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India Today
25-05-2025
- Health
- India Today
From the India Today archives (1994)
(NOTE: This article was originally published in the India Today issue dated June 28, 2021)In the beginning of April, Covid came knocking for the Bhatias, a family of five, who live in Bengaluru's Banaswadi neighbourhood. The second wave had yet to assume its brutal proportions; most of the family, including two teenagers aged 18 and 17, got away with cold and fever, their recovery made easier with a five-day course of antibiotics and vitamin supplements. Only their 70-year-old grandmother had to be given steroids, to douse the internal that they had survived the worst, the Bhatias resumed their normal routine as soon as the symptoms subsided—only to have the nightmare return in two weeks. 'My mother was diagnosed with Parkinson's,' says Abhishek Bhatia, 45, a manager at a software engineering firm. 'A blood clot had possibly travelled to her brain. She hadn't been given anti-coagulants during treatment.'Chronic fatigue and bodyache prevented his wife from resuming her duties in the kitchen. The children complained of 'brain fog', unable to focus or think clearly. Bhatia himself reported low-grade fever for six days after he tested negative, indicating internal inflammation, and was later found to have blood clots in one hand. 'It has been two months since we tested negative, but none of us has the energy to live like we used to,' he The unpredictability of Covid symptoms continues to baffle experts and patients alike. In general, such symptoms include body or muscle ache, fatigue, headache, loss of smell or taste and breathlessness. Over the past year and a half, enough data has been collected to confirm that a majority of Covid survivors experience one or more of these symptoms even after 14 days (the average time it takes for the body to fight off the virus). Of the 9,751 patients it surveyed worldwide in May 2021, the Stanford University School of Medicine found that 70 per cent of those who had suffered moderate or severe infection reported 84 different symptoms months after situation isn't any better for those with mild symptoms. A study by the Journal of the American Medical Association, or JAMA, in Sweden in May 2021 showed that one out of 10 people with mild Covid infection was unable to fully resume their normal daily activities even eight months after recovery. On an average, patients experienced symptoms for at least three weeks.'It is not only those hospitalised for Covid who feel its after-effects,' says Dr Farah Ingale, an internal medicine specialist at Fortis Hospital in Hiranandani, Mumbai. 'I have patients who were treated at home for fever and cough and have severe joint aches even four months after the initial symptoms receded. I have also had patients who had no symptoms for the first two weeks, and later developed severe fatigue and gastrointestinal symptoms. Since they had tested positive just two weeks before, one can only assume their symptoms were due to the virus.'advertisementWHAT IS LONG COVID?'We still do not entirely know the short- and long-term impact of the virus on the body,' says N.K. Arora, head of the operations research group of the ICMR's (Indian Council of Medical Research) national task force for Covid. 'But we do know that patients may develop new symptoms even six months to a year after recovery. This is known as Long Covid.'According to ICMR, if a person has symptoms four to 12 weeks after testing negative for Covid, it should be treated as post-Covid Syndrome or PCS. 'If after 12 weeks, symptoms continue or reappear, the patient should go for an RT-PCR test. If positive, they are deemed reinfected with Covid. But if negative, it should be treated as Long Covid,' says Dr Randeep Guleria, director of the All India Institute of Sciences (AIIMS) in Delhi. A majority of the second round of symptoms, according to most doctors, begin four weeks after the onset of the first symptoms. Not all symptoms indicate serious underlying conditions but, left untreated and undiagnosed, can lead to medical problems in the short or long Covid has made its presence felt in other countries too. In the US, for example, a study looking at two million Covid-19 patients found that 250,000 of them had sought treatment for PCS even a month after recovery. Many of them had had a mild or asymptomatic run. The most common new problem reported was pain, including in the nerves and muscles, along with breathing difficulties, high cholesterol, fatigue, high blood pressure and parosmia (a distortion of the senses of smell and taste).In the absence of national data on PCS, or the symptoms and risk factors, one has to rely on the testimonies of doctors across Covid wards in the country. And they present a grim picture. 'We have seen a very high percentage of patients developing PCS,' says Dr Vivek Nangia, a pulmonologist at the Max Super Specialty Hospital in Delhi.'Most of them complain of persisting bodyache, fatigue, breathlessness, anxiety, voice changes, even memory lapses.' At the Rajiv Gandhi Super Specialty Hospital in Delhi, director Dr B.L. Sherwal says that 80-90 per cent of their patients complain of a dry cough, weakness and the tendency to get dehydrated very quickly post recovery. 'Many cannot do simple activities like walking from one room to the other in the house.'advertisementWith the B.1.617.1 and B.1.617.2 lineages of the new Delta variant dominating the second wave, experts have noticed a change in PCS symptoms too, though any direct correlation has yet to be scientifically ascertained. 'Brain fog is much more common this time,' says Dr Sherwal. Other Covid survivors complain of persistent low-grade better understand PCS, experts recommend dividing patients into two categories—those with mild to moderate Covid (who recovered at home with or without significant medical intervention) and those whose affliction was severe (who were hospitalised, admitted into an ICU, put on a ventilator, and/ or given steroids). The risk of PCS, they say, can be different in both groups. 