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She saw 26 doctors and had 37 procedures with no diagnosis in sight. Then, an answer.

She saw 26 doctors and had 37 procedures with no diagnosis in sight. Then, an answer.

USA Today23-04-2025

She saw 26 doctors and had 37 procedures with no diagnosis in sight. Then, an answer.
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How important is your family medical history?
If you've been to a doctor before, you've probably been asked about your family medical history. How important is it actually?
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Nika Beamon thought she was going to die.
The former college athlete always played high-impact sports. Rugby, ice hockey, you name it. Always knocked down but toughing it out. By the time she was a senior at Boston College, though, toughing it out grew impossible. Waking up everyday was a struggle. Aches appeared out of nowhere, even when she wasn't exercising. She ran spontaneous fevers, like she was fighting an infection. Test after test – for mono, for anything – all failed to spit out a diagnosis. She had no family history of diseases; her brothers were perfectly healthy. But everyone agreed on one thing: Something was up.
"I did not have any doctor who didn't think nothing was wrong," the now 52-year-old award-winning journalist says. "Everybody thought something was wrong. They just didn't know what it was."
Fatigue and joint pain plagued her 20s. She suffered two strokes by the time she turned 35. Her lymph nodes swelled constantly, but biopsies showed no cancer. "I don't know who this is, but this doesn't seem like me," she adds. "I felt like I was aging rapidly. It was like, as if you went from 20 to 50 in a day."
Beamon set out on a journey, and 26 doctors, 37 procedures and more than 17 years later, a rheumatologist finally cracked the confounding code: She had immune disorder IgG4-related disease, and all she needed was a blood test to confirm it.
"There's no way I could have been to this many doctors and had this much blood drawn and nobody saw it," Beamon recalls. "(Her doctor) said, 'Well, they wouldn't be testing for it unless there was a reason.'"
I got 14 tests done at this resort: I didn't need most of them.
'Most patients do well'
IgG4-RD is an immune-mediated disorder. When someone has it, their immune system goes into overdrive, producing more antibodies (or immunoglobulins, hence the name) than necessary that disrupt typical organ function.
"It's not cancers or anything," says Dr. Arezou Khosroshahi, associate professor at Emory University School of Medicine. "It's just that they are confused and they are reacting to something." The disease itself is not deadly, but left untreated, the antibodies can infiltrate different parts of the body like the pancreas, lung or liver. For example, if an accumulation of cells block the bile ducts, a patient can develop cirrhosis, or liver damage. The same pattern may pop up across different organs. Another wrinkle: Patients may be asymptomatic.
If you catch it on time, a patient can live a normal life with regular follow-up appointments. But if someone's organ(s) already had severe dysfunction, you'll have to treat any associated consequential conditions, too. "I can't emphasize enough, this is very important, because people think, 'Oh, I've got a steroid and I feel much better, so I don't need treatment,' but then they come back two years later with significant damage. But in general, if this disease is diagnosed on time and treated, most patients do well."
It's a challenging diagnosis, as the disease mimics other conditions. A majority of the time, if the cell accumulation turns into a mass, a doctor will do a biopsy to make sure it's not cancer. As more awareness of the disease grows, a radiologist might look at a CT scan and notice a similar pattern of inflammation or swelling across multiple organ systems that put IgG4-RD into a diagnosis differential.
It mostly affects middle-aged and older men, though anyone can have it regardless of age, gender, race or ethnicity.
Japanese gastroenterologists first recognized the condition in 2006, with Khosroshahi and colleagues at Massachusetts General Hospital identifying it in 2008. The disease was officially named in 2012 at the premier symposium focused on IgG4-RD.
In case you need: Boost your immune system to fight germs
'You still have good days and bad days'
Beamon takes medication and sees all kinds of doctors today to keep her organs in check. She started out with steroids to keep her inflammation down, but they're notorious for rough side effects, not meant to be taken long-term.
IgG4-RD has been typically treated with a taper dose of a steroid like prednisone, followed by off-label immunosuppressive medications. The FDA recently approved new drug Uplizna to treat IgG4-RD, the first to treat the specific condition. It's a monoclonal antibody that targets certain B-cells to inhibit production of IgG4; in a clinical trial, it had an 87% reduction of flare-ups of the disease.
"You still have good days and bad days, and that's the thing," Beamon says of how she currently lives with the disorder. "Depends on when you have a flare or the inflammation is high."
She's coped well with a supportive online community, particularly after she began documenting her journey and writing a book: "Misdiagnosed: The Search for Dr. House."
Beamon hopes anyone searching for a diagnosis advocates for themselves, keeps track of their medical records and brings loved ones to appointments with them. Don't think your doctor knows more about your body than you do, either. Still, she doesn't blame anyone for not figuring out her IgG4-RD sooner.
"I found it when I found the right person who looked outside the box and said, 'forget what she looks like. Forget what they're telling you. Let me just look at what the documents tell me that she might have' and that's how we got there," she says. "But I don't think it was anybody's fault."
Her biggest takeaway, though – apart from do not Google your symptoms too much, because every website will tell you you're dying – keep the faith. "There's always a doctor out there that can help you. You just have to find the right one."

