurance coverage, the cost of the medications can run over $1,000 per month.

"What I've seen when patients are on these medications is that it drastically changes their relationship with food, so this idea that this is an easy fix is completely not true," Feller said. "There are tons of side effects that go on with this medication, and people are actually sacrificing quite a bit to have thinness and live in a smaller body."

Ozempic, Mounjaro and similar medications cannot be given to patients with certain medical conditions, including medullary thyroid cancer, pancreatitis or gallstones.

Side effects of the medications can include severe nausea and constipation.

Copyright © 2023, ABC Audio. All rights reserved.

Women who struggle with PCOS find help using Ozempic, Mounjaro

Tiffany Groves, of Texas, says taking the drug Mounjaro has improved her PCOS and helped her lose weight. -- Courtesy Tiffany Groves

(NEW YORK) -- Branneisha Cooper of Texas said she was diagnosed during her senior year of high school with polycystic ovary syndrome, or PCOS, a reproductive hormone imbalance that can cause problems with the menstrual cycle and lead to the formation of multiple ovarian cysts and infertility, according to the U.S. Office on Women's Health.

The exact cause of PCOS is unknown, but people with this condition have higher levels of androgens, such as testosterone, and insulin that can lead to insulin resistance which is a risk factor for Type 2 diabetes.

Cooper, now 26, said she suffered for over a decade with irregular menstrual cycles, hormonal imbalances and weight gain.

That changed late last year, she said, when her doctor prescribed her Mounjaro, an injectable medication approved by the Food and Drug Administration in May 2022 to treat Type 2 diabetes.

"[My doctor] said, 'There's this great medication and I have a couple of women on it already who also have PCOS,'" Cooper told Good Morning America, adding, "Since starting on Mounjaro, it has honestly just been like a stress relief. I feel like a weight has been lifted off my shoulders."

Since starting on the medication in November, Cooper said she has had a menstrual cycle regularly each month, has experienced reduced inflammation and has lost over 40 pounds.

She said she is also thinking, for the first time since her diagnosis, about becoming pregnant in the future, something she said she was previously told was unlikely to happen.

"For me especially, since I'm taking this for PCOS, this is so much more than weight loss for me, Cooper said. "Now that my cycles are regular again and I'm ovulating, it's like I can think again about that thought I'd pushed back in my mind, of being a mom."

Cooper is among a growing number of women with PCOS who are turning to medications like Mounjaro and Ozempic to treat their condition. The medications have been in the headlines recently for their growing popularity as drugs used for weight loss.

Like Mounjaro, Ozempic is approved by the FDA to treat Type 2 diabetes, but some doctors prescribe the medication "off-label" for weight loss, as is permissible by the FDA.

Many women, including Cooper, are talking about the medications on social media, where they say they're finding a community of women who have long struggled with PCOS and struggled to find any medications to ease their symptoms.

Symptoms of PCOS can include everything from irregular or absent periods to excessive facial hair, acne and obesity. The exact cause of PCOS is not known.

The condition affects 1 in 10 women of childbearing age, according to the Office on Women's Health.

"Prior to being on this medication, I thought it was just a me problem, that there was just something that I wasn't getting right that other people were," Cooper said. "It wasn't until I [went] on Mounjaro and realized it's a chronic disease ... and you weren't the problem."

Tiffany Groves, who also lives in Texas, said she too struggled with PCOS for nearly a decade before going on Mounjaro last October, after learning about the medication on TikTok.

She was prescribed the medication off-label to help treat PCOS, and said she has since experienced regular menstrual cycles for the first time in her life. The 38-year-old said she has also lost around 43 pounds.

"This whole time I've been living life and thinking it's normal to think about food all the time and then all of a sudden, you don't think about food," Groves told GMA of her experience on Mounjaro. "I can just eat a little bit and be perfectly fine."

How drugs like Ozempic, Mounjaro can help PCOS

Typically, treatment options to manage PCOS symptoms include hormonal birth control and anti-androgen medicines as well as weight loss, according to the Office on Women's Health.

Dr. Rekha Kumar, an endocrinologist at Weill Cornell Medicine and NewYork-Presbyterian and an expert in obesity and PCOS, said that drugs like Ozempic and Mounjaro can be helpful in treating the condition because they help address one of its main underlying problems, insulin resistance.

"It's not necessarily that we're using the meds to treat PCOS, but the meds can be helpful for one of the symptoms of PCOS, which is the actual weight gain and hormonal drive to eat carbohydrate because of the insulin resistance," Kumar said, adding, "What we've learned in the past 20 years is that PCOS is actually an insulin-carbohydrate-metabolism problem called insulin resistance, meaning the body makes more insulin in response to carbohydrates."

She continued, "And what people often forget about insulin is that it's a fat storage-promoting hormone, so the more insulin your body is making, the better you are at storing fat."

The active ingredient in Mounjaro, tirzepatide, works by activating two naturally produced hormones in the body: glucagon-like peptide-1, known as GLP-1, and glucose-dependent insulinotropic polypeptide, or GIP.

The combination is said to slow the emptying of the stomach by making people feel full longer, suppress appetite by slowing hunger signals to the brain, and help reduce blood sugar.

Ozempic is made from a compound called semaglutide, which works by helping the pancreas release insulin to move sugar from the blood into body tissues.

It also works by slowing down movement of food through the stomach and curbing appetite, thereby causing weight loss.

Ozempic and Mounjaro cannot be given to patients with certain medical conditions, including medullary thyroid cancer, pancreatitis or gallstones. Side effects of the medications can include severe nausea and constipation.