'For mild patients, the symptoms are not life-threatening. But for severe cases, thrombosis and inflammation can prove fatal,' says Dr SILENT KILLERSInflammation and thrombosis are among the two very important pathogenic mechanisms of Covid. Inflammation is a natural process through which the body fights off harmful infection or injury. When the immune system senses damage to a cell in the body, it releases chemicals to resist the invasion. When these chemicals continue to linger, triggering what is recognised as a cytokine storm, inflammation can harm other healthy tissues and manifests most commonly in a fever, but c-reactive protein (CRP) levels in the blood can also reveal the extent of internal inflammation. 'A variety of organs can be involved in the inflammatory cascade of Covid-19. Inflammation can indicate lung pneumonia or damage to the kidney and liver,' says Dr Nangia. Inflammation-related problems are commonly seen in people with underlying comorbidities, and in elders whose immune system may be suppressed because of history of past disease or on the other hand, refers to the blood's tendency to clot in the presence of a foreign substance. Appearing either in the veins or in the arteries, these clots, if not dissolved in time with medication, can trigger pulmonary thrombosis, cardiac events, strokes or kidney damage. 'We have even seen patients with clots in their hands and legs,' says Dr Nangia. Among those more prone to thrombosis are the bed-ridden, people with cancer, the elderly, or those with a past history of thrombosis or thrombophilia. As Abhishek Bhatia, who developed a clot in his hand, said, 'We never knew we had a history of thrombosis in the family; it was found through tests only after Covid.'What makes inflammation and thrombosis truly dangerous is their silent explosion in the body. Left untreated and unsupervised, they can result in organ injury even in Covid patients who did not have to be hospitalised because their oxygen levels had remained to doctors, while one knows that clots can damage organs, it is difficult to predict whether post-Covid thrombosis can be a cause of death in itself. 'It has been recorded in theory,' says Dr Atul Ingale, a nephrologist at the Fortis Hospital in Mumbai. 'But we need more practical evidence for it.'RISK TO LUNGS AND HEARTWhen 39-year-old Manik Biswas, a travel agent in Pune, died of a sudden heart attack on May 2, his family just couldn't believe it. Manik and his wife Kritika had recovered from Covid 24 days ago. The couple, who liked to cycle together every morning, had resumed their 'normal' routine a week after their Covid symptoms subsided. 'We felt fine, and didn't think of further monitoring our health,' says had been treated for the disease at home, but the use of steroids and Covid-induced internal inflammation put Manik in the high-risk category for post-Covid complications. 'The acute inflammation during his infection 'loosened' some plaque in an artery, which led to a blood clot and then a heart attack,' says numbers are hard to come by, there have been several instances of young Covid survivors succumbing to sudden heart attacks after recovery. All of us acquire some measure of arterial blockage as we age, but till such blockage exceeds 50-70 per cent, we don't feel any symptoms and are, therefore, unaware of the risks. But, according to research, Covid puts pressure on the heart German studies published in the July 2020 issue of JAMA Cardiology showed abnormal heart imaging findings in 78 per cent of the 57 Covid-19 patients they observed. A majority of them had ongoing cardiac inflammation even weeks after recovery. Dr Rajeev Rathi, cardiologist and director of the transradial interventional programme at the Max Hospital in Saket, Delhi, explains: 'The moment the virus enters the body, it starts an inflammatory reaction in almost all the organs. The heart too has the ACE2 receptor, the protein the virus hooks onto to gain entry into the body, and so patients have a chance of the heart muscles getting inflamed.'There is already evidence of viral infections having a negative impact on the heart. A JAMA Cardiology study of the 2019-20 flu season found that the virus affected the heart health of 94 per cent of the patients under study. The most commonly noted cardiac events were low ejection fraction (when the heart cannot pump enough blood, often indicating a heart failure), and blocked arteries triggering sudden heart attacks.'There is increased incidence of cardiac problems in those with Covid infection. Viral infection leads to instability in the coronary tree. Most people do not know how much blockage they already have in their hearts because some plaque formation is natural and does not affect people unless it becomes severe. But when Covid strikes, these plaques can rupture because of inflammation in the heart muscles. The rupture happens within the lumen (the inside of the artery) itself, which increases the chances of thrombosis. When clots form, then the artery with the rupture can find itself blocked 100 per cent, triggering a heart attack,' Dr Rathi elaborates.A D-Dimer blood test can help monitor the inflammation and chances of thrombosis. 'D-Dimer,' explains Dr Rathi, 'is a parameter that suggests high chances of blood coagulability, or if the patient is at a higher risk of clotting complications. Covid patients who needed oxygen, steroids and hospitalisation for treatment need to check clotting chances.'What is still unknown, though, is for just how long a recovered patient remains at risk of developing heart complications. 'We still don't know about long-term cardiac health after Covid recovery,' says Dr Rathi. 'Unstable plaques can behave differently over a period of one or two months. A heart attack does not necessarily occur during hospitalisation. If the plaque is unstable and patients quickly jump back into intense physical activity after Covid, the risk goes up.'Cardiologists recommend that those recovering from Covid should take it easy irrespective of the severity of the illness. 'One can never know what is going on inside your heart, so it is better not to exert yourself unduly. Rest for a few months and gradually increase your activity level. Long Covid symptoms for the heart can be silent at times, but if you take it for granted, it can also be fatal,' says Dr Rajiv Passey, cardiologist at the Sir Ganga Ram Hospital in effects of Covid on the lungs before and after the infection could be completely different. During Covid, patients are at the risk of developing pneumonia and hypoxia. After Covid, patients can get permanent fibrosis of the lungs, pulmonary embolism (clots in the lung tissue) and long-term breathlessness. A May 2021 study in the European Respiratory Journal showed that 14 per cent of the patients under study were at the risk of pulmonary embolism at the time of hospital admission itself.'Clotting is a major concern after recovery; it puts all vital organs at risk,' says Dr Nangia. While most hospitalised patients with lung infection recover well, some, he adds, show slow recovery; others can even relapse. 