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Trump team set to destroy $12m worth of HIV drugs and contraceptives that were bought before closing USAID
Trump team set to destroy $12m worth of HIV drugs and contraceptives that were bought before closing USAID

Yahoo

time10 hours ago

  • Yahoo

Trump team set to destroy $12m worth of HIV drugs and contraceptives that were bought before closing USAID

Roughly $12 million worth of HIV-prevention drugs and contraceptives purchased by the U.S. Agency for International Development will likely be destroyed after President Donald Trump dismantled the organization, according to a report. These drugs have been sitting in distribution centers in Belgium and the UAE since January, when Trump ended the agency's spending, The Washington Post reported. Now, negotiators have been instructed to sell the drugs or else they'll be thrown out, according to the outlet. 'The mandate that [the USAID negotiator] has been given is 'get us money for it, and if you can't do that, we're just going to trash it,'' someone with knowledge of the situation told the Post. These supplies include more than 26 million condoms, 2 million doses of injectable birth control, millions of packages of oral birth control, hundreds of thousands of implantable contraceptive devices, and over 50,000 vials of a drug that prevents HIV contraction, the Post reports. Some of these supplies were earmarked for 18 countries, meaning those governments may never get the aid even though it was already purchased, according to the Post. When contacted for comment, a senior State Department official told The Independent that the Post has 'once again delivered fake news' and the 'story is full of inaccuracies.' Atul Gawande, a former assistant USAID administrator, told the Post the potential destruction of these drugs is 'inconceivable.' Meanwhile, Former USAID head Andrew Natsios called the decision 'nuts.' 'At this point, just give it away instead of destroying it, for heaven's sakes,' he told the Post. Trump cut off USAID funds in January, saying the organization that provides humanitarian aid abroad is 'not aligned with American interests.' The Trump administration is also poised to ask Congress for $8.3 billion in cuts to foreign aid efforts, which range from climate work to LGBTQ+ programs, The Independent previously reported. The decision has derailed the projected end of the AIDS pandemic and means the number of AIDS-related deaths could jump from six million to 10 million in the next five years unless aid is reinstated, The Independent previously reported. Data projections indicate there will be 3.4 million more orphans who have lost at least one parent to AIDS, and 600,000 more newborns could contract HIV by 2030. 'All the gains that we've seen over the last 20 years will start being steadily reversed,' Professor Francois Venter, a leading HIV doctor at the University of Witwatersrand in Johannesburg, previously told The Independent. Hadja, a 27-year-old mother of three in Uganda, previously told The Independent she has lost access to lifesaving medication since Trump effectively shut down USAID. 'Our lives depend on medicine – without it, our lives are shortened,' she said. 'If I die, my children will suffer.'