Kumar said she has been prescribing this class of medications to patients with PCOS for over a decade, saying, "The people that really know the science about how these medicines work as well as the science of PCOS have understood the link for some time."

Kumar noted that as drugs like Ozempic and Wegovy have risen in popularity in recent months, she has found it harder to get her prescriptions for patients approved by insurance.

Both Ozempic and Wegovy are considered off-label for PCOS. Without insurance coverage, the cost of the medications can run over $1,000 per month.

"We used to be able to prescribe these a little easier, before the Ozempic craze," Kumar said. "Because now there's so much inappropriate prescribing that even the one-off cases that might do really well on these medicines are getting denied because there's so much scrutiny on each prescription."

Kumar and other doctors say that patients having a hard time accessing Ozempic or Mounjaro due to shortages or insurance problems should speak to their doctor about alternative options within the same class of medications.

Because PCOS is many times diagnosed in women as they are experiencing fertility struggles, Kumar said it's also important for women to know that medications like Ozempic and Mounjaro should not be taken during pregnancy or while trying to become pregnant.

"We just have to really make sure that patients understand the risks and the unknowns of getting pregnant on these medicines, because when we do treat people's insulin resistance, they become more fertile," Kumar said. "Women who thought that they could never get pregnant, if you're treating them with these medicines, they might, so we just have to be very careful with educating on the risks."

The FDA also says in its safety profiles of these drugs that they should not be taken during pregnancy, noting there is "insufficient data" available.

The FDA also explains that the drugs could cause weight loss, and that "weight loss offers no benefit to a pregnant patient and may cause fetal harm."

The FDA recommends that people discontinue treatment at least two months before they plan to become pregnant.

Both Cooper and Groves said they have plans in place with their doctors to go off Mounjaro if they ever try to become pregnant in the future. Cooper said she anticipates being on Mounjaro "long-term" for PCOS, except for when she tries to have a child.

"It's treating my PCOS -- it's not curing it, it's treating it," Cooper said. "And this is the best I've felt my entire adult life."

Copyright © 2023, ABC Audio. All rights reserved.

COVID cases could be ticking up in New York City, wastewater data shows

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(NEW YORK) -- COVID-19 cases may be increasing again in New York City, new wastewater data hints.

Nearly all of the 14 wastewater treatments plants in the city are currently in the "high" detection level category, meaning likely 50 or more cases per 100,000 people, according to the NYS Wastewater Surveillance Network dashboard, which was updated Friday.

What's more, two-week trend data shows that just three of the plants are seeing decreases in virus detection.

Reported case numbers have not jumped. But fewer people are getting tested than earlier in the pandemic, so case numbers are a less reliable indicator of COVID-19 spread.

Health experts told ABC News that wastewater tracking is a good early detection tool for monitoring potential future upticks, but it's too early to determine what it means.

"Wastewater data can be a very helpful indicator of what is taking place," said Dr. John Brownstein, an epidemiologist and chief innovation office at Boston Children's Hospital and an ABC News contributor. "Now, it's an indication of the level of virus that people might be shedding, but it's not 100% related to the amount of illness people are experiencing."

He continued, "Because with the significant amount of immunity from previous infections, from vaccination, there may be community transmission, but it may be asymptomatic and so what wastewater can't tell you is actually the severity of the cases in the community."'

Wastewater surveillance checks for the virus in sewage -- from households and buildings -- that contains human fecal matter.

Because at least half of COVID-19 patients shed genetic material from the virus, or viral RNA, in their feces, the same tests that can determine if someone is positive can also detect the virus in wastewater samples.

When people shed the virus in their stool, they are often in the early stages of the infection, meanings levels of the virus in wastewater samples will often occur before the number of cases rise.

Reported COVID-19 cases have remained relatively flat since mid-April at about 270 cases for a seven-day rolling average, according to data from the city's Department of Health and Mental Hygiene. Hospitalizations and deaths have also remained relatively flat.

"Wastewater data is…unbiased," Dr. Peter Chin-Hong, an infectious diseases specialist at the University of California, San Francisco, told ABC News. "It just depends on the amount of virus circulating in the community, so although the absolute number might be debatable, that trend is always something that makes us pay attention."

However, he cautioned not to panic and said just because there are areas of the city in the "high" category, that does not mean a surge is imminent.

While the end of mitigation measures such as masking and some waning immunity may play a role if cases increase, Chin-Hong said the U.S. is in a much better position than it was in years past.

"In the old days, we just kind of had to be subject to the whims of the virus, but now we have weapons to fight back," he said. "And even if vulnerable populations are infected, they could avert or prevent hospitalization and death by taking advantage of these early, antivirals taken early in the course of disease, like Paxlovid and remdesivir and molnupiravir."

The experts said it's natural that wastewater data is going to ebb and flow and it is not going to stay low all the time. However, because everyone has a different risk tolerance, the data can help people decide if they want to modify their behavior.

"Knowing that viruses circulating may inform people about the kinds of activities you want to take part in," Brownstein said. "So just like you bring an umbrella for rain, you may change your behavior if you know that viruses are circulating. This is not a reason to panic. But more information can help empower people to make their own decisions."

Copyright © 2023, ABC Audio. All rights reserved.

Breast cancer success: Drug found to reduce risk of cancer coming back

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(NEW YORK) -- A breast cancer drug already on the market has been found to lower the chances of breast cancer recurring, an advancement that could open the drug to a broader range of patients.

The pharmaceutical company Novartis announced the findings Friday about its breast cancer treatment Kisqali, a drug already approved by the U.S. Food and Drug Administration for people with more advanced stages of breast cancer.

The vast majority of breast cancer patients are diagnosed in the early stages of disease. Right now, many are treated with chemotherapy and endocrine therapy.