'There are cases where the infection in the lung can return, leading to inflammation (also referred to as a ground glassing effect). Such people can potentially develop fibrosis, which is a scarring of the lung in which normal breathing lung space gets converted into dead tissue. There is no exchange of gases in that tissue then, leaving people breathless as they don't get enough oxygen in the lungs,' says Dr above the age of 60, smokers, alcoholics, and those with a prolonged hospital, ICU or ventilator stay are more prone to developing lung fibrosis. These patients will require oxygen support often for months after recovery. 'I have patients who need oxygen at home for 2-3 months. Some cannot take a flight of steps or walk for more than 10 minutes at a go even six months after recovery,' says Dr Abhuday Dasgupta, a pulmonologist in fibrosis can be a permanent problem for many Covid survivors. Classifying them into two types, Dr Rajesh Chawla, a pulmonologist at the Apollo Hospital in Delhi, says, 'One is immediate post-Covid fibrosis, which usually resolves on its own. But some people may develop permanent and irreversible fibrosis. However, it is too soon to tell since it has only been a year and a half of Covid.' As for those who experienced severe Covid infection in the lungs, experts say that only time will tell how long their Long Covid will ON OTHER ORGANSBesides the heart and lungs, the brain and kidneys are the two other vital organs at risk from Long Covid. Blood clots travelling to both these organs have been found in the post-mortems of several patients. 'Patients shouldn't get alarmed by any symptom, but they should also not be in denial. Any symptom such as fever, fatigue, bodyache, breathlessness, or anything else where you feel your body isn't functioning as it used to or anything that causes distress to your daily movement, should be reported, investigated and treated,' says Dr and brain fog are being associated with Long Covid. However, according to doctors, brain fog, where people find it difficult to think clearly for a prolonged period of time, is temporary. Only in rare cases, where people have a predisposition to Parkinson's or other neurological disorders, can Covid lead to their with chronic kidney disease or CKD are another risk group for Long Covid. With hypertension and diabetes patients more prone to CKD, they are likely to have a longer hospital stay in case of Covid. 'CKD compromises your immune system,' says Dr Ingale. 'The risk is even higher for those who have had kidney transplants.'Covid can also lead to acute kidney injury, a condition that requires treatment long after the viral symptoms have eased up. 'Dehydration in Covid patients causes pre-renal injury,' explains Dr Ingale. 'But they recover fast post hydration. Covid-19 is also a precursor to sepsis such as cytokine storms. During this condition, a person can develop acute tubular necrosis or kidney injury. For this category, the recovery is variable, it may not be a hundred per cent and it can take anywhere between two weeks and three there is a third category where patients develop tubulointerstitial nephritis (inflammation in the tubules of the kidney) as a result of certain drugs given for Covid. But if the drugs are stopped in time, then the person recovers well.' The virus itself also causes nephron-glomerulopathies (damage caused to blood vessels in the kidney). 'In China, the virus was found in kidney tissue after post-mortem. We don't know if this was the cause of death but the presence of the virus in the kidney tissue itself suggests a glomerulopathy,' adds Dr millions recover from Covid's lethal second wave, a national database of post-Covid symptoms as well as more post-mortem studies can help doctors better predict the risk factors and symptoms for Long Covid. As Dr Guleria recommends, 'We need a research-backed multi-disciplinary approach towards post-Covid care. The virus does not spare any organ.'Last August, the Rajiv Gandhi Super Speciality Hospital became the first in the country to open an OPD exclusively for patients who had recovered from Covid. The OPD services have continued through the second wave this year. Farooq Mohammad, 48, a cab driver, came all the way from Lucknow to get post-Covid treatment here. 'I recovered from Covid at the end of March this year,' he says. 'Throughout April, I had terrible fatigue and weakness; on some nights, my joints felt as though they would break. But there were very few OPD services available for those who weren't Covid-positive. I didn't need medicines, I needed physiotherapy. I stayed with my family in Delhi while I took physiotherapy for body pain.''When patients have issues after recovery, it is a crucial time as they need medical care and supervision,' says director Dr Sherwal. 'Else, even if there is no direct threat to life, Long Covid can reduce the quality of a person's life.' Besides blood investigations and personal counselling, physiotherapy for patients with lung fibrosis is much sought-after at the hospital. 'Patients with even 10 per cent fibrosis have difficulty breathing,' says Dr Sherwal. 'We improve their lung capacity through various breathing exercises.'Secondary infections, too, are common among recovered patients and heighten the chances of mortality. The latest ICMR study demonstrates that the mortality is 56.7 per cent higher in those who develop secondary infections post-Covid. Blood and respiratory sites are the most common for such infection. 