I've got a personal situation going on that I want to eventually talk about here, but in summary transphobes and fundamentalist christians hate women and can suck my spiritual dick about it

300+ TOP GYNECOLOGY Interview Questions and Answers

GYNECOLOGY Interview Questions for freshers experienced :-

1. Is some bleeding normal when starting Hormone Replacement Therapy? Yes, it is not uncommon to notice some light spotting during the first 3 months after beginning Hormone Replacement Therapy. Heavy bleeding like your menstrual cycle is not normal and should be reported to the doctor immediately. 2. Should I continue to have a pelvic exam each year if I have had a Hysterectomy? Women should have a yearly physical exam by a physician which includes a pelvic exam and breast exam beginning in their late teens and early twenties. All women should have their cholesterol checked every 3 to 5 years. A yearly mammogram is essential after age 40. Women over 50 need a screening colonoscopy every 5 years. There are different opinions concerning whether women should have a pap smear every year after hysterectomy. You should discuss your individual medical history with your doctor before deciding whether you should continue to get a pap smear after hysterectomy 3. Is there an ovarian tumor with hair and teeth? Dermoid cysts, also known as mature cystic teratomas, are the commonest ovarian tumor. They occur primarily in the reproductive years, but can also occur in children. The tumor has all three germ layers that are seen in the body - ectoderm, mesoderm and endoderm. As such, the tumor has fat, hair and teeth in it. Teratomas sometimes can be very organized and appear to form fetal-like tissues. Dermoids are bilateral 15-20 percent of the time. Treatment is surgical removal prior to torsion or rupture. 4. Is it possible to have a polyp in the uterus? Polyps can form where there is glandular tissue, i.e. in the colon, nose or uterus. Endometrial polyps occur in the uterus and patients will have the symptom of heavymenstrual periods. These polyps can be resected with a simple procedure called hysteroscopy. With a small telescope inserted through the cervix and into the uterus, the polyp can be directly visualized and removed. 5. What should I do if I miss a birth control pill? If you miss one pill, you should take it as soon as you remember and take the next one as usual. If 2 pills are missed during the first 2 weeks of your cycle, then you should take 2 pills a day for the next 2 days and use a back-up method such as a condom for the next 7 days. If 2 pills or more are missed in the 3rd week of the cycle then you should take 2 pills a day for the next 2 days and then complete the pack of pills. You should then begin your new pack on a Sunday. A back-up form of birth control should be used for the next 7 days such as a con.... 6. What are fibroids? Fibroids, also known as leiomyomas, are benign smoothmuscle tumors that occur in the uterus. They grow under the influence of estrogen and progesterone, and are thus seen in the reproductive years. By the age of 40, 40% of women have fibroids. African-American women may be prone to get symptomatic fibroids in their 20’s. With menopause and the decrease in hormones, fibroids also decrease in size. The most common symptom fromfibroids is abnormal bleeding. When fibroids grow, it can also cause pressure symptoms on the bladder, rectum or pelvis. There may be a genetic predisposition to havingfibroids and multiple fibroids. 7. Should I continue to have a pelvic exam each year if I have had aHysterectomy? Women should have a yearly physical exam by a physician which includes a pelvic exam and breast exambeginning in their late teens and early twenties. All women should have their cholesterol checked every 3 to 5 years. A yearly mammogram is essential after age 40. Women over 50 need a screening colonoscopy every 5 years. There are different opinions concerning whether women should have a pap smear every year afterhysterectomy. You should discuss your individual medical history with your doctor before deciding whether you should continue to get a pap smear after hysterectomy 8. Is there an ovarian tumor with hair and teeth? Dermoid cysts, also known as mature cystic teratomas, are the commonest ovarian tumor. They occur primarily in the reproductive years, but can also occur in children. The tumor has all three germ layers that are seen in the body - ectoderm, mesoderm and endoderm. As such, the tumor has fat, hair and teeth in it. Teratomas sometimes can be very organized and appear to form fetal-like tissues. Dermoids are bilateral 15-20 percent of the time. Treatment is surgical removal prior to torsion or rupture. 9. Is irregular bleeding common when starting a new birth control pill? Yes. It can take up to 3 months after switching to new a birth control pill before your menstrual period becomes regular. You should not discontinue your new pills for at least 3 months to see if they are going to begin working. Spotting between your cycle, nausea and occasional vomiting and headaches are all common when starting a new birth control method. 10. Should I continue to have a pelvic exam each year if I have had a Hysterectomy? Women should have a yearly physical exam by a physician which includes a pelvic exam and breast exambeginning in their late teens and early twenties. All women should have their cholesterol checked every 3 to 5 years. A yearly mammogram is essential after age 40. Women over 50 need a screening colonoscopy every 5 years. There are different opinions concerning whether women should have a pap smear every year after hysterectomy. You should discuss your individual medical history with your doctor before deciding whether you should continue to get a pap smear after hysterectomy