The new data shows that adding Kisqali after primary treatment will reduce the risk of the cancer coming back.

This finding could be good news specifically for women who are diagnosed in the earlier stages of the disease and those who are hormone-receptor positive, and HER2 negative, who make up 70% of the breast cancer population, according to the National Cancer Institute.

"Women who have this subtype can have recurrences even 20 to 25 years after their initial diagnosis," Dr. Dennis Slamon, director of the Revlon/UCLA Women's Cancer Research Program and lead investigator of the Kisqali clinical trial, told " Good Morning America." "We found that adding this drug to the best available standard therapy will decrease the recurrence rate by as much as 25%."

Suzanne Garner, 45, participated in the clinical trial for Kisqali after being diagnosed with Stage 2 cancer five years ago.

She said she was treated with chemotherapy and endocrine therapy, but the potential outcome of the treatments "didn't feel right."

"I felt that my risk of recurrence was still too high," Garner told "GMA." "I have a young daughter who needs her mom around for as long as possible and I would absolutely do anything to reduce my risk of recurrence so I can be her mom for as long as she needs me."

Novartis announced the findings on Kisqali at the 2023 annual meeting of the American Society of Clinical Oncology.

The company said it plans to submit the data to "regulatory authorities in the U.S. and Europe before end of year."

"Patients diagnosed with HR+/HER2- early breast cancer remain at risk of cancer recurrence, given that one-third of patients diagnosed with stage II and more than half of those diagnosed with stage III will unfortunately experience a return of their cancer," Dr. Shreeram Aradhye, chief medical officer of Novartis, said in a statement. "The compelling data from NATALEE [the clinical trial] highlight the potential of Kisqali to reduce the risk of cancer recurrence in this at-risk population, including node-negative patients, while maintaining a favorable safety profile. These potentially practice-changing results reinforce the unique and well-established profile of Kisqali as a proven treatment in HR+/HER2- metastatic breast cancer."

Copyright © 2023, ABC Audio. All rights reserved.

FDA warns about safety of 'off-brand' versions of Ozempic, Wegovy


(NEW YORK) -- Federal regulators are warning about safety concerns amid the rising popularity of drugs like Ozempic and Wegovy for weight loss.

The U.S. Food and Drug Administration is warning consumers that off-brand forms of the medications could be unsafe.

The warning comes as many people have reported turning to compounding pharmacies to get cheaper doses of semaglutide, the active ingredient in both Ozempic and Wegovy.

Without insurance coverage, the cost of medications like Ozempic and Wegovy can run more than $1,000 a month.

The FDA said it's received reports of adverse events after people took semaglutide that came from a compounding pharmacy. It did not specify the number of reports or what the adverse events were.

"Patients should not use a compounded drug if an approved drug is available to treat a patient. Patients and health care professionals should understand that the agency does not review compounded versions of these drugs for safety, effectiveness, or quality," the FDA said in a new safety warning this week.

The FDA also said that some compounding pharmacies claiming to sell semaglutide might instead be selling other formulations of the chemical, like semaglutide sodium and semaglutide acetate. Those haven't been shown to be safe or effective, according to the FDA.

Compound versions of drugs are made for individual patients using raw ingredients.

They are not the same as generic drugs, which are FDA-approved and monitored for safety and effectiveness.

There are currently no generic versions of semaglutide medications, including Ozempic and Wegovy.

Insurance coverage for Ozempic and Wegovy varies, depending on everything from a person's medical diagnosis to where they live and their insurance plan.

Ozempic is approved by the FDA to treat Type 2 diabetes, but some doctors prescribe the medication "off-label" for weight loss, as is permissible by the FDA.

Wegovy is FDA-approved for weight loss for people with obesity or who are overweight with a comorbidity like high blood pressure.

Ozempic and Wegovy are not currently covered for weight loss under most Medicare and Medicaid programs.

In addition to the high cost of the drugs, there have also been intermittent shortages of the drugs, which is also why some people have turned to compounding pharmacies.

In May, the FDA told ABC News' Good Morning America that while the medications are eligible for compounding because of shortages, the compounded versions "pose a higher risk."

"Compounded drugs pose a higher risk to patients than FDA-approved drugs because compounded drugs do not undergo FDA premarket review for safety, effectiveness, or quality," the agency said in a statement at the time. "The FDA's compounding program aims to protect patients from poor quality compounded drugs, while preserving access to lawfully marketed compounded drugs for patients."

Experts say people who would like to take the brand names of the medications should check on their insurance coverage every few months because coverage may change.

Additionally, people should only use drugs that contain semaglutide with a prescription.

Purchasing medications online "can expose patients to potentially unsafe products that have not undergone appropriate evaluation or approval, or do not meet quality standards," the FDA said in its warning this week.

Copyright © 2023, ABC Audio. All rights reserved.

Cancer drug shortage is forcing doctors to decide which patients get treatment

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(NEW YORK) -- Just six weeks ago, Greg DeStefano began a new chemotherapy combination. The 50-year-old, from Northbrook, Illinois, had recently been diagnosed with his fourth round of cancer and doctors were hopeful the medication would treat the tumors growing in his neck.

DeStefano was responding well, but then, in late May, he got a call from his doctor and was told one of the three drugs he was receiving -- carboplatin -- was under a global shortage and because of the way the hospital had to prioritize treatments, he wouldn't be qualified to receive it anymore.

"We're frustrated because not only are we dealing with cancer, now we have to deal with a drug shortage of a pretty critical drug," DeStefano told ABC News.

DeStefano's experience is similar to thousands across the United States of patients either having delayed treatment or being unable to receive treatment because of cancer drug shortages.