'Covid is one of the most dynamic diseases; it is hard to say how any one individual will respond to it. The challenge, therefore, is while they might recover after 14 days, the underlying damage is very hard to predict,' says Dr Sriram Satya, CEO of preventive health at the Apollo Hospital in to experts, there are three categories of Covid survivors and you will not know which one you fall in until you get tested. The first comprises those who immediately feel better after Covid, whose energies may be on the lower side but whose symptoms have subsided and they can engage in daily tasks. The second includes patients who have prolonged symptoms and for whom even walking at a reasonable pace is difficult; they might also experience brain fog, pain and more intense fatigue. The third category consists of those undergoing physiological change without realising it—rising blood pressure, uncontrolled sugar levels or patients in the first category, doctors advise regular blood monitoring as a simple precaution. 'We have a set of investigations that can be done from home itself, since many patients don't want to come to the hospital even after having had Covid. Based on these, a doctor can advise if further tests are needed,' says Dr Satya. Blood tests should cover the liver, kidney, heart, as well as basic metabolic disorders and blood profile. These should be done four to eight weeks after quarantine has ended.'Covid plays such havoc that you want to let the symptoms settle down before investigating long-term damage,' she explains. Dr Megha Jaina, a clinical nutritionist with the Max Hospital in Saket, Delhi, says that nutrition plays an enormous role in post-Covid recovery (see Menu for Recovery). 'For the first time, I am getting patients who aren't interested in weight loss. Now people want to know how food can improve health and mitigate symptoms of Long Covid,' she in the second and third categories require longer term and systematic rehabilitation. Experts advise that they continue in-person doctor consultations and monitor vital organs. The Apollo Hospital in Chennai has a package for such patients, and has in the past two months received 1,000 requests. While it is still too early to tell the success rate, Dr Satya says, 'We are certainly seeing a reduction and control of some symptoms.'The rehabilitation process can take anywhere between three and six months, according to most doctors, but depends largely on the severity of Covid symptoms along with a patient's medical history and lifestyle. 'Post-Covid wellness is crucial for all patients—to control long-lasting symptoms and to predict any additional risks that may develop after a few weeks,' says Dr Satya. Patients who develop lung fibrosis need a pulmonary physiotherapist for lung exercises, as they cannot be replicated at home. Others find yoga and pranayama useful to improve fatigue symptoms and ease their bodies back into daily routine.'You have to reorganise your life, keeping in mind that you had Covid,' says Dr Ingale. It is a piece of advice she has given to thousands of patients in the past year and a half. Patience, planned activity, a healthy diet, rest, regular medical check-ups and sustained effort towards your health are the only way to end Covid for good. Indeed, there are no short-cuts to treating Long to India Today MagazineMust Watch
Hindustan Times
24-05-2025
- Business
- Hindustan Times
Who is Harvard President Alan Garber and what is his salary?
Alan Garber, current president of Harvard, has been making headlines recently due to his stance against the Trump administration's efforts tp revoke the college's Student and Exchange Visitor Program (SEVP) and deny it up to $2.3 million in federal grants. Born in 1955 in Rock Island, Illinois, to a Jewish family, Garber's association with Harvard has spanned well over five decades. After passing out from Rock Island High School in 1973, he then went on to graduate summa cum laude from Harvard with an AB in Economics in 1976 and an AM in Economics in 1977. In 1982, he further earned a PhD in Economics from the same university, along with receiving an MD with research honors from Stanford University School of Medicine in the same year. This was followed by his employment as a faculty member at Stanford University from 1986 to 2011. Read More: US judge blocks Trump administration's move to revoke Harvard's international student enrolment rights Graber then joined Harvard as provost and chief academic officer in 2011. He took over as the university's interim president on January 2, 2024 following then-president Claudine Gray's resignation amid concerns over her handling of pro-Palestinian and antisemitism sentiments on campus. Owing to his proven leadership and conflict management skills, he was named president on August 2, 2024. Harvard's official website currently describes Garber as, 'the Mallinckrodt Professor of Health Care Policy at Harvard Medical School, a Professor of Economics in the Harvard Faculty of Arts and Sciences, Professor of Public Policy in the Harvard Kennedy School of Government, and Professor in the Department of Health Policy and Management in the Harvard T.H. Chan School of Public Health. An economist and physician, he studies methods for improving health care productivity and health care financing.' Read More: Mark Carney's daughter, Belgian royal among high-profile Harvard students affected by Trump's move Though Garber's exact salary for FY2025 remains undisclosed, according to Harvard's most recent publicly available tax filing, he earned more than $1.1 million a year in compensation as provost. In order to deal with the drastic cuts in university budget due to the freezing of federal funds, Garber recently announced his decision to take a voluntary 25% cut in his paycheck. Several senior administrators have also agreed to follow in his footsteps and take voluntary cuts in pay to ease the university's financial burden. In other cost-cutting measures, Harvard froze all staff hiring in March, urged schools to reduce discretionary spending, paused taking up multi-year commitments, and halted capital projects. Merit-based pay raises for faculty and union staff for FY2026 are to be discontinued, according to an announcement made in April, and the Faculty of Arts and Sciences has been instructed to create backup plans to deal with budget shortfalls. About 80 faculty members across various academic units have pledged 10% of their salaries to Harvard for up to a year if they continue to resist fiscal threats from the federal government. Garber had last taken a voluntary 25% pay cut in 2020 to deal with the financial blowback faced by the university due to COVID-19.