DISCO topline results: 64Cu-SARTATE is highly effective in detecting tumours in NET patients compared to SOC imaging. Phase III planning underway.
DISCO topline results: 64Cu-SARTATE is highly effective in detecting tumours in NET patients compared to SOC imaging. Phase III planning underway.

Yahoo

time19 hours ago

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DISCO topline results: 64Cu-SARTATE is highly effective in detecting tumours in NET patients compared to SOC imaging. Phase III planning underway.

HIGHLIGHTS Topline data from Clarity's diagnostic Phase II trial, DISCO, confirms that 64Cu-SARTATE is safe and highly effective compared to standard-of-care (SOC) imaging at detecting lesions in patients with neuroendocrine tumours (NETs). DISCO compared the diagnostic performance of 64Cu-SARTATE at an average of 4 hours (between 3 to 5 hours) and 20 hours post-administration (same-day and next-day imaging, respectively) to 68Ga-DOTATATE. 64Cu-SARTATE lesion detection substantially outperformed that of 68Ga-DOTATATE. 64Cu-SARTATE detected 393 to 488 lesions, and 68Ga-DOTATATE identified 186 to 265 lesions among 45 study participants across the readers. Out of all the lesions identified by the readers, 230-251 were deemed to be discordant (i.e. only present on one of the scans, 68Ga-DOTATATE or 64Cu-SARTATE positron emission tomography [PET] / computed tomography [CT]). Of these lesions, 93.5% (average across readers) were only detected on the 64Cu-SARTATE PET/CT scans. The number of discordant lesions detected by 64Cu-SARTATE on the same-day and next-day scans was comparable. Approximately half of all the discordant lesions had an available standard-of-truth (SOT), such as histopathology or conventional imaging. The identified discordant lesions yielded a lesion-level sensitivity of 93.4% to 95.6% (95% confidence interval [CI]: 65.1, 99.5) for 64Cu-SARTATE (across both timepoints) and only 4.4% to 6.6% (95%CI: 0.5, 34.9) for 68Ga-DOTATATE across both readers. 64Cu-SARTATE was deemed safe and well tolerated. Only 7 (15.6%) participants experienced 64Cu-SARTATE-related adverse events (AEs). No serious treatment-emergent AEs were observed in the study. Based on the exciting preliminary results of the DISCO trial, Clarity will commence next steps to conduct a registrational Phase III study of 64Cu-SARTATE in NETs with the US Food and Drug Administration's (FDA) guidance. SYDNEY, June 5, 2025 /PRNewswire/ -- Clarity Pharmaceuticals (ASX: CU6) ("Clarity" or "Company"), a clinical-stage radiopharmaceutical company with a mission to develop next-generation products that improve treatment outcomes for patients with cancer, is pleased to announce positive results from the diagnostic Phase II DISCO trial (NCT04438304)[1] with 64Cu-SARTATE in patients with known or suspected NETs. DISCO trial design DISCO is a "Diagnostic Imaging Study of 64COpper-SARTATE Using PET on Patients with Known or Suspected Neuroendocrine Tumours". It assessed the performance of Clarity's SARTATE imaging product as a potential new method to diagnose and manage NETs. The trial aimed to build on earlier clinical experience with 64Cu-SARTATE in patients with NETs, which demonstrated that the diagnostic has excellent imaging characteristics and suggested that 64Cu-SARTATE PET/CT provides comparable or superior lesion detection to 68Ga-DOTATATE PET/CT in all patients, especially in the liver[2]. DISCO recruited participants with Gastroenteropancreatic NETs (GEP-NETs) across 4 sites in Australia, comparing the diagnostic performance of 64Cu-SARTATE PET at an average of 4 hours (between 3 and 5 hours) and approximately 20 hours post-administration (same-day and next-day imaging, respectively) to the current SOC, 68Ga-DOTATATE PET. Participants were required to have undergone a pre-study 68Ga-DOTATATE PET/CT scan within 5 weeks, but not closer than 6 hours prior to the administration of 64Cu-SARTATE as part of their routine clinical care. The trial was initially designed to enrol up to 63 patients, based on the anticipated lesion-level discordance rate between 64Cu-SARTATE and 68Ga-DOTATATE PET. Following a pre-planned early analysis of the data collected during the study, the sample size was adjusted to 45 patients, allowing for an