At least 11 oncology medications are currently in short supply, according to an ABC News analysis of data from the U.S. Food and Drug Administration.

Among them are carboplatin, used to treat ovarian and head and neck cancer; azacytidine, which treats a form of leukemia; and dacarbazine, used to treat skin cancer.

"We've experienced drug shortages, intermittency, my entire career, it has always been a challenge," Julie Kennerly-Shah, associate director of pharmacy at The Ohio State University Comprehensive Cancer Center, told ABC News. "The past six months have been the most challenging in my career for managing drug shortages in the cancer population."

She continued, "As you can imagine, it's extremely frustrating to know that you have a medication that can potentially cure a patient of cancer or extend their life and to know that you may not have enough to treat that patient."

Last month, the American Cancer Society issued a warning that chemotherapy drugs had returned to the list of the top-five drug classes affected by shortages and warned this could have a devastating effect on patients.

Some hospitals and clinics are completely out of the medications. In others, doctors are being forced to either ration cancer drugs or triage which patients receive the drugs first.

"We're sort of on life support, whether or not we're going to have enough drugs and we have internally operationalized various ways to prioritize who gets which drugs," Dr. Mark Einstein, a gynecologic oncologist at University Hospital in Newark, New Jersey, told ABC News. "Especially when there are limited or no other alternatives."

DeStefano said this shortage means that unless he chooses a different course of treatment -- which involves chemotherapy and then a resection or a removal of the tumor -- he will be ineligible to receive the drug.

However, because he's had multiple surgeries in the past due to previous bouts of cancer, surgery has more risks for him, his wife, Mindy DeStefano, told ABC News.

"This is the crux of our frustration, that he has a therapy and treatment that's working and now because of the way they have to categorize and prioritize patients, he is now not able to access this drug any longer," she said.

Doctors say there are a number of factors behind the nationwide shortage including low profit margins for generic versions of these drugs as well as labor and supply chain issues.

"All these drugs that we have shortages in, they're all generic, old chemotherapy drugs that are fairly cheap as it relates to cancer drugs," Dr. Hanna Sanoff, a gastrointestinal medical oncologist at the University of North Carolina's Lineberger Comprehensive Cancer Center, told ABC News. "And so, the economic margin here is just much smaller for the drug manufacturers."

She continued, "A lot of our supply comes from India and China, and there have been some recent shutdowns of a couple of major suppliers of generic drugs and so it was already sort of a tenuous supply chain that then got disrupted by plant closures."

For short-term solutions, the Society of Gynecologic Oncology currently recommends minimizing ordering the drugs under shortage if there is another medication available with comparable efficacy and safety and using the lowest dose possible and the longest interval between doses that is acceptable.

Kennerly-Shah said at her center, patients have either been switched to alternative medications or there have been operational changes.

"Dose rounding is a frequent practice, so rounding to the nearest vial size, within typically a 10% range, so that we're not wasting additional medication leftover by opening an additional vial," she said.

For long-term solutions, doctors are calling for more transparency from companies on when additional shipments can be expected, potentially giving incentives for generic drugmakers or even seeing if the FDA can come up with ways to potentially extend the shelf life of critical medications.

Greg DeStefano and Mindy DeStefano said they have potentially found another local hospital in Chicago with supply of carboplatin, but need to have more conversations to see if he qualifies for treatment.

"This is life and death," she said. "This not like symptom relief; it's life and death. And it's really frustrating that in this country, we have to be scrambling to try and find a drug that technically should be available. I mean, it is a life and death drug."

Copyright © 2023, ABC Audio. All rights reserved.

Teenage birth rates in the US reached historic lows in 2022, CDC report finds

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(NEW YORK) -- Teenage birth rates have fallen to their lowest levels ever, new provisional federal data published Thursday found.

The report, from the Centers for Disease Control and Prevention's National Center for Health Statistics, showed the birth rate among 15- to 19-year-olds in 2022 was 13.5 per 1,000 females.

That's a 3% drop from the rate of 13.9 per 1,000 in 2021 and a record low in the United States.

Aside from an increase in 2006 and 2007, the teen birth rate in the U.S. has been continuously declining since 1991.

"I'm excited the U.S. has made significant progress in reducing pregnancies among youth," Dr. Vincent Guilamo-Ramos, dean of the Duke University School of Nursing and whose research interests include teen sexual and reproductive health, told ABC News. "The all-time low should be an indication that we're continuing to move in the right direction."

For the report, the authors looked at birth certificate data received and processed by the NCHS.

They found that birth rates declined not just across all teens, but for both younger (ages 15–17) and older (ages 18–19) groups as well.

There was a small drop among 15- to 17-year-olds from 5.6 per 1,000 in 2021 to 5.5 per 1,000 in 2022 but a larger drop among 18- to 19-year-olds from 26.6 per 1,000 to 25.6 per 1,000.

The report did not discuss reasons behind the drop, but experts told ABC News it's a combination of factors including more teens abstaining from sex, contraceptives becoming more easily available to teens and more pregnancy prevention programs aimed at teenagers.

Dr. Monica Woll Rosen, an assistant professor of obstetrics and gynecology at Michigan Medicine who specializes in pediatric and adolescent gynecology, said there's also been an increase in popularity among teens for long-acting reversible contraception, like intrauterine devices (IUDs).

"In fact, the American Academy of Pediatrics came out and said that it should be used as first line for birth control," she told ABC News. "And sort of the marketing around that has caused a lot of teens in this age group to get the IUD and therefore not become pregnant."

Guilamo-Ramos said these decreases are encouraging to see but said it's important to keep an eye on the data to make sure birth rates among teens are not slowing down.