Yahoo
20-05-2025
- Health
- Yahoo
Biden's cancer raises questions around screening, timing
Former President Biden's aggressive prostate cancer diagnosis is raising questions about whether warning signs could have been caught earlier, and if the current screening recommendations should be changed. Prostate cancer is one of the most common types of cancer in older men. One in every eight men will be diagnosed in his lifetime. According to the American Cancer Society, prostate cancer kills 35,000 a year, meaning a man dies from prostate cancer every 15 minutes. Biden's diagnosis is serious, and while treatable, it can't be cured. Prostate cancer experts said it's unclear how long Biden has had cancer. Even if he was screened regularly in recent years, they said it's not uncommon for cancer to develop without notable symptoms. 'Cancer doesn't necessarily follow a rule book. It's possible that this came out of the blue, because cancer can do that,' said Alicia Morgans, a prostate cancer specialist at the Dana-Farber Cancer Institute, and board member of the advocacy group ZERO Prostate Cancer. Doctors diagnosed Biden with a prostate nodule last week after he experienced increasing urinary symptoms. By Friday, he was diagnosed with cancer that had metastasized to his bones. It's not clear if the symptoms were due to cancer, or if the nodule was found as part of a routine screening. Morgans said even if Biden had been getting regular screening, it is an imperfect science. 'Sometimes our tests are imperfect. And even if we're doing perfect blood tests and perfect imaging and perfect everything, we don't find things,' she said. Biden left office as the oldest serving president in history, consistently dogged by concerns over his physical health and mental acuity. Prior to the diagnosis last week, his most recent medical update came in February 2024, when he was declared 'fit to serve' after a routine physical at Walter Reed National Military Medical Center. The public summary of his visit listed several tests doctors performed, but not a prostate-specific antigen (PSA) test. That's not surprising, said Geoffrey Sonn, an associate professor of urology at Stanford University School of Medicine. 'Really, there's not many people out there that will advocate for continuing aggressive PSA screening for men in their 80s,' he said. 'In retrospect, I think that it's likely that if he had continued screening against pretty much all guidelines, that they probably would have found this earlier.' Current cancer screening guidelines are complicated, and Biden's case echoes a tension; it's best if the cancer is caught early, but there needs to be a balance between early detection and overtreatment. The American Cancer Society does not recommend routine testing for men at any age. Instead, it recommends men have a conversation with their health provider about the benefits, risks and uncertainties of screening starting at age 40 for those at highest risk, and age 50 for men at average risk. The U.S. Preventive Services Task Force, an independent panel of experts that makes recommendations on services like screenings, suggests men ages 55 to 69 make an 'individual' decision after first discussing it with their provider. The 'shared decisionmaking' recommendation generally stops at age 70 and older, because prostate cancer is slow-growing and physicians don't see a clinical benefit in doing a screening for people with only 10 to 15 years of life expectancy. 'One of the reasons that you don't want to screen older men is they're so likely to have prostate cancer, even though it's that benign-ish prostate cancer that's never going to kill them,' said Otis Brawley, a medical oncologist at Johns Hopkins University who treats patients with metastatic prostate cancer. 'I've seen an awful lot of guys have a lot of mental torment and a lot of physical torment because they were diagnosed with a prostate cancer that all the doctors knew was a cancer that was never going to bother them if It was left alone,' Brawley said. President Trump had his PSA levels tested in April, according to the White House. They were normal. Speaking to reporters at the White House on Monday afternoon, Trump questioned whether Biden was tested, and why the cancer wasn't caught sooner. Behfar Ehdaie, a urological surgeon at Memorial Sloan Kettering Cancer Center in New York, said while it's difficult to provide an accurate assessment of Biden's prognosis, men typically are not screened for prostate cancer after the age of 70, unless they show symptoms. In Biden's case, for example, frequent urination prompted a screening. And while Ehdaie was cautious about discussing Biden's case specifically, more generally, he said 'in many cases, this type of cancer is treatable' even in someone in their 80s, such as the former president, who is 82. Still Ehdaie added, 'the goal is to discover it and detect it early.' A spokesperson for Biden did not respond to questions about when he was last screened for the cancer. Politically, the timing of the announcement from Biden's team raised some eyebrows among Democrats and Republicans. Democrats have blamed their record-low polling numbers in part on a perception that Biden and his team covered up the former president's age-related health decline. A new book on Biden's decline by CNN's Jake Tapper and Axios's Alex Thompson, set for release on Tuesday, is sure to exacerbate the Democratic blame game. However, even Democrats who had blamed Biden for causing Trump's victory in November called for a more respectful and muted response. 'Joe Biden has given so much to this country, it's time for us to give him some time and space to focus on his health,' Democratic strategist Jamal Simmons told The Hill. 'This isn't a time for politics.' But they were skeptical that Biden's diagnosis would ultimately change the narrative. 'It is politics, I expect them to use anything they think will keep the base happy and give them an advantage,' one longtime Biden ally said. 'I've never known that side to think there was much of a line.' Since the revelation of Biden's cancer diagnosis on Sunday, Trump and his aides have tried to thread a needle on the delicate issue. In a statement on Sunday, Trump said that he and first lady Melania Trump were 'saddened' to hear about Biden's diagnosis. 