GYNECOLOGY Interview Questions 11. Is irregular bleeding common when starting a new birth control pill? Yes. It can take up to 3 months after switching to new a birth control pill before your menstrual period becomes regular. You should not discontinue your new pills for at least 3 months to see if they are going to begin working. Spotting between your cycle, nausea and occasional vomiting and headaches are all common when starting a new birth control method. 12. Can an ovarian cyst be normal? During a woman?s menstrual cycle, ovarian cystformation is normal. These cysts are part of developing an egg to ovulate or to make hormones to support a potential early pregnancy, and are called functional cysts. These type of cysts should disappear with each cycle. I get worried that a cyst is abnormal if it persists for more than 2 cycles, if it is larger than 5 cm, or if it has unusual features such as a septum or solid elements. Sometimes a functional cyst can cause severe pain and internal bleeding if it should rupture internally. This is usually an emergent situation that requires immediate evaluation. 13. If I am no longer having my monthly period because ofmenopause, when should I be worried about new onset vaginalbleeding? If you have not had a menstrual cycle in over 6 months you are probably in the menopause. The loss of your monthly period along with occasional hot flashes or night sweats usually indicate menopause. This begins for most women between the ages of 45 and 52. Any bleedingafter the menopause is considered abnormal and requires evaluation by a doctor immediately. 14. How Is Called The Small Opening Of The Uterus That Sperm Would First Enter? Cervix 15. In Scanning Report Of My Wife At Gender Column It Is Written As Iii, What Is The Meaning? in scanning report both testostorone and progestron hormone found tats why she is not male or female. 16. 35 Year Second Gravida With Single Umbilical Artery And Ctev (club Foot)? ctev is asso. with consanguity, oligohydroamnios, breech presentation and some cong. malformations. single umb. artery is ass. with increased risk for cong. malformation e.g. renal and cardiac. so screening should be done for other cong. malformation 17. 34 Year Old Woman Is Found To Have A Monochorionic Twin Pregnancy At 12 Weeks Gestation In Her First Pregnancy. She Requests Information On The Antenatal Risks To Her And Her Fetuses And Their Management. How Would You Counsel Her? because of the age of the woman, it will be too dificult to countinue the pregnancy. Other than the multiple pregnancy, She have only one plasenta for bothe child. so better she can do LSCS at the onset of labour. Tell the posibilty and de merits of the LSCS to the PT. 18. How Would You Assess And Treat A 52 Year Old Woman Who Complains Of Heavy Prolonged Menstrual Bleeding? It may or maynot be any symptom of ovarian Ca, or fiberus formation of the uterus or any other complications. So better she go for hysteroscopy, and blood study for any infestations of micro organism. check the platelet level in blood, and WBC count and BT,CT . Her age is abow 50. so in this age there is less chance menstuation. 19. A 35 Year Old Woman Has Been Listed For Hysteroscopy. What Are The Indications For Hysteroscopy In A Woman Of This Age? Abnormal uterine bleeding, Habitual abortion, pelvic pain, cancer,GIFT, ZIFT, TET, FIVET, Bone metaplasia of the endometrium are some of the diagnostics observed in this age. 20. What Is The Most Effective Form Of Birth Control? There are many birth control methods on the market today that are highly effective. The primary methods of birth control available include Barrier Methods - Generally speaking, barrier methods do not prevent pregnancy as effectively as hormonal methods or IUD's, and they must be used EVERY TIME that you have sex. Barrier methods Include condoms, sponges, and diaphragms. Hormonal Methods - Statistically very good at preventing pregnancy. Hormonal methods include birth control pills, shots (Depo-Provera), and the vaginal ring. Intrauterine Devices (IUD's) - IUD's are inserted into your uterus, work for 5-10 years at a time, and are a generally safe and effective way to prevent pregnancy. The Mirena IUD contains a hormone that can help with heavy periods and cramping. Natural Family Planning - Also referred to as "fertility awareness," Natural Family Planning can be effective provided that you and your sexual partner are extremely careful, and are especially mindful of what times of the month are best to engage in sexual activity. Women practicing natural family planning are strongly encouraged to keep good records so as to know when they are fertile; and for times when you ARE fertile, you will need to abstain from sex, or use a barrier method. With all of this in mind, it's important to remember that all women are different, and that the best way to find out what method is best for you is by consulting with a licensed OB GYN. GYNOCOLOGY Interview Questions and Answers pdf Download Read the full article

How Do You Deal with Childhood Obesity?

Childhood obesity is fast becoming endemic among modern day children as they increasingly lead a sedentary lifestyle along with bad eating habits. Parents need to take heed to prevent this problem. 

Obesity is a big problem, no matter what age you are. So, when your child is obese, you need to seriously worry because the chances are that your child will become an obese adult and suffer from many health issues related to excess weight.

Therefore, nip the issue of childhood obesity in the bud by following some simple steps, mentioned as follows.

BMI: The first step to beat childhood obesity

Before attempting to right a wrong situation, it is of utmost importance to be completely aware of it. Hence, the first and arguably the most important step is to calculate your child’s body mass index (BMI) to gain an idea about where their current weight lies on the BMI scale.

The BMI of a person is basically means of quantifying the tissue mass in a person’s body by taking their height and weight into consideration.

Obesity prevalence in various age groups was recorded by the CDC as follows:

Age GroupPercentage of obese population2-5 years old13.9%6-11 years old18.4%12-18 years old20.6%

 Calculate the BMI of your child using any of the free online resources available over the internet, and determine which of the various categories—underweight, normal weight, overweight or obese—he or she falls in.

Now that we have assessed the current situation, we may take steps to correct it.

Identify the culprits

This tip involves observing your child’s as well as your own daily habits to figure out the areas where improvement is well overdue. The said areas could be dietary habits, lifestyle choices (like how much time your kids spend outdoors and so on) and even sleeping patterns.

In certain cases of childhood obesity, the cause of obesity may be genetic, and it is highly recommended to consult a physician or a doctor who is well aware of your family history before making any dietary changes.

This step is crucial as not only does it provides valuable insight into what all we are doing wrong, but also saves time by pinpointing the exact problem.

Get rid of all the junk food

This is probably the most common advice received related to weight loss and childhood obesity prevention, but that does not make it any less true. It involves thorough cleaning of the pantry of the house to ensure that only healthy options are available to children, thereby setting them up to make healthier eating choices.

Remove all the junk food from the house, including packaged snacks like chips and cookies. If there is no junk food in the house, the kids cannot consume it, which automatically improves their diet.

Replace the junk food items with healthier alternatives to deal with those in-between-meals hunger pangs. For example, potato chips can be replaced with plantain chips, and normal French fries can give way to sweet potato fries.

Whole wheat donuts and cookies baked at home with healthier ingredients can easily step in for the unhealthier, store-bought alternatives.

Once healthier alternatives are presented to children, it is best to not exercise control over their portions for the first couple of days. This helps the children be more aware of their body and its needs, as well as be more responsible while eating.

Family initiative

Children are more likely to improve their eating habits and do their bit in obesity prevention when they are held accountable by someone else. One of the most important contributors to childhood obesity prevention is the family of the child.

Planning and preparing healthy meals as a family is always a great way to introduce the child to a healthier lifestyle.

Involve the children as much as possible in the food cooking process, and regularly reprise them about the benefits of the healthier alternatives.

Plan outdoor activities that involve physical work as a family. The frequency of said activities can be adjusted according to various factors, to ensure that it always remains enjoyable.

Pets can help prevent your child from getting obese too. Ask your kids to walk the dog on a regular basis, which shall help them get exercise as well.

Most importantly, a family provides the support and encouragement that every child needs, especially while making such drastic changes to their lifestyle. It is always helpful to talk with your kids every once in a while, to understand how they are dealing with the changes and whether they need any changes made or not.

Mix passion with health

The easiest thing for any child to do is to sit around and watch television, and this is where you, as a parent, need to step in. Determine which sport your child is interested in and encourage them to participate in it.

Enroll them in regular classes that involve physical activity, like dance classes or gymnastics, or any such activity.

Map out the hiking trails, parks and wildlife areas around your residence and accompany your child to such places. This not only helps them in losing weight but also instills a love for the outdoors in them by bringing them closer to nature.

Make smart choices

Most people think childhood obesity prevention means banishing all kinds of fat and anything tasty from their diets, which is not the case. Instead of getting rid of all things tasty, it is more important to make smart decisions when it comes to food.

It is important to include the good fats in your diet and eliminate the saturated fats. Unsaturated fats that are healthy, include avocado oil, fish oil, and oils and fats obtained from nuts and seeds.

Saturated fats, however unhealthy, cannot be completely eradicated from our diets. Hence, it is advised to choose them wisely. Saturated fat up to 10 percent are permissible in a person’s diet and do not cause much harm. These include butter, ghee, refined oil as well as nuts like peanuts and cashews.

Sodas and other aerated drinks are heavily calorie-laden and must be replaced with fruit juices and milk wherever possible. This significantly reduces the sugar intake and juices and milk provide other health benefits as well.

Encourage children to eat as much organic produce and whole foods as possible. This helps them to obtain various essential nutrients.