"From 2007 to 2021, on average, the sort of reduction in the teen birth rate was about 8%," he said. "And if you look at the more recent data that was released in the report, it's 3%. Something kind of to keep an eye on and that it appears like that rate could be slowing down in terms of the progress."

Rosen added there is more work to be done when it comes to reducing the number of teen pregnancies.

"The number is not zero and teens get pregnant all the time, who may not want to be pregnant but may not be aware of contraceptive options or options for emergency contraception and so [people should] still consider education necessary and at the forefront and the birth rate can still improve even though it's at an all-time low right now," she said.

The report also looked at other provisional data and found that overall births did fall to 3,661,220 in 2022 from 3,664,292 in 2021, but it was described by the authors as a nonsignificant decline.

Additionally, the general fertility rate among women aged 15 to 44 declined, but by less than 1% from 56.3 per 1,000 to 56.1 per 1,000.

Among race/ethnicity between 2021 and 2022, the provisional number of births declined 3% for American Indian/Alaska Native and white women and by 1% for Black women from 2021 to 2022.

However, birth rates rose 2% for Asian women and 6% for Native Hawaiian/Pacific Islander and Hispanic women.

The report also focused on pre-term births and found the rate declined 1% in 2022 to 10.38%, from 10.49% in 2021.

Copyright © 2023, ABC Audio. All rights reserved.

How to prevent hot car deaths after recent string of fatalities

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(NEW YORK) -- Experts are reminding the public of the dangers of heatstroke after a recent spate of hot car deaths.

The latest incident occurred Sunday, when an 11-month-old girl in Palm Bay, Florida, died after she was left in a car while authorities said her parents attended a church service for three hours.

The temperature in the east-central Florida city reached the high 70s that day. According to the National Highway Traffic Safety Administration, temperatures inside a car can climb to over 100 degrees Fahrenheit, even when the temperature outdoors is in the 70s.

The NHTSA also notes that heat-related illnesses such as heatstroke, which can lead to death, can start to occur when one's body temperature reaches 104 degrees Fahrenheit. A child can die when their internal body temperature reaches 107 F due to their body's inability to further regulate their temperature, leading to organ failure and death.

According to the nonprofit Kids and Car Safety, at least six children have already died this year in a hot car and over 1,050 kids have died since 1990. Thirty-three children died last year as a result of being in a hot car, according to the NHTSA.

"This is something that most parents would like to believe would never happen to them. However, what we know after documenting well over 1,000 fatalities is that this happens to wonderful, loving, responsible parents," Kids and Car Safety Director Amber Rollins told ABC News' Good Morning America. "It can literally happen to anybody, even ... organized, safety-conscious parents, and so it's really important for families to take these dangers seriously and to take precautions to keep their children safe."

With the official start of summer just three weeks away, here is what parents and caregivers need to know, as well as the top five tips to prevent hot car deaths:

Never leave children unattended in a vehicle

The No. 1 tip for any parent or caregiver is to never leave a child in a car, even if it's for a short period of time.

"Rolling windows down or parking in the shade does little to change the interior temperature of the vehicle," the NHTSA states.

Always check a car before walking away

Rollins calls this important step the "look before you lock" reminder.

"We want people to make it a habit, any which way you have to do it, to make it a habit of opening that back door and checking the back seat every single time you leave your vehicle," Rollins said.

"If a child does go missing, check the inside floorboard and trunk of all vehicles in the area immediately, even if they're locked," she continued.

Always lock car doors after completing a check

"We want to keep our cars locked 100% of the time, even if you don't have kids," Rollins said. "Keep your keys and your remote openers to your vehicle out of reach of children at all times so that they can't gain access if they are locked."

Ask a child's day care provider or a family member for notifications

"If your child goes to day care or a family member watche[s] them during the day, any kind of child care, you want to make the policy with them, that they will call you immediately if your child doesn't show up as scheduled," Rollins said.

Use a reminder item

"Any time that you put the baby in the backseat, put something in the backseat on the floorboard right in front of them that you can't start your day without," Rollins said, adding that a laptop might work for a parent who needs to work with a computer.

"Keep some type of stuffed animal, a big bright stuffed animal or reminder item in your car. So for me, I've got this big giant lion stuffed animal. You can't miss it. I mean, it's obnoxious and that stuffed animal lives in the car seat. And then anytime I put my son in the car seat, that stuffed animal comes up to the front seat with me as a visual reminder that he is with me," she said.

Both the NHTSA and Rollins also recommend teaching children about the hazards of being in a car and how a car should not be considered a play area.

"We talk to our kids about how it's never safe to get into a vehicle without a grown-up," Rollins said.

Additionally, Rollins said parents can take further steps to safeguard their homes and vehicles.

"A lot of times, what happens in these cases is mom and dad think the toddler is napping. The toddler wakes up from the nap and sneaks outside and gets in the car, and then they can't get back out, and before anybody realizes it, it's too late," Rollins said.

"So, you can get those childproofing doorknob covers. Also, you could buy these little stick-on-door alarms that you can put on the door [leading to the] outside of your home and those will alert you with a visual and audio alert that a door has been opened," she added.

If a child is found in distress or is spotted inside a vehicle unattended, the NHTSA reminds everyone to immediately dial 911. A child in a hot car should be removed from the vehicle as soon as possible and rapidly cooled, according to the NHTSA.

Copyright © 2023, ABC Audio. All rights reserved.

Mental health apps might put your privacy at risk. Here's how to stay protected

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(NEW YORK) -- Digital mental health company BetterHelp is facing multiple potential class action lawsuits over claims from patients that it shared their personal information to advertisers — including Facebook. The lawsuits came soon after BetterHelp agreed in March to pay $7.8 million over charges from the Federal Trade Commission that it revealed sensitive patient data.