earlier enrolment completion. Study participants were dosed with 200 MBq of 64Cu-SARTATE. Both the 64Cu-SARTATE and 68Ga-DOTATATE PET/CT scans were reviewed by 2 blinded central readers. Participants were followed for up to 12 months to complete additional investigations (e.g. biopsy and conventional imaging) and obtain the SOT used to verify discordant findings between the scan pairs. The verification of discordant findings against the SOT evidence (as true- or false-positive findings) was completed by an independent central assessor, distinct from the central readers evaluating the 64Cu-SARTATE and 68Ga-DOTATATE scans. Lesion-level sensitivity was calculated for the discordant lesions between the scan pairs, with each true-positive discordant lesion on one scan considered a false-negative lesion on the other scan, and each false-positive discordant lesion on one scan considered a true-negative lesion on the other scan. Topline results The results indicate that lesion detection by 64Cu-SARTATE (regardless of imaging timepoint) substantially outperformed that of 68Ga-DOTATATE. 64Cu-SARTATE detected 393 to 488 lesions, and 68Ga-DOTATATE identified 186 to 265 lesions among 45 participants across the readers (Figure 1). Out of all lesions identified by the readers, 230-251 were deemed to be discordant between 64Cu-SARTATE and 68Ga-DOTATATE PET/CT, with 93.5% (average across readers and imaging days) of these discordant lesions detected on the 64Cu-SARTATE scans only. A previously completed Phase I study demonstrated a 1.7 fold increase (median of 6.70 vs. 3.92, p=0.002) in contrast (i.e. lesion-to-background ratio) for 64Cu-SARTATE PET/CT performed at 4 hours post-administration compared to 68Ga-DOTATATE PET/CT2. This improvement in contrast may explain the detection of additional lesions observed in the DISCO trial. The average SUVmax, representing the highest concentration of 64Cu-SARTATE uptake in lesions, was notably high, ranging from 37.42 to 43.90 across both imaging days in the DISCO trial. Approximately half of all discordant lesions had an available SOT, which yielded a lesion-level sensitivity of 93.4% to 95.6% (95%CI: 65.1, 99.5) for 64Cu-SARTATE, including both timepoints, and only 4.4% to 6.6% (95%CI: 0.5, 34.9) for 68Ga-DOTATATE. 64Cu-SARTATE was deemed safe and well tolerated. Only 7 (15.6%) trial participants experienced 64Cu-SARTATE-related AEs, the majority of which were mild (Grade 1) gastrointestinal events, commonly observed in NET patients, and typically resolved within 2 days of onset. No serious treatment-emergent AEs were observed in the study. Based on the findings of the DISCO trial to date, Clarity will commence the next steps to conduct a registrational Phase III study of 64Cu-SARTATE in NETs with the US FDA's guidance. Clarity's Executive Chairperson, Dr Alan Taylor, commented, "We are very excited about the initial topline data from the DISCO trial as 64Cu-SARTATE was confirmed to be safe and very effective in detecting NET lesions in patients with known or suspected disease. The DISCO trial demonstrates a significant advantage of our diagnostic over 68Ga-DOTATATE. 64Cu-SARTATE detected almost double the number of lesions compared to the SOC, and, where SOT was available, a very high lesion-level sensitivity of 93.4% - 95.6% in comparison to just 4.4% - 6.6% for 68Ga-DOTATATE for these discordant findings. In addition to identifying more lesions with our product, lesions detected by 64Cu-SARTATE also exhibited high uptake with low background on the PET scans, making it easier to identify those lesions by readers. Excellent lesion visualisation was also supported by substantial clearance from the liver. The favourable biodistribution of 64Cu-SARTATE PET enabled high-contrast diagnostic imaging for up to approximately 24 hours post-injection (Figure 1), offering greater flexibility in the scheduling of PET/CT scans. "In the DISCO trial, we continue to observe the substantial limitations of the current-generation of short half-life isotope products, what we call isotope-centric medicine. This is clearly illustrated by 68Ga-DOTATATE with imaging timepoints solely dictated by the very short isotope half-life (approximately 1 hour for gallium-68) as opposed to good science and