Hence, the process of childhood obesity prevention must begin with a careful assessment of the situation by calculating the body mass index of the child. This should be followed by taking appropriate steps to improve the situation, but the most important thing to do here is to keep trying and not give up. Things shall seem difficult in the beginning, and the children may even act out, but the key here is to keep at it, and sure enough, things shall get better.

QUICK BYTES

Can short-term dieting help a child in battling obesity?

Short-term diets are only helpful in kick-starting the weight loss process, but the child can quickly gain all the weight back if they revert to their old ways. Making lifestyle changes is what leaves a lasting impact.

What are some of the main health consequences for childhood obesity?

Cardiovascular diseases, early onset diabetes and certain types of cancers (like breast and colon cancer) are few of the vast variety of health consequences of childhood obesity.

What is BMI?

BMI stands for body mass index, and it is a method of quantifying the total amount of tissue mass in a person’s body. It is calculated using the person’s height and weight.

How do I replace the high-calorie soft drinks in my child’s diet?

Aerated soft drinks are very high in calorie and should be replaced with fruit juices and milk. Flavoured milk is a tasty yet healthy alternative for sodas.

What are some of the exercises a child should indulge in?

Skipping, running, and even yoga are easy yet effective physical activities a child can easily indulge in.

To get a clearer insight into childhood obesity and know how to prevent childhood obesity, check in with our Truweight Nutritionist and Weight Consultant right here.

 The post How Do You Deal with Childhood Obesity? appeared first on Blog.

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Can Genetic Counselors Keep Up With 23andMe?

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In hindsight, clicking on the email from 23andMe at 10 p.m., alone, on a particularly cold March night probably wasn’t the best idea. Still, Nancy Wurtzel thought she was prepared for the genetic-testing company to give her the news that she had inherited the gene for late-onset Alzheimer’s disease. Both her parents died from it—her father at 86 and her mother at 92.

But when Wurtzel stared at the blue glow of her computer screen announcing she had two copies of the ApoE4 variant and quoting her a 60-percent chance of developing Alzheimer’s by age 85, she panicked. “I could hardly catch my breath, and I felt like the floor was opening up. The reality hit me,” says Wurtzel, a 62-year-old public-relations consultant from Minneapolis. “I thought, ‘What do I do now?’”

What she should have done, she has come to believe, was see a genetic counselor. The 23andMe results included a link from the National Society of Genetic Counselors (NSGC) on where to find one in her area. But Wurtzel dismissed the idea. “I was kind of cocky because I had already done so much research. I thought, ‘What will they tell me that I don’t already know?’” She knew there was nothing she could do to prevent Alzheimer’s (although some research suggests lifestyle changes might delay onset). Besides, she didn’t want to pay $250 to $350 out of pocket for a consultation.

As the field of precision medicine explodes, the nation’s 4,600 genetic counselors have the job of interpreting genetic-testing results for patients and advising them on whether they should get more testing or medical treatment. Or for patients like Wurtzel, they provide reassurance that the presence of a genetic variant doesn’t automatically mean one will get sick later on.

The way genetic counseling has worked for decades is that doctors refer patients to genetic counselors after testing—and often before to go over expectations—and insurance typically covers the visits. With the arrival of direct-to-consumer (DTC) genetic testing like 23andMe, however, people can order so-called spit kits online, return their saliva sample in the mail, and read their results at home several weeks later. Because DTC patients are out of the referral pipeline, they may be on the hook financially for genetic-counseling visits to translate those often confusing and scary results, or left trying to decipher them on their own.

Now genetic counselors are figuring out how to help the growing DTC set, while their field is in transition. As demand for their services grows, the field is facing a national shortage in which there are an estimated two to three jobs available for every graduate of genetic-counselor training programs. To address it, in addition to recruiting future students and expanding training programs, professional societies are at work trying to change the way genetic counselors are viewed in the health-care system. Currently, only eight states allow genetic counselors to directly order tests for patients. To give counselors more professional autonomy industry leaders are calling on Congress and state legislatures to recognize genetic counselors as independent health-care providers. The moves, says NSGC President Erica Ramos, would reflect their growing importance in a field in which scrutinizing our genes is quickly becoming routine.

For the past few months, Taylor Berninger, a genetic counselor in San Diego, has been emailing back and forth with her colleagues about how to cater to 23andMe clients. Unlike traditional patients who visit her because they’re worried about a specific medical condition, she says that DTC patients are more likely to want their DNA decoded out of general curiosity. “The healthy person is trying to determine what kind of disease risk they face in the future,” says Berninger, who works at University of California at San Diego Health. “So they have different questions.” She also finds that they’re more likely to bring in a long health report, including insights on their risk of cardiac disease and what mutations they could pass on to their children. “We decided to ask 23andMe patients to bring us their top three questions. That way they don’t say, ‘Here’s a bunch of data. Tell me what it means!’ It makes the visit less daunting for both of us,” she says.

That amount of data is quickly expanding. A year ago, the U.S. Food and Drug Administration gave the green light for 23andMe to start releasing results to customers about their genetic risks for 10 health conditions, including late-onset Alzheimer’s and Parkinson’s diseases. The company recently added breast cancer to its list, and began informing customers last month of whether they were a carrier for BRCA1/BRCA2 breast-cancer gene mutations. So far, 23andMe has more than 5 million customers, although the company doesn’t release how many have purchased the health reports. Last month, the biotech company PerkinElmer announced it would start offering its clinical test of 59 genes involved in 34 conditions—previously available only to physicians—through the consumer sequencing marketplace Helix, a spin-off of the genomics giant Illumina. And more tests are on the way: FDA Commissioner Scott Gottlieb announced in November the agency had streamlined the process so future products could be approved faster.

This has led to controversy around what information DTC patients should be expected to handle without medical guidance. Last month, the CEO of 23andMe, Anne Wojcicki, wrote an opinion piece in Stat titled, “Consumers Don’t Need Experts to Interpret 23andMe Genetic Risk Reports.” She argues that in this new era of the empowered health consumer, people should be trusted to make rational decisions based on their genetic health risk information. The FDA required 23andMe to “demonstrate that we can deliver genetic risk information to customers in a way they understand,” Wojcicki wrote. “In rigorous studies submitted to the FDA ... we demonstrated user comprehension of 90 percent or greater.”

Yet Kelly Ormond, a genetics professor at the Stanford University Center for Biomedical Ethics, worries that customers won’t understand the nuances or the limitations of their results, especially if their heads are spinning after reading the words breast cancer. “There’s a lot of confusion about what these tests detect,” says Ormond. Case in point: 23andMe tests only for three mutations in the genes associated with breast cancer that are most common in Eastern European Jews. “If you have a family history and don’t know there are other tests that more fully look at those genes and other breast-cancer genes, you might falsely think, ‘I’m off the hook’ if your result comes back negative,” she says. Those other test results help genetic counselors advise patients on when to undergo early screening and whether they should take preventative medication to reduce their risk, adds Scott Weissman, a genetic counselor with Chicago Genetic Consultants in Northbrook, Illinois.