'We wish Joe a fast and successful recovery.' However, in his remarks to reporters Monday, President Trump drew a link between the cancer diagnosis and reports of Biden's circle hiding his decline. And he asked why it wasn't caught sooner. Earlier in the day, Vice President Vance questioned Biden's overall health during his time as president. 'We can pray for good health but also recognize that if you're not in good enough health to do the job, you shouldn't be doing the job.' Doctors not involved in Biden's care said they did not see any signs of a missed diagnosis. 'Nothing about his story sounds to me as if there's been a cover-up or a delay, or anything that is untoward,' said Morgans. 'It really sounds like an unfortunate case of prostate cancer diagnosed just a hair too late to cure in a man who also happened to be the President of the United States very recently, and now has a very real-world problem that he and his family have to tackle.' Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
The Hill
19-05-2025
- Health
- The Hill
Biden's cancer raises questions around screening, timing
Former President Biden's aggressive prostate cancer diagnosis is raising questions about whether warning signs could have been caught earlier, and if the current screening recommendations should be changed. Prostate cancer is one of the most common types of cancer in older men. One in every eight men will be diagnosed in his lifetime. According to the American Cancer Society, prostate cancer kills 35,000 a year, meaning a man dies from prostate cancer every 15 minutes. Biden's diagnosis is serious, and while treatable, it can't be cured. Prostate cancer experts said it's unclear how long Biden has had cancer. Even if he was screened regularly in recent years, they said it's not uncommon for cancer to develop without notable symptoms. 'Cancer doesn't necessarily follow a rule book. It's possible that this came out of the blue, because cancer can do that,' said Alicia Morgans, a prostate cancer specialist at the Dana-Farber Cancer Institute, and board member of the advocacy group ZERO Prostate Cancer. Doctors diagnosed Biden with a prostate nodule last week after he experienced increasing urinary symptoms. By Friday, he was diagnosed with cancer that had metastasized to his bones. It's not clear if the symptoms were due to cancer, or if the nodule was found as part of a routine screening. Morgans said even if Biden had been getting regular screening, it is an imperfect science. 'Sometimes our tests are imperfect. And even if we're doing perfect blood tests and perfect imaging and perfect everything, we don't find things,' she said. Biden left office as the oldest serving president in history, consistently dogged by concerns over his physical health and mental acuity. Prior to the diagnosis last week, his most recent medical update came in February 2024, when he was declared 'fit to serve' after a routine physical at Walter Reed National Military Medical Center. The public summary of his visit listed several tests doctors performed, but not a prostate-specific antigen (PSA) test. That's not surprising, said Geoffrey Sonn, an associate professor of urology at Stanford University School of Medicine. 'Really, there's not many people out there that will advocate for continuing aggressive PSA screening for men in their 80s,' he said. 'In retrospect, I think that it's likely that if he had continued screening against pretty much all guidelines, that they probably would have found this earlier.' Current cancer screening guidelines are complicated, and Biden's case echoes a tension; it's best if the cancer is caught early, but there needs to be a balance between early detection and overtreatment. The American Cancer Society does not recommend routine testing for men at any age. Instead, it recommends men have a conversation with their health provider about the benefits, risks and uncertainties of screening starting at age 40 for those at highest risk, and age 50 for men at average risk. The U.S. Preventive Services Task Force, an independent panel of experts that makes recommendations on services like screenings, suggests men ages 55 to 69 make an 'individual' decision after first discussing it with their provider. The 'shared decisionmaking' recommendation generally stops at age 70 and older, because prostate cancer is slow-growing and physicians don't see a clinical benefit in doing a screening for people with only 10 to 15 years of life expectancy. 'One of the reasons that you don't want to screen older men is they're so likely to have prostate cancer, even though it's that benign-ish prostate cancer that's never going to kill them,' said Otis Brawley, a medical oncologist at Johns Hopkins University who treats patients with metastatic prostate cancer. 'I've seen an awful lot of guys have a lot of mental torment and a lot of physical torment because they were diagnosed with a prostate cancer that all the doctors knew was a cancer that was never going to bother them if It was left alone,' Brawley said. President Trump had his PSA levels tested in April, according to the White House. They were normal. Speaking to reporters at the White House on Monday afternoon, Trump questioned whether Biden was tested, and why the cancer wasn't caught sooner. Behfar Ehdaie, a urological surgeon at Memorial Sloan Kettering Cancer Center in New York, said while it's difficult to provide an accurate assessment of Biden's prognosis, men typically are not screened for prostate cancer after the age of 70, unless they show symptoms. In Biden's case, for example, frequent urination prompted a screening. And while Ehdaie was cautious about discussing Biden's case specifically, more generally, he said 'in many cases, this type of cancer is treatable' even in someone in their 80s, such as the former president, who is 82. Still Ehdaie added, 'the goal is to discover it and detect it early.' A spokesperson for Biden did not respond to questions about when he was last screened for the cancer. Politically, the timing of the announcement from Biden's team raised some eyebrows among Democrats and Republicans. Democrats have blamed their record-low polling numbers in part on a perception that Biden and his team covered up the former president's age-related health decline. A new book on Biden's decline by CNN's Jake Tapper and Axios's Alex Thompson, set for release on Tuesday, is sure to exacerbate the Democratic blame game. However, even Democrats who had blamed Biden for causing Trump's victory in November called for a more respectful and muted response. 