"When a person struggling with mental health issues reaches out for help, they do so in a moment of vulnerability and with an expectation that professional counseling services will protect their privacy,” said Samuel Levine, director of the FTC's Bureau of Consumer Protection, in a statement. "Instead, BetterHelp betrayed consumers’ most personal health information for profit.”

This isn’t the first time a digital mental health service — which could include apps that connect you with a therapist, chatbots, meditation apps, and others — has come under fire for privacy violations. These products market themselves as useful resources for people struggling to navigate mental health care. They’re also more accessible at times than traditional therapists and easier to use from home.

But many of these mental health tools have privacy risks that you won’t find with a traditional, in-person therapist. Mozilla’s Privacy Not Included project says that mental health apps, as a category, have some of the worst privacy protections of any apps on the market.

However, digital mental health tools might still be a good option for some people, but it’s important to check beforehand if you can trust the privacy protections offered by the service you’re using, says Dr. Rebecca Brendel, president of the American Psychiatric Association.

Here are some things to think about when you sign up.

Don’t assume your information will be private

Many digital mental health tools are not governed by the medical privacy law HIPAA. That law protects data collected by health care professionals or hospitals — but not always by apps or websites. An app could, for example, legally share the fact that you signed up for its service with third-party advertisers.

That’s why it’s so important to do your due diligence before using a service, Brendel says. “Entering into mental health treatment is something that's deeply private and personal for so many of us. And so being sure ahead of time that you can trust that your treatment is actually private and protected is critical,” she says.

Check the privacy policy

Read the privacy policy of any mental health tool closely before you use it, Brendel says. Check if it will be sharing data and what kind of data it will be sharing. Find out if any information will be used for research — either medical research or to improve the app.

“What are some of the guarantees that are being made and what isn't being made?” she added. Make sure you’re comfortable with the policy, and that you know your rights.

Ask questions during your first visit

People should also ask questions about privacy during their first visit with a provider through the app, Brendel says.

“Asking direct questions at the beginning of a first session is a really important way to ensure that there is integrity in the treatment, and that it protects privacy in a way that makes treatment possible and trustworthy,” she says.

That should include asking if there have been any data breaches at the company, where data is stored, and if there are any reasons to worry about data privacy.

“If there are any red flags or any concerns, it might not be the best option or it might require a little more investigation, Brendel says.

Consider using a virtual service through a hospital rather than a tech company

It can be hard to track down all the information about privacy on an app or website, Brendel notes. If you want to have a higher level of certainty, you may consider accessing a virtual mental health service that’s connected to a hospital or a health care system — rather than a startup or app-based platform.

“Think about systems that really are behind medical firewalls,” she says.

If you’re really worried about privacy, those might be able to give you more peace of mind.

“That can be very, very helpful and reassuring so that you can enter into treatment and focus on getting better and getting the help you need, rather than whether you're going to be exposed or others are going to find out about it,” Brendel says.

If you are struggling with suicidal thoughts, substance use, or other mental health crises please call or text 988. Trained crisis counselors are available for free, 24 hours a day, seven days a week.

Copyright © 2023, ABC Audio. All rights reserved.

Does 'cycle syncing' your workouts give you better results? We asked the experts

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(NEW YORK) -- If you're a female who loves fitness you may have heard the term "cycle syncing," the idea that you should change up your workouts based on where you are in your menstrual cycle.

The impact of the menstrual cycle in women's sports has been prominent among professional athletes over the last few years with the U.S. Women's National Soccer Team tracking their periods ahead of their 2018 World Cup win as a strategy to maximize performance. This year, Orlando Pride, a National Women's Soccer League team based in Florida, changed their uniforms from white shorts to black shorts to help players feel more "comfortable and confident" while playing on their periods.

Now, curiosity over how the menstrual cycle impacts performance has gone mainstream. The hashtag #cyclesyncing has been used more than 280 million times on TikTok with millions of women sharing how changing their workouts each month based on where they are in their menstrual cycle has benefited their personal health.

Cycle syncing focuses on four main phases of the menstrual cycle: the menstrual phase, follicular phase, ovulatory phase and luteal phase. This training regimen recommends doing different types of workouts for the four different stages of your cycle.

The breakdown of the average cycle syncing training regimen, according to Nike trainer Lauren Schramm, looks like this:

  • Menstrual phase: Lasts three to seven days. Rest on days one and two of your period, then use optimal movement for when energy levels are low and rest needed is high with activities such as yoga, walking, and barre.
  • Follicular phase: Lasts around seven days. Focus on speed, power and optimal movement for when energy levels are low to moderate and rest needed is moderate with activities such as heavy lifting, HIIT, boxing, dance and track workouts.
  • Ovulatory phase: Lasts around three to seven days. Focus on aerobic, endurance and optimal movement for when energy levels are the highest and rest needed is low with activities such as a group fitness classes, long runs, cycling and hot yoga.
  • Luteal phase: Lasts around seven days. Focus on mobility, recovery and optimal moment for when energy levels are low to moderate and rest needed is moderate to high. Activities can include mobility training, stretching, breath work, yoga and massage.

Does cycle syncing your workouts really help your performance? How can you effectively track your cycle? Is it one size fits all? We asked the experts.

What experts know about cycle syncing

Dr. Ellen Casey, a sports medicine physician from the Department of Physiatry and the Women's Sports Medicine Center at the Hospital for Special Surgery in New York City, spoke with ABC News' Good Morning America about her thoughts on the science of cycle syncing.