DTC patients are more likely to be caught off guard by worrisome results and need perspective, says Weissman, who’s seen an uptick in 23andMe clients over the last six months. “I often hear, ‘I didn’t realize this was on the test. I don’t know what this means,’” he says. “It’s important for you to know what the information you’re getting can and can’t tell you.” For example, estimates of your genetic disease risk don’t take into account your family history or environmental influences.

Though consumers may well be rational enough to process their own results, Wojcicki’s stance ignores the emotional punch people often experience when they receive upsetting news. “Some people respond with denial and avoidance and tuck away the information. Some are angry, and others are just sad and overwhelmed,” says Berninger.

As the population of genetic-counseling patients has changed and grown, so has the industry that serves them. The profession was born in 1969 when Sarah Lawrence College in New York established the first master’s training program in genetic counseling, and the field today includes specialties in cancer, cardiovascular disease, and fertility. There are 95 percent more genetic counselors in the United States today than there were a decade ago, according to the American Board of Genetic Counseling.

Now the industry is fighting to get the respect it feels it deserves. “It’s really important that genetic counselors are recognized as providing a unique service that becomes more critical as genetics play an increased role in all areas of health care and medicine,” says Ramos. Her organization has drafted a congressional bill seeking to have the Centers for Medicare and Medicaid Services acknowledge genetic counselors as health-care providers and reimburse their services accordingly. It’s also sponsoring bills in state legislatures to have counselors licensed as independent medical practitioners.

The designations would be in line with the NSGC’s latest survey results showing that around 75 percent of genetic counselors provide direct patient care. “That would pave the way for more hospitals to hire them and pay them more competitive salaries,” says Ramos. Although the survey shows that genetic-counseling pay is on the rise—the median was $82,000 in 2018, compared to $75,000 in 2016—that’s lower than other medical professions with similar training. Plus, making genetic counselors more available to Medicare patients would lead to an estimated $4 billion in savings to Medicare over 10 years by relieving higher-priced physicians of counseling duties and preventing unnecessary test orders, according to a study the NSGC commissioned from the health-economics consulting firm Dobson DaVanzo.

In the meantime, start-ups have emerged to fill the information gap for DTC patients by making counseling services more accessible and cheaper. In July, My Gene Counsel plans to launch a digital product that will help users interpret their test results for hereditary cancer genes for a $40 yearly subscription. The service will also send you push notifications as new clinical recommendations or trials become available.

A telemedicine company called Genome Medical offers virtual consultations. For $179, you’re connected with one of 14 genetic counselors (including Weissman) for a 30-minute “Genetic Navigator” session to discuss your concerns before testing, or afterward to decipher your results.

Despite the dizzying growth of testing services, experts still aren’t sure about the right number of genetic counselors needed to serve the population—especially in light of U.S. Bureau of Labor projections that demand for these positions will grow nearly 30 percent between 2016 and 2026. “It’s a very underserved profession. There are so many jobs available and not enough qualified, trained counselors,” says Stephanie Gandomi, the assistant program director for the genetic counseling program at Boise State University, which is launching an online program to help meet that demand. Enrollment in the nation’s 39 genetic-counseling graduate programs has risen from 364 students in 2017 to 402 in 2018, and at least 20 new programs are slated to begin enrolling students in the next few years, according to industry data. The industry’s goal: to have one counselor per 100,000 people in the United States by 2020.

Genomics companies are also trying to find creative ways to promote genetic counseling as the hot career of the future. Last year, Illumina, the market leader in DNA sequencers, and the nonprofit One San Diego hosted an educational event for about 200 San Diego–area high-school students and commissioned the “Genomics Rap” from the educational music company Music Notes with this lyric: “I’m cracking the code ... Genetic counselor, yeah! My job is working with patients. Help them understand the meaning of their genomic information.”

As more DTC companies tell people about serious health threats lurking in their DNA, including those they are powerless to influence, it remains to be seen how many of these customers will see the need to supplement what they can find on Google with a professional’s perspective.

“Not every single patient needs traditional genetic counseling,” says Ormond, who’s part of a working group that’s developing a model about when to prioritize traditional genetic counseling. For example, if your results revealed you were at risk for a genetic heart condition that needed rapid medical attention or an unexpected condition that’s harder to deal with emotionally, traditional genetic counseling would be appropriate. But for a straightforward test where the results might not impact your health immediately, it might be enough to have a shorter appointment with a counselor, to chat with a primary-care doctor, or even just to watch some educational videos.

Perhaps the genetic counselor of the future will assume an increased role in providing psychological support and comfort. “Some people just want to talk to an unbiased third party who will listen to their story and provide empathy, so they don’t have to keep all their feelings and fears inside,” Weissman says.

Wurtzel, who received her 23andMe results in March that revealed her risk for Alzheimer’s disease, wishes she’d anticipated her need for a sympathetic ear. “I wished someone was there to listen to what I was feeling at the time,” she says. “I don’t advise anyone to do it by themselves.”

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Can Genetic Counselors Keep Up With 23andMe?

In hindsight, clicking on the email from 23andMe at 10 p.m., alone, on a particularly cold March night probably wasn’t the best idea. Still, Nancy Wurtzel thought she was prepared for the genetic-testing company to give her the news that she had inherited the gene for late-onset Alzheimer’s disease. Both her parents died from it—her father at 86 and her mother at 92.

But when Wurtzel stared at the blue glow of her computer screen announcing she had two copies of the ApoE4 variant and quoting her a 60-percent chance of developing Alzheimer’s by age 85, she panicked. “I could hardly catch my breath, and I felt like the floor was opening up. The reality hit me,” says Wurtzel, a 62-year-old public-relations consultant from Minneapolis. “I thought, ‘What do I do now?’”

What she should have done, she has come to believe, was see a genetic counselor. The 23andMe results included a link from the National Society of General Counselors (NSGC) on where to find one in her area. But Wurtzel dismissed the idea. “I was kind of cocky because I had already done so much research. I thought ‘What will they tell me that I don’t already know?’” She knew there was nothing she could do to prevent it (although some research suggests lifestyle changes might delay onset). Besides, she didn’t want to pay $250 to $350 out of pocket for a consultation.

As the field of precision medicine explodes, the nation’s 4,600 genetic counselors have the job of interpreting genetic-testing results for patients and advising them on whether they should get more testing or medical treatment. Or for patients like Wurtzel, they provide reassurance that the presence of a genetic variant doesn’t automatically mean one will get sick later on.

The way genetic counseling has worked for decades is that doctors refer patients to genetic counselors after testing—and often before to go over expectations—and insurance typically covers the visits. With the arrival of direct-to-consumer (DTC) genetic testing like 23andMe, however, people can order so-called spit kits online, return their saliva sample in the mail, and read their results at home several weeks later. Because DTC patients are out of the referral pipeline, they may be on the hook financially for genetic-counseling visits to translate those often confusing and scary results, or left trying to decipher them on their own.