medicine. In contrast, 64Cu-SARTATE highlights the extraordinary benefits of next-generation patient-centric medicine, where imaging is guided by the optimal timepoint to scan and detect lesions, focusing on the needs of the patients and their treating professionals. "We believe that the flexibility of imaging with 64Cu-SARTATE, in comparison to approximately 1 hour with 68Ga-DOTATATE, plays an important role in the detection benefits seen in the DISCO study. We have known this for many years and have demonstrated these advantages of optimal timepoint imaging with different products in our Targeted Copper Theranostic (TCT) platform, including SARTATE. We have seen first-hand in a number of clinical trials that once radiopharmaceutical products are administered, they take time to find the lesion whilst also needing to clear from non-target organs, providing greater contrast. This is known as signal-to-noise ratio or, in our case, tumour-to-background ratio. Having greater contrast is especially important to identify smaller or more difficult to find cancers. "The longer half-life of copper-64, combined with Clarity's proprietary SAR Technology, sets up a strong foundation for next-generation diagnostics, which could be unmatched in the radiopharmaceutical sector. In addition to clinical benefits, the opportunity for high-volume centralised manufacturing and broad, on-demand distribution of ready-to-use diagnostics translates into flexibility and reliability for patients and their treating staff, meaning that every patient with access to PET imaging, including those in underserved and broad geographic areas, may access improved cancer diagnostics. "Patients with NETs are often misdiagnosed and experience delays in receiving the correct diagnosis, which may lead to disease progression and identification of their cancer at later stages. Visualising NET lesions earlier and more accurately may have a significant impact on patient outcomes as it equips clinicians with crucial information on disease burden, helping to determine an optimal treatment plan. As such, the SSTR2 imaging market is an important focus for Clarity. We estimate the NET diagnostic market in the US alone to be around 100,000 scans per year, growing to approximately 120,000 scans per year by 2029. "Importantly, the positive results of the DISCO trial open broader opportunities for the development of 64Cu-SARTATE in additional SSTR2-expressing malignancies beyond NETs, such as certain types of breast and lung cancers, where unmet clinical needs remain high. We believe the SSTR2 market is set to grow substantially with a number of therapies in development for this target, which include large indications such as breast and lung cancers. Subject to the successful completion of these studies, we believe that the imaging market for 64Cu-SARTATE could be as large, if not larger, than the very lucrative prostate cancer imaging market where radiopharmaceuticals currently dominate the diagnostic paradigm. "We look forward to sharing additional data readouts from the trial and presenting the results at future international medical conferences. We plan to rapidly progress discussions with the FDA to initiate a diagnostic registrational Phase III study, as a first key step in expanding SARTATE into the theranostic field of NETs, as well as other SSTR2-expressing cancers, with the copper-64/copper-67 pair. If the findings from the DISCO trial are substantiated in a registrational Phase III study and lead to regulatory approval by the US FDA, 64Cu-SARTATE may play an important role in improving diagnostic accuracy, lesion detection and staging of patients with NETs. These factors could improve clinical decision-making and treatment outcomes, potentially positioning 64Cu-SARTATE as a best-in-class agent for the diagnosis of NETs." About SARTATE SARTATE is a next generation, highly targeted theranostic radiopharmaceutical. It is being developed for diagnosing, staging and subsequently treating cancers that express SSTR2, such as NETs. Like all Clarity products, the SARTATE product can be used with copper-64 (64Cu) for imaging (64Cu-SARTATE) or copper-67 (67Cu) for therapy (67Cu-SARTATE). Disclaimer 64Cu-SARTATE is an unregistered product. The safety and