While your menstrual cycle will impact your physical performance and energy levels, Casey, who has been researching this topic since 2009, says there are benefits for female athletes to track their cycles, but adds there is not enough scientific evidence to show this structured "cycle syncing" method works for everyone.

"I do think it's very important for female athletes to track their cycles," Casey says. "It's when you try to give a sort of group recommendation that I think [is] where we're falling short to date in the literature, and where I worry that there may be some overselling of cycle tracking and conforming that to your workouts, because we don't have the data to support that as a group effect at this time."

Casey said that everyone's cycle is different -- things like the length of phases and estrogen levels vary for every person. This makes it difficult to track the change in phases without using an ovulation stick every morning, which she said can be expensive and time consuming.

"Even if we know exactly that everybody's on day 10 of their follicular phase, it's still going to be different, because my level of estrogen might be totally different than yours," Casey said.

While the cycle syncing method can be used as a baseline, Casey said without proper equipment, like using an ovulation stick each day, there is no sure, scientific way to tell what phase of your cycle your body is in.

"What would be nice is for everybody to be like, 'Cool, this is where I'm really going to push my strength gains, and this is where I'm going to do endurance work.' I think at some point you know, when we can check these markers in saliva or whatever ... [but] we're not there yet with the science," she said.

How tracking your period can influence your workouts

While Casey said the science is not there for a one size fits all cycle syncing program just yet, she does recommend tracking your cycle to figure out how to get best results for yourself.

"I do think there's value in individual following," she said.

Referring to cycle syncing, she added, "I think it's such a fascinating area and I love that people are thinking of it. So, embrace that interest."

Schramm said she began tracking her cycles when she noticed she wasn't able to train in the same way and get the same consistent results that her male coworkers and clients were getting.

"I believe cycle-syncing is something that can be taken as far as you desire, and if it's of interest to begin experimenting with yourself, after clearance from your doctor is obtained, then I think it's an ideal approach to movement as someone with monthly hormonal fluctuations," Schramm said.

Schramm said she has seen improvements in her own training by tracking her cycle and following the cycle syncing method of training.

"Understanding the hormonal fluctuations … has clarified why some days I feel my strongest, have unlimited energy and could workout for hours and then the following week, it's a struggle to get through my warmup," Schramm said.

Where to start

If you'd like to start monitoring your cycle in relation to your workouts, here several ways you can get started:

  • Consult with a doctor or trainer: If you are looking to begin a cycle syncing-type process, start by making observations regarding your own menstrual cycle, then consult with a trainer or doctor about the best ways to be active while still respecting your body's needs for rest and energy.
  • Track your cycle with apps: Start tracking your cycles. The FitrWoman app, designed by Dr. Georgie Bruinvels, breaks down the four phases of the menstrual cycle and uses evidence-based research to match symptoms and solutions to each phase. This app was used by the U.S. Women's National Team when training for the World Cup. Other period tracking apps such as MyFlo, Cycles and Period Tracker Lite will help you track your cycle and follow how you feel turning workouts at different points of your cycle.
  • Use cycle-friendly training tools: More and more fitness brands are adding cycle syncing training as an option in their training programs. Nike has started a "NikeSync" training program with physiologist Stacy Sims, Ph.D., which includes training plans and nutrition suggestions for every phase of the menstrual cycle. Fitness membership program Les Mills + contains a cyclical training guide that includes four workouts to match each week of cycle. Adidas also offer a free "PE(riod)" lesson plan online developed by Buinvels that helps you better understand working out during your menstrual cycle and gives recommendations for each of the four phases.

Copyright © 2023, ABC Audio. All rights reserved.

Tennessee woman gets emergency hysterectomy after doctors deny early abortion care

Courtesy Mayron Hollis

(NEW YORK) -- Mayron Hollis said she had just started taking contraceptives when she found out she was pregnant again a few months after giving birth in February 2022. Despite the surprise, Hollis and her husband say they were excited about the pregnancy and eager to add another child to their growing family.

Hollis, 32, had no idea the excitement would turn into a fight for her baby's life and her own.

The Tennessee woman would end up needing a lifesaving emergency hysterectomy, ending her opportunity to give birth to more children, after she says she was denied medically necessary abortion care at a hospital in her home state for life-threatening complications earlier in her pregnancy.

"[My doctor] told me I needed to do the surgery. If I didn't, I could die; the baby could die," Hollis said.

Because she had delivered by cesarean section and the two pregnancies were so close together, Hollis' OB-GYN was worried she could develop a cesarean scar pregnancy, a type of ectopic pregnancy where the fertilized egg is implanted in the cesarean scar after a previous C-section, which can cause the uterus to rupture, leading to excessive bleeding and even death, according to the National Institutes of Health.

In August, Hollis found out that she did have a cesarean scar pregnancy, with the pregnancy bulging out of her uterus, and a placenta accreta -- a serious pregnancy complication in which the placenta grows too deeply into the uterine wall and part or all of the placenta then remains attached to the uterine wall during delivery. The condition can cause severe blood loss after delivery, according to the Mayo Clinic.

"I [could] hemorrhage, because that was already bulging out," Hollis said. "It was scary."

Hollis was eight weeks pregnant when she met with a maternal fetal medicine specialist, who confirmed that she had a cesarean scar pregnancy and sent her back to Vanderbilt University Medical Center for care.

Vanderbilt University Medical Center said it would not comment on the case.

Because she wanted the baby, Hollis said it took her and her husband time before they were able to decide that they wanted to end the pregnancy because the risk it posed to her life was too high.

Hollis said she was unaware of the changing landscape in Tennessee after the U.S. Supreme Court overturned Roe v. Wade, ending federal protections for abortion rights. A trigger ban prohibiting nearly all abortions went into effect in Tennessee on Aug. 24, 2022.