Now genetic counselors are figuring out how to help the growing DTC set, while their field is in transition. As demand for their services grows, the field is facing a national shortage in which there are an estimated two to three jobs available for every graduate of genetic-counselor training programs. To address it, in addition to recruiting future students and expanding training programs, professional societies are at work trying to change the way genetic counselors are viewed in the health-care system. Currently, only eight states allow genetic counselors to directly order tests for patients. To change this, and other practices, industry leaders are calling on Congress and state legislatures to recognize genetic counselors as independent health-care providers. The moves, says NSGC President Erica Ramos, would give counselors more professional autonomy and reflect their growing importance in a field in which scrutinizing our genes is quickly becoming routine.

For the past few months, Taylor Berninger, a genetic counselor in San Diego, has been emailing back and forth with her colleagues about how to cater to 23andMe clients. Unlike traditional patients who visit her because they’re worried about a specific medical condition, she says that DTC patients are more likely to want their DNA decoded out of general curiosity. “The healthy person is trying to determine what kind of disease risk they face in the future,” says Berninger, who works at University of California at San Diego Health. “So they have different questions.” She also finds that they’re more likely to bring in a long health report, including insights on their risk of cardiac disease and what mutations they could pass on to their children. “We decided to ask 23andMe patients to bring us their top three questions. That way they don’t say, ‘Here’s a bunch of data. Tell me what it means!’ It makes the visit less daunting for both of us,” she says.

That amount of data is quickly expanding. A year ago, the U.S. Food and Drug Administration gave the green light for 23andMe to start releasing results to customers about their genetic risks for 10 health conditions, including late-onset Alzheimer’s and Parkinson’s diseases. The company recently added breast cancer to its list, and began informing customers last month of whether they were a carrier for BRCA1/BRCA2 breast cancer gene mutations. So far, 23andMe has more than 5 million customers, although the company doesn’t release how many have purchased the health reports. Last month, the biotech company PerkinElmer announced it would start offering its clinical test of 59 genes involved in 34 conditions—previously available only to physicians—through the consumer sequencing marketplace Helix, a spin-off of the genomics giant Illumina. And more tests are on the way: FDA Commissioner Scott Gottlieb announced in November the agency had streamlined the process so future products could be approved faster.

This has led to controversy around what information DTC patients should be expected to handle without medical guidance. Last month, the CEO of 23andMe, Anne Wojcicki, wrote an opinion piece in Stat titled “Consumers Don’t Need Experts to Interpret 23andMe Genetic Risk Reports.” She argues that in this new era of the empowered health consumer, people should be trusted to make rational decisions based on their genetic health-risk information. The FDA required 23andMe to “demonstrate that we can deliver genetic risk information to customers in a way they understand,” Wojcicki wrote. “In rigorous studies submitted to the FDA ... we demonstrated user comprehension of 90 percent or greater.”

Yet Kelly Ormond, a genetics professor at the Stanford University Center for Biomedical Ethics, worries that customers won’t understand the nuances or the limitations of their results, especially if their heads are spinning after reading the words breast cancer. “There’s a lot of confusion about what these tests detect,” says Ormond. Case in point: 23andMe tests only for three mutations in the genes associated with breast cancer that are most common in Eastern European Jews. “If you have a family history and don’t know there are other tests that more fully look at those genes and other breast-cancer genes, you might falsely think, ‘I’m off the hook’ if your result comes back negative,” she says. Those other test results help genetic counselors advise patients on when to undergo early screening and whether they should take preventative medication to reduce their risk, adds Scott Weissman, a genetic counselor with Chicago Genetic Consultants in Northbrook, Illinois.

DTC patients are more likely to be caught off guard by worrisome results and need perspective, says Weissman, who’s seen an uptick in 23andMe clients over the last six months. “I often hear, ‘I didn’t realize this was on the test. I don’t know what this means,’” he says. “It’s important for you to know what the information you’re getting can and can’t tell you.” For example, estimates of your genetic disease risk don’t take into account your family history or environmental influences.

Though consumers may well be rational enough to process their own results, Wojcicki’s stance ignores the emotional punch people often experience when they receive upsetting news. “Some people respond with denial and avoidance and tuck away the information. Some are angry, and others are just sad and overwhelmed,” says Berninger.

As the population of genetic counseling patients has changed and grown, so has the industry that serves them. The profession was born in 1969 when Sarah Lawrence College in New York established the first master’s training program in genetic counseling, and the field today includes specialties in cancer, cardiovascular disease, and fertility. There are 95 percent more genetic counselors in the United States today than there were a decade ago, according to the American Board of Genetic Counseling.

Now the industry is fighting to get the respect it feels it deserves. “It’s really important that genetic counselors are recognized as providing a unique service that becomes more critical as genetics play an increased role in all areas of health care and medicine,” says Ramos. Her organization has drafted a congressional bill seeking to have the Centers for Medicare and Medicaid Services acknowledge genetic counselors as health-care providers and reimburse their services accordingly. It’s also sponsoring bills in state legislatures to have counselors licensed as independent medical practitioners.

The designations would be in line with the NSGC’ s latest survey results showing that around 75 percent of genetic counselors provide direct patient care. “That would pave the way for more hospitals to hire them and pay them more competitive salaries,” says Ramos. Although the survey shows that genetic counseling pay is on the rise—the median was $82,000 in 2018, compared to $75,000 in 2016—that’s lower than other medical professions with similar training. Plus, making genetic counselors more available to Medicare patients would lead to an estimated $4 billion in savings to Medicare over 10 years by relieving higher-priced physicians of counseling duties and preventing unnecessary test orders, according to a study the NSGC commissioned from the health-economics consulting firm Dobson DaVanzo.

In the meantime, start-ups have emerged to fill the information gap for DTC patients by making counseling services more accessible and cheaper. In July, My Gene Counsel plans to launch a digital product that will help users interpret their test results for hereditary cancer genes for a $40 yearly subscription. The service will also send you push notifications as new clinical recommendations or trials become available.

A telemedicine company called Genome Medical offers virtual consultations. For $179, you’re connected with one of 14 genetic counselors (including Weissman) for a 30-minute “Genetic Navigator” session to discuss your concerns before testing, or afterwards to decipher your results.

Despite the dizzying growth of testing services, experts still aren’t sure about the right number of genetic counselors needed to serve the population—especially in light of U.S. Bureau of Labor projections that demand for these positions will grow nearly 30 percent between 2016 and 2026. “It’s a very underserved profession. There are so many jobs available and not enough qualified, trained counselors,” says Stephanie Gandomi, the assistant program director for the genetic counseling program at Boise State University, which is launching an online program to help meet that demand. Enrollment in the nation’s 39 genetic-counseling graduate programs has risen from 364 students in 2017 to 402 in 2018, and at least 20 new programs are slated to begin enrolling students in the next few years, according to industry data. The industry’s goal: to have one counselor per 100,000 people in the United States by 2020.