efficacy of 64Cu-SARTATE has not been assessed by health authorities such as the US FDA or the Therapeutic Goods Administration (TGA). There is no guarantee that this product will become commercially available. About NETs NETs, also known as well-differentiated neuroendocrine neoplasms or carcinoids, represent a heterogeneous group of malignant transformations of cells of the diffuse neuroendocrine system[3]. They most commonly occur in the gastrointestinal tract (48%), lung (25%), and pancreas (9%), but may also originate in other areas, including the breast, prostate, thymus and skin[4]. NETs can either be benign or malignant, as well as non-functional and functional[5]. NETs traditionally have been considered uncommon; however, the incidence has been increasing as a worldwide phenomenon[6]. Overall, it is estimated that more than 20,000 people in the United States are diagnosed with a NET each year[7], and approximately 190,000 people are living with this diagnosis[8]. Patients with NETs present with subtle clinical symptoms, which can lead to a delay in diagnosis of more than 4 years[9]. As such, about 30-75% of NET patients have distant metastases at the time of diagnosis[10]. A 10-year relative survival rate for patients with metastatic GEP-NETs is 3–36%[11]. About Clarity Pharmaceuticals Clarity is a clinical stage radiopharmaceutical company focused on the treatment of serious diseases. The Company is a leader in innovative radiopharmaceuticals, developing Targeted Copper Theranostics based on its SAR Technology Platform for the treatment of cancers. For more information, please contact: Clarity Pharmaceuticals Dr Alan Taylor Lisa SadetskayaExecutive Chairperson Director, Corporate Communicationsataylor@ lisa@ References [1] Identifier: NCT04438304 [2] Hicks R et al. First-in-human trial of 64Cu-SARTATE PET imaging of patients with neuroendocrine tumours demonstrates high tumor uptake and retention, potentially allowing prospective dosimetry for peptide receptor radionuclide therapy. The Journal of Nuclear Medicine. 2019. [3] Cheung VTF, Khan MS. A guide to midgut neuroendocrine tumours (NETs) and carcinoid syndrome. Frontline gastroenterology. 2015;6(4):264-269. [4] Hallet J, Law CH, Cukier M, Saskin R, Liu N, Singh S. Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes. Cancer. 2015;121(4):589-597. [5] Yau H, Kinaan M, Quinn SL, Moraitis AG. Octreotide long-acting repeatable in the treatment of neuroendocrine tumors: patient selection and perspectives. Biologics : targets & therapy. 2017;11:115-122. [6] Leoncini E, Boffetta P, Shafir M, Aleksovska K, Boccia S, Rindi G. Increased incidence trend of low-grade and high-grade neuroendocrine neoplasms. Endocrine. 2017 Nov;58(2):368-379. doi: 10.1007/s12020-017 1273-x. Epub 2017 Mar 16. PMID: 28303513; PMCID: PMC5671554. [7] Wu C, Song Z, Balachandra S, Dream S, Chen H, Rose JB, Bhatia S, Gillis A. Charting the Course: Insights into Neuroendocrine Tumor Dynamics in the United States. Ann Surg. 2025 Jun 1;281(6):968-975. doi: 10.1097/SLA.0000000000006331. Epub 2024 May 6. PMID: 38708616; PMCID: PMC11538379. [8] Dasari A, Shen C, Halperin D, Zhao B, Zhou S, Xu Y, Shih T, Yao JC. Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States. JAMA Oncol. 2017 Oct 1;3(10):1335-1342. doi: 10.1001/jamaoncol.2017.0589. PMID: 28448665; PMCID: PMC5824320. [9] Basuroy R, Bouvier C, Ramage JK, Sissons M, Srirajaskanthan R. Delays and routes to diagnosis of neuroendocrine tumours. BMC Cancer. 2018 Nov 16;18(1):1122. doi: 10.1186/s12885-018-5057-3. PMID: 30445941; PMCID: PMC6240263. [10] Aluri V. and Dillion, J.S. 2017, "Biochemical Testing in Neuroendocrine Tumors", Endocrinology & Metabolism Clinics of North America, [11] Polee, I.N. et al. 2022, "Long-term survival in patients with gastroenteropancreatic neuroendocrine neoplasms: A population-based study", European Journal of Cancer, Volume 172, 2022, Pages 252-263, ISSN 0959-8049, • Krasnovskaya et al. Recent Advances in 64Cu/67Cu-Based Radiopharmaceuticals. Int J Mol Sci. 2023 May 23;24(11):9154. doi: 10.3390/ijms24119154. This announcement has been authorised for release by the Executive Chairperson. View original content to download multimedia: SOURCE Clarity Pharmaceuticals Sign in to access your portfolio