Hollis said her doctor did not explain to her that there was a narrow window in which she could receive care before the ban went into effect.

One day before the ban went into effect, medical records show that in the early weeks of her pregnancy, Hollis' placenta accreta had progressed and was "concerning," according to her medical records. She was 11 weeks pregnant at the time.

"It was a hard pregnancy. It was scary the whole time," Hollis said.

"They thought they were gonna have to reconstruct my bladder. They didn't know if it was gonna touch any other organs -- if they could even stop the bleeding if I did start to hemorrhage," Hollis said.

When the couple realized how big the risk was to Hollis' life, they decided it was best to end the pregnancy.

Hollis had been offered abortion care since the ban had not yet gone into effect. But when she reached out to her OB-GYN to ask for the care on Aug. 24, it was too late. That was the day Tennessee's trigger ban prohibiting all abortions went into effect.

The ban criminalizes performing an abortion, making it a felony. An exception to save the life of the mother or prevent serious and permanent bodily injury only comes into play when a physician is defending themselves in court after they have been charged with the felony. A separate so-called "heartbeat ban" that prohibited all abortions after fetal cardiac activity is detected was also in effect.

Physicians told ABC News the exception is unclear and many worry about the consequences they could face for providing essential care.

The procedure Hollis needed was complex and required a number of physicians from different specialties to perform. Not enough physicians were willing to provide the care with the ban in effect, according to Hollis.

A specialist would have needed to inject the pregnancy with something to stop the heart before physicians from other specialties could provide abortion care that would preserve Hollis' fertility, Dr. Sarah Osmundson, a maternal fetal medicine specialist in Tennessee who treated Hollis later in her pregnancy, told ABC News.

There is a very narrow window in which pregnancies with placenta accreta can be terminated without the need for a hysterectomy, due to the excessive bleeding that the condition causes, according to Osmundson. The window generally closes at around 12 weeks of pregnancy, Osmundson said.

Few facilities would have been able provide the complex care needed to preserve her fertility, according to Osmundson.

Hollis was recommended a facility in Pittsburgh, but she said traveling for care wasn't an option because Hollis and her husband both needed to work and couldn't afford to take time off.

Under the ban, Hollis was told the only way doctors could intervene was if her life was in danger, so she had to continue her pregnancy.

"Because of everything that was going on, they didn't know what was the right thing to do was. So the only way to save me was for something bad to happen to me," Hollis said. "That's how it felt anyways."

"They really had no answer for me the whole time I was pregnant. It was the scariest thing I ever did. [Doctors were] telling me that my pregnancy wasn't viable, but we can't send you anywhere and we can't do anything to help you. So it's just a lot of prayers for me. Reading up and just having a lot of faith," Hollis said.

Procedure to deliver and save her life

As her pregnancy progressed, it had gradually attached to her bladder and her accreta progressed to placenta percreta -- meaning her placenta grew through the uterine wall and attached to surrounding organs, Hollis said.

At one point she had to be put on bedrest because doctors were worried her uterus could rupture, Hollis said.

Hollis was admitted to the hospital at 25 weeks pregnant after she began excessively bleeding, according to medical records. After staying in the hospital for four days, Hollis said she went home. It was almost Christmas.

One day after returning home, Hollis was taken back to the hospital after she began significantly bleeding again, according to medical records.

Before she had the hysterectomy, Hollis said she had to write a will and tell doctors whose life to prioritize if they could only save her or the baby.

She had a cesarean delivery and an emergency hysterectomy in one procedure, according to medical records.

"I didn't want the hysterectomy. But they said that was the only way that they could stop the bleeding to help me, so I didn't have a choice," Hollis said.

Hollis said she lost so much blood that doctors set up IV lines in both arms, both legs and her neck, allowing for a large transfusion of blood. Medical records show she was given eight units of packed red blood cells and six units of fresh frozen plasma. Hollis probably lost at least 2 liters of blood, Osmundson said.

"She could have easily died at another institution," Osmundson said.

By the time Hollis was 26 weeks along, there was no other option than to perform an emergency hysterectomy to be able to stop the bleeding, Osmundson said.

An amendment was recently added to the Tennessee ban allowing abortions for ectopic pregnancies, so physicians are now able to treat patients with complications similar to Hollis, but Osmundson said there are still other cases where doctors are unsure how to act.

"So much of medicine is gray areas," Osmundson said. "Regulating these complex decisions will result in people getting hurt and will result in people dying."

Hollis' baby, whom she named Alayna, was delivered so premature she was in an incubator for a month, Hollis said. She slowly graduated to different beds at the hospital. The baby was delivered on Dec. 13, but she was only able to go home on Feb. 23, needing oxygen and other interventions at the hospital.

Since the newborn returned home in February, she has been taken back to the hospital five times, Hollis said. The longest she has been at home since February was for two weeks.

"I thought I lost her one time for like five minutes. She turned colors and I had to wait on the ambulance to get here, doing CPR and an off-duty cop showed up," Hollis said. "He did CPR on the hood of his car and saved her life."

Hollis said the baby's lungs are not fully formed and she is not growing as fast as she could be. She had only been eating through a feeding tube through her nose, but just started taking food by mouth, according to Hollis.

"[I've] just been stressed out a little bit not knowing what's going to go on with my daughter, how I'm gonna get her what she needs and what's gonna happen next. So I'm just trying to hang in there," Hollis said.

"I'm very adamant to make sure that I'm on top of her care," Hollis said. "It's been really hard to go back to work because I don't have the means to pay for the adequate care that she needs. So I've been trying to get help."

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