Genomics companies are also trying to find creative ways to promote genetic counseling as the hot career of the future. Last year, Illumina, the market leader in DNA sequencers, and the nonprofit One San Diego hosted an educational event for about 200 San Diego–area high-school students and commissioned the “Genomics Rap” from the educational music company Music Notes with this lyric: “I’m cracking the code ... Genetic counselor, yeah! My job is working with patients. Help them understand the meaning of their genomic information.”

As more DTC companies tell people about serious health threats lurking in their DNA, including those they are powerless to influence, it remains to be seen how many of these customers will see the need to supplement what they can find on Google with a professional’s perspective.

“Not every single patient needs traditional genetic counseling,” says Ormond, who’s part of a working group that’s developing a model about when to prioritize traditional genetic counseling. For example, if your results revealed you were at risk for a genetic heart condition that needed rapid medical attention or an unexpected condition that’s harder to deal with emotionally, traditional genetic counseling would be appropriate. But for a straightforward test where the results might not impact your health immediately, it might be enough to have a shorter appointment with a counselor, to chat with a primary care doctor, or even just to watch some educational videos.

Perhaps the genetic counselor of the future will assume an increased role in providing psychological support and comfort. “Some people just want to talk to an unbiased third party who will listen to their story and provide empathy, so they don’t have to keep all their feelings and fears inside,” Weissman says.

Wurtzel, who received her 23andMe results in March that revealed her risk for Alzheimer’s disease, wishes she’d anticipated her need for a sympathetic ear. “I wished someone was there to listen to what I was feeling at the time,” she says. “I don’t advise anyone to do it by themselves.”

from Health News And Updates https://www.theatlantic.com/health/archive/2018/05/can-genetic-counselors-keep-up-with-23andme/560837/?utm_source=feed

Can Genetic Counselors Keep up With 23andMe?

In hindsight, clicking on the email from 23andMe at 10 p.m., alone, on a particularly cold March night probably wasn’t the best idea. Still, Nancy Wurtzel thought she was prepared for the genetic-testing company to give her the news that she had inherited the gene for late-onset Alzheimer’s disease. Both her parents died from it—her father at 86 and her mother at 92.

But when Wurtzel stared at the blue glow of her computer screen announcing she had two copies of the ApoE4 variant and quoting her a 60-percent chance of developing Alzheimer’s by age 85, she panicked. “I could hardly catch my breath, and I felt like the floor was opening up. The reality hit me,” says Wurtzel, a 62-year-old public-relations consultant from Minneapolis. “I thought, ‘What do I do now?’”

What she should have done, she has come to believe, was see a genetic counselor. The 23andMe results included a link from the National Society of General Counselors (NSGC) on where to find one in her area. But Wurtzel dismissed the idea. “I was kind of cocky because I had already done so much research. I thought ‘What will they tell me that I don’t already know?’” She knew there was nothing she could do to prevent it (although some research suggests lifestyle changes might delay onset). Besides, she didn’t want to pay $250 to $350 out of pocket for a consultation.

As the field of precision medicine explodes, the nation’s 4,600 genetic counselors have the job of interpreting genetic-testing results for patients and advising them on whether they should get more testing or medical treatment. Or for patients like Wurtzel, they provide reassurance that the presence of a genetic variant doesn’t automatically mean one will get sick later on.

The way genetic counseling has worked for decades is that doctors refer patients to genetic counselors after testing—and often before to go over expectations—and insurance typically covers the visits. With the arrival of direct-to-consumer (DTC) genetic testing like 23andMe, however, people can order so-called spit kits online, return their saliva sample in the mail, and read their results at home several weeks later. Because DTC patients are out of the referral pipeline, they may be on the hook financially for genetic-counseling visits to translate those often confusing and scary results, or left trying to decipher them on their own.

Now genetic counselors are figuring out how to help the growing DTC set, while their field is in transition. As demand for their services grows, the field is facing a national shortage in which there are an estimated two to three jobs available for every graduate of genetic-counselor training programs. To address it, in addition to recruiting future students and expanding training programs, professional societies are at work trying to change the way genetic counselors are viewed in the health-care system. Currently, only eight states allow genetic counselors to directly order tests for patients. To change this, and other practices, industry leaders are calling on Congress and state legislatures to recognize genetic counselors as independent health-care providers. The moves, says NSGC President Erica Ramos, would give counselors more professional autonomy and reflect their growing importance in a field in which scrutinizing our genes is quickly becoming routine.

For the past few months, Taylor Berninger, a genetic counselor in San Diego, has been emailing back and forth with her colleagues about how to cater to 23andMe clients. Unlike traditional patients who visit her because they’re worried about a specific medical condition, she says that DTC patients are more likely to want their DNA decoded out of general curiosity. “The healthy person is trying to determine what kind of disease risk they face in the future,” says Berninger, who works at University of California at San Diego Health. “So they have different questions.” She also finds that they’re more likely to bring in a long health report, including insights on their risk of cardiac disease and what mutations they could pass on to their children. “We decided to ask 23andMe patients to bring us their top three questions. That way they don’t say, ‘Here’s a bunch of data. Tell me what it means!’ It makes the visit less daunting for both of us,” she says.

That amount of data is quickly expanding. A year ago, the U.S. Food and Drug Administration gave the green light for 23andMe to start releasing results to customers about their genetic risks for 10 health conditions, including late-onset Alzheimer’s and Parkinson’s diseases. The company recently added breast cancer to its list, and began informing customers last month of whether they were a carrier for BRCA1/BRCA2 breast cancer gene mutations. So far, 23andMe has more than 5 million customers, although the company doesn’t release how many have purchased the health reports. Last month, the biotech company PerkinElmer announced it would start offering its clinical test of 59 genes involved in 34 conditions—previously available only to physicians—through the consumer sequencing marketplace Helix, a spin-off of the genomics giant Illumina. And more tests are on the way: FDA Commissioner Scott Gottlieb announced in November the agency had streamlined the process so future products could be approved faster.

This has led to controversy around what information DTC patients should be expected to handle without medical guidance. Last month, the CEO of 23andMe, Anne Wojcicki, wrote an opinion piece in Stat titled “Consumers Don’t Need Experts to Interpret 23andMe Genetic Risk Reports.” She argues that in this new era of the empowered health consumer, people should be trusted to make rational decisions based on their genetic health-risk information. The FDA required 23andMe to “demonstrate that we can deliver genetic risk information to customers in a way they understand,” Wojcicki wrote. “In rigorous studies submitted to the FDA ... we demonstrated user comprehension of 90 percent or greater.”

Yet Kelly Ormond, a genetics professor at the Stanford University Center for Biomedical Ethics, worries that customers won’t understand the nuances or the limitations of their results, especially if their heads are spinning after reading the words breast cancer. “There’s a lot of confusion about what these tests detect,” says Ormond. Case in point: 23andMe tests only for three mutations in the genes associated with breast cancer that are most common in Eastern European Jews. “If you have a family history and don’t know there are other tests that more fully look at those genes and other breast-cancer genes, you might falsely think, ‘I’m off the hook’ if your result comes back negative,” she says. Those other test results help genetic counselors advise patients on when to undergo early screening and whether they should take preventative medication to reduce their risk, adds Scott Weissman, a genetic counselor with Chicago Genetic Consultants in Northbrook, Illinois.