'Joe Biden has given so much to this country, it's time for us to give him some time and space to focus on his health,' Democratic strategist Jamal Simmons told The Hill. 'This isn't a time for politics.' But they were skeptical that Biden's diagnosis would ultimately change the narrative. 'It is politics, I expect them to use anything they think will keep the base happy and give them an advantage,' one longtime Biden ally said. 'I've never known that side to think there was much of a line.' Since the revelation of Biden's cancer diagnosis on Sunday, Trump and his aides have tried to thread a needle on the delicate issue. In a statement on Sunday, Trump said that he and first lady Melania Trump were 'saddened' to hear about Biden's diagnosis. 'We wish Joe a fast and successful recovery.' However, in his remarks to reporters Monday, President Trump drew a link between the cancer diagnosis and reports of Biden's circle hiding his decline. And he asked why it wasn't caught sooner. Earlier in the day, Vice President Vance questioned Biden's overall health during his time as president. 'We can pray for good health but also recognize that if you're not in good enough health to do the job, you shouldn't be doing the job.' Doctors not involved in Biden's care said they did not see any signs of a missed diagnosis. 'Nothing about his story sounds to me as if there's been a cover-up or a delay, or anything that is untoward,' said Morgans. 'It really sounds like an unfortunate case of prostate cancer diagnosed just a hair too late to cure in a man who also happened to be the President of the United States very recently, and now has a very real-world problem that he and his family have to tackle.'
Yahoo
16-04-2025
- Health
- Yahoo
These Facts About Menopause Will Make You Say "Wait, Why Didn't I Know This?!"
When it comes to women's health, there are many topics that aren't discussed as often as they should be — or discussed without shame. Menopause is, unfortunately, one of the topics, even though an estimated 1.3 million Americans enter menopause each year. The secrecy leads to false information and fear, in addition to unnecessary discomfort for those going through the change. Many people don't even know what menopause is, other than hot flashes (which can be part of it). 'The definition of menopause is one full year without a period in the absence of something else to explain it, like pregnancy,' said Dr. Mary Jane Minkin, a gynecologist at Yale Medicine in Connecticut. And, we only know it's our last period when looking back in time, added Dr. Karen E. Adams, a clinical professor in the department of obstetrics and gynecology at Stanford University School of Medicine in California and the director of Stanford's menopause and healthy aging program. 'When you have your last period, you don't know that's your last period until a year later, and you say, 'Well, I guess that was it,'' Adams added. The average age of menopause in the United States is 52 (and 51 is the average age throughout the world), said Dr. Ella Speichinger, an OB-GYN at University of Missouri Health Care. Menopause is just one day — 'it's the day that you have gone 12 months without a period,' Adams added. After that, you're in post-menopause, which is the phase of life you remain in until you die. There are signs and symptoms associated with this time in life, along with the segments before it. Below, doctors share what they want everyone to know about perimenopause, menopause and post-menopause. 1. The symptoms you likely associate with menopause start during perimenopause, which generally happens in your 40s. 'The buildup to that last period is the perimenopause timeframe, and perimenopause, on average, lasts four to seven years, but it can be one to 10 years,' Adams said. Meaning with menopause at an average age of 52, perimenopause will start for many people in their mid-40s or even early 40s. 'It's not necessarily when you're 55 or 60 that you need to be thinking about this. It could be in your mid-30s that you need to be thinking about it and putting the pieces in place to have that transition go smoothly and go well,' Adams said. (More on that below.) While there's a misconception that symptoms such as hot flashes and night sweats happen once you reach menopausal age, that's not the case. 'Perimenopause often is the most symptomatic time, and people aren't even really aware of it yet. It's not even on their radar screen,' she added. People tend to notice changes to their menstrual cycle, like skipped periods or varying cycle lengths, for example, in addition to hot flashes, night sweats, trouble sleeping, joint pain and brain fog. 'Those are all kind of nonspecific symptoms,' Adams said. You could easily mistake the symptoms of perimenopause for any number of issues that have similar signs. 'It could be your thyroid. It could be that you have major depression, and you need to get that treated. It could be you're developing rheumatoid arthritis ... it could be long COVID,' Adams said. Or, it could be perimenopause. 'There's a lot of different things it could be, but when you have them all together, it's definitely important that people think, 'Wow, this could be perimenopause,'' she said. If you notice these symptoms, it's important to talk to your doctor to figure out what's going on, whether it's perimenopause or not. 2. More than half of people experience PMI during perimenopause, which is kind of like PMS. 'About 65 to 70% of people get a thing called perimenopausal mood instability, or what we call PMI, and that's more common than PMS [premenstrual syndrome], but people have never heard of it, right?' Adams said. 