Want to stay healthy when you fly? Here's the plane truth
Want to stay healthy when you fly? Here's the plane truth

San Francisco Chronicle​

timea day ago

  • San Francisco Chronicle​

Want to stay healthy when you fly? Here's the plane truth

Whether your vacation plans involve a romantic getaway to a faraway locale or just a summer visit with the grandkids, odds are an airplane will be involved. For the most part, planes are a great way to go, health experts say. "Overall, it's a very safe mode of transportation," said Dr. Leigh Speicher, an aerospace medicine specialist who is president of the Civil Aviation Medical Association. But commercial air travel does come with some health baggage. Issues range from simple stress to "complex physiologic changes occurring in the setting of air travel that can affect the heart, the blood vessels and the brain-heart axis," said Dr. Laurence Sperling, the Katz Professor in Preventive Cardiology at Emory University School of Medicine in Atlanta. Here's what the doctors say you can do to stay grounded in health before you're cleared for departure. Beware of the air? In the jet-travel anthem "Come Fly With Me," Frank Sinatra sang that once you're up there, where the air is rarefied, you can just glide, starry-eyed. But that rarefied air can pose a health challenge for some. On commercial flights, cabin air is usually pressurized to the equivalent of around 6,000 to 8,000 feet in altitude, according to the Centers for Disease Control and Prevention. That's roughly the elevation of Estes Park, Colorado, or Mount Olympus in Washington, and it means passengers are inhaling less oxygen than they might normally. That pressurized air can also be dry – around 5% to 25% relative humidity, according to a research review published in Clinical Cardiology in 2017 about air travel's cardiovascular effects. Sperling, a preventive cardiologist who founded the Emory Center for Heart Disease Prevention, was senior author of that review. Speicher, who started piloting planes as a teenager, said most healthy people will be fine breathing the cabin air. But the CDC says the lower pressure can exacerbate problems for people with anemia, underlying lung issues, cerebrovascular disease such as stroke, or other conditions that require supplemental oxygen. The Clinical Cardiology review adds heart disease and heart failure, where the heart can't pump efficiently. If you have any concerns about whether it's safe for you to fly, ask a doctor, Speicher said. "Your best resource to talk to is your own primary care provider. Or, if you've had a recent heart attack or a stroke, it might be the specialist who's cared for you." The lower air pressure in the cabin also causes gas trapped inside the body to expand. That can affect someone who has had bypass surgery within the past 10 days, the Clinical Cardiology review said. Expanding air inside the body also can lead to abdominal pain, sinus pain or "airplane ear," Speicher said. The CDC says decongestants can help with ear and sinus symptoms. But because decongestants can raise blood pressure, they should be used for the shortest duration possible or avoided altogether in people with severe or uncontrolled high blood pressure, according to guidelines from the American Heart Association and American College of Cardiology. Flying dry The low humidity inside a plane can lead to problems such as dry eye or a cough, Speicher said. To combat dehydration, she recommends traveling with your own water bottle, which you can fill once you clear airport security. Be careful with caffeine and alcohol, she said, both of which can be dehydrating. The air aboard modern planes is filtered and "cleaner than most of our homes and buildings that we're in," Speicher said. So when it comes to airborne viruses and bacteria, "it's not like you're being exposed to everyone in the whole plane." But you can still be exposed to germs from the people around you, she said, and if you're sick, you can expose them as well. "I'm not at the point where I would say, 'Everyone needs to wear a mask for every