DTC patients are more likely to be caught off guard by worrisome results and need perspective, says Weissman, who’s seen an uptick in 23andMe clients over the last six months. “I often hear, ‘I didn’t realize this was on the test. I don’t know what this means,’” he says. “It’s important for you to know what the information you’re getting can and can’t tell you.” For example, estimates of your genetic disease risk don’t take into account your family history or environmental influences.

Though consumers may well be rational enough to process their own results, Wojcicki’s stance ignores the emotional punch people often experience when they receive upsetting news. “Some people respond with denial and avoidance and tuck away the information. Some are angry, and others are just sad and overwhelmed,” says Berninger.

As the population of genetic counseling patients has changed and grown, so has the industry that serves them. The profession was born in 1969 when Sarah Lawrence College in New York established the first master’s training program in genetic counseling, and the field today includes specialties in cancer, cardiovascular disease, and fertility. There are 95 percent more genetic counselors in the United States today than there were a decade ago, according to the American Board of Genetic Counseling.

Now the industry is fighting to get the respect it feels it deserves. “It’s really important that genetic counselors are recognized as providing a unique service that becomes more critical as genetics play an increased role in all areas of health care and medicine,” says Ramos. Her organization has drafted a congressional bill seeking to have the Centers for Medicare and Medicaid Services acknowledge genetic counselors as health-care providers and reimburse their services accordingly. It’s also sponsoring bills in state legislatures to have counselors licensed as independent medical practitioners.

The designations would be in line with the NSGC’ s latest survey results showing that around 75 percent of genetic counselors provide direct patient care. “That would pave the way for more hospitals to hire them and pay them more competitive salaries,” says Ramos. Although the survey shows that genetic counseling pay is on the rise—the median was $82,000 in 2018, compared to $75,000 in 2016—that’s lower than other medical professions with similar training. Plus, making genetic counselors more available to Medicare patients would lead to an estimated $4 billion in savings to Medicare over 10 years by relieving higher-priced physicians of counseling duties and preventing unnecessary test orders, according to a study the NSGC commissioned from the health-economics consulting firm Dobson DaVanzo.

In the meantime, start-ups have emerged to fill the information gap for DTC patients by making counseling services more accessible and cheaper. In July, My Gene Counsel plans to launch a digital product that will help users interpret their test results for hereditary cancer genes for a $40 yearly subscription. The service will also send you push notifications as new clinical recommendations or trials become available.

A telemedicine company called Genome Medical offers virtual consultations. For $179, you’re connected with one of 14 genetic counselors (including Weissman) for a 30-minute “Genetic Navigator” session to discuss your concerns before testing, or afterwards to decipher your results.

Despite the dizzying growth of testing services, experts still aren’t sure about the right number of genetic counselors needed to serve the population—especially in light of U.S. Bureau of Labor projections that demand for these positions will grow nearly 30 percent between 2016 and 2026. “It’s a very underserved profession. There are so many jobs available and not enough qualified, trained counselors,” says Stephanie Gandomi, the assistant program director for the genetic counseling program at Boise State University, which is launching an online program to help meet that demand. Enrollment in the nation’s 39 genetic-counseling graduate programs has risen from 364 students in 2017 to 402 in 2018, and at least 20 new programs are slated to begin enrolling students in the next few years, according to industry data. The industry’s goal: to have one counselor per 100,000 people in the United States by 2020.

Genomics companies are also trying to find creative ways to promote genetic counseling as the hot career of the future. Last year, Illumina, the market leader in DNA sequencers, and the nonprofit One San Diego hosted an educational event for about 200 San Diego–area high-school students and commissioned the “Genomics Rap” from the educational music company Music Notes with this lyric: “I’m cracking the code ... Genetic counselor, yeah! My job is working with patients. Help them understand the meaning of their genomic information.”

As more DTC companies tell people about serious health threats lurking in their DNA, including those they are powerless to influence, it remains to be seen how many of these customers will see the need to supplement what they can find on Google with a professional’s perspective.

“Not every single patient needs traditional genetic counseling,” says Ormond, who’s part of a working group that’s developing a model about when to prioritize traditional genetic counseling. For example, if your results revealed you were at risk for a genetic heart condition that needed rapid medical attention or an unexpected condition that’s harder to deal with emotionally, traditional genetic counseling would be appropriate. But for a straightforward test where the results might not impact your health immediately, it might be enough to have a shorter appointment with a counselor, to chat with a primary care doctor, or even just to watch some educational videos.

Perhaps the genetic counselor of the future will assume an increased role in providing psychological support and comfort. “Some people just want to talk to an unbiased third party who will listen to their story and provide empathy, so they don’t have to keep all their feelings and fears inside,” Weissman says.

Wurtzel, who received her 23andMe results in March that revealed her risk for Alzheimer’s disease, wishes she’d anticipated her need for a sympathetic ear. “I wished someone was there to listen to what I was feeling at the time,” she says. “I don’t advise anyone to do it by themselves.”

Article source here:The Atlantic

Final Paper

What is Genetic Counseling and How Will It Affect Our Lives?

The study of genetics has been around since the mid-1800’s, but only in the past one hundred years has science started to understand the mechanisms and impact of genetics. A major leap forward was made in 2003 when The Human Genome Project successfully mapped and quantified all the genes that make up a human’s genome. This project took almost fifteen years to finish and cost 2.7 billion 1991 US dollars, which means today it would have cost over 4.9 billion dollars. Luckily, gene mapping technology has made leaps and bounds in the past fifteen years alone, and today, companies such as 23andMe will map a person’s entire genome for only one hundred and fifty dollars. With this, one can find out not only their genetic predispositions but also their health risks and ancestry. Affordable genetic testing has opened up a whole new world of medicine that is revolutionizing the way you and I diagnose, treat, and prevent future medical crises. A person that specializes in dealing with humanity’s new found power to peer into and understand the genome is a genetic counselor.

So what is a Genetic Counselor, and what do they do exactly? A genetic counselor is a medical professional who is an expert in genetics and has received, at the very least, a master’s degree in genetic counseling from an accredited university. On top of that, most US states require a genetic counselor to be licensed with the American Board of Genetic Counseling, commonly known as the ABGC, which means the counselor has passed a certification test that ensures he or she is competent in their field. As for what a genetic counselor does, their job consists of two distinct duties. The counselor's first duty is the role of diagnosing a genetic condition. The second, and the part where a genetic counselor’s title actually comes from, is the role of counseling a patient on their options and concerns.

For the role of diagnosis, a genetic counselor has a number of invaluable tools at his or her disposal. They include, but are not limited to, familial history, physical exam, medical history, and of course genetic testing. The tool of familial history consists of gathering as much information from the patient about any diseases and conditions that have affected family members. Methods for collection include talking to not only the patient but also any available family members, preferably parents or grandparents. This tool is useful because genetic conditions usually run in a family. For example, if a person is suspected of having early-onset Alzheimer’s, it would be easily diagnosable if their mother or father also did.