'We all know what PMS is. We talk about it. We know what it is. PMI is more common than PMS, but nobody's ever heard of it,' she added. With PMS, you can generally anticipate when the mood swings, fatigue and cravings will happen, but the same can't be said for PMI. 'It's completely unpredictable because hormone cycling becomes unpredictable in perimenopause, so people wake up every day and they don't know how they're going to feel,' Adams explained, 'they don't know if they're going to be irritable or angry or anxious, or if they're going to feel normal.' This is a major sign that you may be in perimenopause, Adams said. 'If something like that's going on, see a provider and think about treatments that might stabilize that mood stuff,' she added. 3. A doctor can't look at you and say exactly when you'll go through menopause, but it can be genetic (although it isn't always). You probably want to know when exactly you'll start perimenopause and menopause, but the answer isn't cut and dry. However, there are a few things you can turn to for guidance. You can talk to your mom or older sister about when they went through menopause. 'That's helpful, certainly helpful, things tend to run in families,' Minkin noted. Meaning, if your mom and older sister both went through menopause in their early 50s, it's reasonable to think that's when you'd go through menopause, too. But it's not absolute, Minkin said. It could happen earlier or later for you, too. It's also possible for certain medical procedures and surgical treatments to put you in menopause, Adams said. This includes things like some cancer treatments or the removal of the ovaries, Adams said. 4. Menopause causes loss of bone density, but there are things you can do to prepare for that. During menopause, folks experience bone density loss because of the decreased estrogen production in the body. 'A lot of what causes morbidity and mortality in elderly women is bone issues, primarily osteoporosis, so falling and breaking a hip when you're 80 or 85 is an absolute disaster because one in four of those women will die, and another one in four will be permanently disabled,' Adams said. The best thing to do to avoid this is to work on prevention methods earlier, like in your 20s and 30s, to help build up your bone density, Adams noted. 'You can build more bone density by doing more weight-bearing exercise, paying attention to calcium and vitamin D, things like that,' Adams said, 'and then you can actually go into perimenopause and menopause with more bone because you can actually build up your bone density in those years.' 5. The symptoms of menopause are treatable via hormone therapy, but mixed messages created panic among American women. It's estimated that only 5% of women take hormone therapy in the United States. This is the result of lots of mixed messaging about the treatment. In 2002, the Women's Health Initiative released a flawed study that linked estrogen replacement therapy to an increase in breast cancer, 'which is ... absolute bullshit, the study didn't even say that but that was the interpretation, unfortunately, that came out,' Minkin said. As a result, American women in droves stopped taking estrogen replacement therapy, and medical residences stopped teaching about menopause because there was no more estrogen therapy, Minkin said. 'Hormone therapy promotes heart health, promotes bone health and manages the symptoms. So that's another important message, which is there's a very, very effective, good treatment for all these symptoms and a lot of the diseases of aging, and many people are not taking advantage of it,' Adams said. To be clear, there are risks to any medication, Tylenol and ibuprofen included. This goes for hormone therapy, too, which is associated with a higher risk of blood clots and can raise cancer risk in those with certain types of cancer history. While certain groups of people should not take the medication, it is overall safe, experts say. 'The risk of menopausal hormone therapy equates to the same relative risk ... of having more than one drink a day of alcohol,' Speichinger said. 'So me, personally, when I counsel patients about this, I say that there's still risk with hormone therapy, but there's actual true benefit with hormone therapy, and alcohol cannot boast the same benefits,' Speichinger said. Minkin added that there are various forms of hormone therapy available, in addition to other treatments, and they don't all carry the same risks. It's important to talk to your doctor about what's best for you. 6. To help you manage and understand your perimenopause, menopause and post-menopause symptoms, it's important to find a doctor who understands. 'If somebody's looking for a provider, [try] checking on the Menopause Society website because people who are interested in it are registered there,' Speichinger said. 'Anybody who's listed there is somebody who knows about menopause, likes to talk about menopause and can probably help you,' Minkin said. For many people, perimenopause, menopause and post-menopause are isolating times because of the stigma attached to them and the unwritten code of silence surrounding them. But it doesn't need to be and shouldn't be. 7. Many aspects of menopause are pretty intimidating, but there is a real thing called 'menopausal zest.' 'The transition time is hard, and people have to manage that, but there is a real thing called menopausal zest,' Adams said, 'and once people are through the transition, and they are stable on the other side, they are happier.' In fact, post-menopausal folks say they're happier in their relationships, happier at work and more joyful, overall, Adams added. 'That is, I think, also a very important message that menopause is not the end of something. For many people, it's a new beginning. It's a window or a door opening and people reinvent themselves,' she said. Medications and treatments from your doctor can help you get to this point quicker, too, which is yet another reminder not to force yourself to suffer in silence. 'Menopause is inevitable if you live long enough, but suffering is not inevitable, and you don't have to suffer through it,' Adams said. 'In fact, it can be quite liberating.' This article originally appeared on HuffPost.