flight,'" she said. But in case you end up next to somebody who is coughing and not wearing a mask themselves, "I think it's lovely to have one on hand." Blood clot risks The long periods of immobility that come with air travel can elevate the risk for deep vein thrombosis – clots that begin in large veins, often in a leg. If a clot travels to the lungs, it can be fatal. Such clots are rare, but Speicher and Sperling both recommend using compression socks on longer flights. Stay well-hydrated, Sperling said, and keep blood flowing by not crossing your legs and by flexing your leg muscles while seated, or "get up and walk in the aisle." But don't loiter. Turbulence can strike without warning, Speicher said. So when you're seated, buckle up, she said. "It'll save you from injury." Stressful? Yes Air travel can be frustrating, to put it mildly. "It's a very stressful time for some people," Speicher said. And that can affect mental health. So "pack your patience," she said. Try to be understanding of your fellow passengers, and listen to the instructions you're given. "The cabin crew and the pilots are trying to do their job. They're trying to get everyone there safely." Nervous fliers should "do the things that help you stay calm in regular life," such as deep breathing, meditation or listening to music, Speicher said. "Travel with someone who centers you and helps you feel safe." Also avoid alcohol, she said. In addition to being dehydrating, it "can compound all the issues going on, instead of calming things down." Pre-flight prep Sperling, who has been on the receiving end of several "Is there a doctor on board?" calls to help people when he's flown, emphasized the importance of checking with your health care team to make sure you're ready to fly. "The physical stress of air travel should not be underestimated," he said. "For many people, it can be the most significant stress test they've had in days, weeks, months or that year." It takes effort to haul luggage through the airport or even just wait in line. "So it's not uncommon for people to unmask some underlying health conditions as they're navigating the stress of air travel." If you're cleared to fly, Sperling said, make plans for keeping up with your regular medications. Keep them in your carry-on luggage. "It's really helpful for a person to have a list of their medications, just to be able to share with whoever is trying to help," he said. People with heart rhythm disorders should carry a copy of a baseline electrocardiogram reading – you can take a photo and store it on your phone, Sperling said. People with implanted devices such as pacemakers or defibrillators should carry the device's card with them. Overseas travelers should make sure they are up to date on vaccinations. Many hospitals have travel specialists who can help. Keep in mind basic needs as well, Speicher said. "I recommend having some snacks or food with you in case there are delays." Don't skimp on sleep Travel can interfere with sleep, which is considered essential for heart health. Adjusting to a new time zone is trickiest when traveling east, Speicher said. "You just stay up a bit later when you travel west." Her simplest advice is to get exposure to mid-morning light to reset your body's internal clock when you travel east. "It's great to get sleep where you can," she said. But be careful with alcohol, which might make you sleepy but can interfere with staying asleep. Sperling cautioned against taking any type of sleep aid or anti-anxiety medication that you don't take regularly. "Stick to your routine," he suggested. If your normal bedtime routine involves reading a book, try the same while you travel. Have fun "Air travel is important for people to see the people they love, their families, their friends, to experience new places and new beauty on this planet," Sperling said. So while putting in the work required by flying, don't lose sight of its rewards. "We should be aware of the risks," Sperling said. "We should be equally aware of the joy."

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