A physical exam usually consists of analyzing physical appearance in order to make an inference about a condition. A physical exam is useful because it makes a disease that manifests itself physically easy to diagnosis. For example, if two parents bring in their baby, who is developing slowly, and want to know what is happening, Down syndrome would be easily diagnosed by simply analyzing physical features such as the baby’s height or the distance at which the baby’s eyes are separated with respect to the overall size of his or her face.

The tool of medical history involves analyzing a patient’s history of illness and symptoms to determine if there is possibly a pre-existing condition that has gone undiagnosed. A patient's medical history is important because it tells the genetic counselor how long a patient has had a condition and what sort of problems they have had in the past. For example, if a woman comes in complaining of long-term weight gain and tiredness and had a father with Hashimoto’s disease, an immune disease that affects the thyroid gland, it would be clear to a genetic counselor that the woman is suffering from an undiagnosed case of Hashimoto’s.

The last and by far most useful tool in a genetic counselor’s arsenal is genetic testing because through genetic research, geneticists have been able to pinpoint exact genes and mutations that code for a certain condition. So now, diagnosing a condition can be as simple as collecting a patient’s DNA and sending it into a genetics lab where scientists can scan for the presence, or hopefully absence, of a disease-causing gene. This is useful for many reasons. The most obvious reason is that it provides a fool proof diagnosis, since genetics do not lie. For example, if someone goes in for testing and bloodwork, finds that they possess the gene for sickle cell disease, then there is no question that they have the condition. Where as with the other tools such as familial history, a genetic counselor cannot say for sure if a patient inherited a gene or not, even if his or her parents do have the condition. Another reason that genetic testing is useful is that it works even in the absence of other information. It gives people such as orphans a way to find out their genetic history, even though they have no access to biological relatives. Yet another way in which genetic testing is invaluable is that it helps with the diagnosis of conditions that were acquired through mutations in a patient’s DNA, and a patient with a genetic condition that is acquired through mutation in his or her DNA will have no familial history of the disease. For example, if a man that appears to have Huntington’s disease, a brain-wasting condition that destroys cognitive function at an early age, has no familial history of the disease, a genetic counselor might be reluctant to make the diagnosis. But if genetic testing is done, the counselor can provide the patient with a concrete diagnosis.

Also, genetic testing is extremely useful when it comes to prenatal care. It allows a genetic counselor to provide a couple that is thinking of having a baby the option to test the genome of each parent and tell them about any risks that they might have of passing on a condition to their baby. For example, genetic testing might reveal that both parents possess a gene for an autosomal recessive disease, which means for someone’s baby to have a disease they must receive a gene for the disease from both of their parents. In this scenario, since both parents have one gene, their baby would have a twenty-five percent chance of being afflicted and a seventy-five percent chance of being unafflicted. Some parents might be fine with that risks, but for many, that is too great a risk to take, and they might choose to use a surrogate or sperm donor that does not possess the gene. This ensures that the couple’s baby will be unaffected because even a baby with one gene for the disease will not have it, since it is recessive.

This segways into the second part of a genetic counselor’s role: the actual counseling. A counselor’s purpose here is to simply tell a patient, or patients in the case of couples, their options. A counselor’s role, according to Melinda Cohen a retired certified genetic counselor, “is not telling what should do” but instead “is telling families what they can do.” On top of conveying information, a genetic counselor is also there to help a patient through the implications that the knowledge might have on them. Effects can include depression, guilt, low self-esteem, and relationship strain. For example, a person figuring out the reason their baby is never going to be normal will most likely feel guilty or may make the person’s partner resent them, and a genetic counselor is there to help the patient through this trying time in their life. Moreover, according to Ms. Cohen, there are five key principles that a genetic counselor must uphold when providing options and information to a patient. The first is non-maleficence, meaning cause no harm. The second is veracity, which means a counselor must always tell the truth. The third is autonomy, which means a counselor must respect a patient's decisions, wishes, and privacy when providing care. The fourth is beneficence, which means a counselor should aim to do good. And the last principle is justice, which means a counselor should always be impartial and just.

To investigate genetic counseling and its real-world applications, I interviewed two people that had been patients of a genetic counselor in order to find out their experiences and results. The first person I interviewed was a lady in her early fifties who went in for genetic counseling around a year ago. Her background was that her mother recently had a battle with breast cancer, and she wanted to know if she was genetically predisposed to developing breast cancer before it was too late. She suspected that she did inherit the predisposition, but she did not know because her mom is a heavy drinker, which can also lead to breast cancer. In this case, the gene being tested for was a mutation in either the woman’s BRCA1 or BRCA2 gene. These genes are important because they are a person’s tumor suppressor genes, meaning the genes prevent mammary cells from becoming cancerous, and if there is a mutation in either one, that means that they are not functional. Even a single mutated gene can lead to breast cancer, so testing can be life-saving. In this woman’s case, testing revealed that she did indeed have a mutation, and she was given two primary options by the genetic counselor: either get a double mastectomy, which is a procedure that removes a person’s mammary glands and prevents cancer, or go in for frequent mammograms, so that if she does develop cancer, it can be caught early. The woman ended up just deciding to go in for regular testing, since she lives “quite a bit healthier” than her mother and thought she had a good chance of not developing cancer.

The second person I interviewed was a mother of four who had taken her fourth child to a genetic counselor when he was an infant. The woman’s background was that she had already had three children that were completely healthy, but her fourth baby had a series of health problems that seemed to be pointing to him having cystic fibrosis. Also, the woman and her husband wanted a fifth child, so it was important to know if they were carriers of the autosomal recessive gene. The disease usually manifests itself as an overproduction of mucus in the respiratory and/or digestive tract. In this case, the baby was having digestive pain and had mucus/blood in his feces. Since the manifestation of the disease requires both parents to have the gene, the genetic counselor had both the woman and her husband tested. Luckily, the test revealed that neither had the gene. This test ruled out the possibility of cystic fibrosis, and it later turned out that the baby just had an autoimmune response to milk that was so severe it seemed like cystic fibrosis. The mom was “beyond happy” when she found out that her baby would be ok.

Each of these cases illustrates a perfect and ethical execution of the duties of a genetic counselor. Despite its good intentions and promising future, there are a few concerns for the uses of genetic testing in society. There are fears that genetics will lead to new problems in two areas that are already problematic: discrimination and inequality. Genetics can lead to discrimination because as genetic information becomes widespread on more and more people, institutions might start requesting it. For example if someone is found to be genetically predisposed to developing a disease, insurance companies might want to charge him or her more for coverage or companies might not want to hire this person. Also, genetics might lead to more inequality in the future as genetic therapies become available. Genetic therapy can be used to reverse diseases and alter genetic makeup, and since these procedures are expensive, only the rich will have access to them. This might lead to designer babies for rich people who excel in school and sports or reversal of Alzheimer's for a rich man, while an impoverished woman loses all her memories. Hopefully, as the wheels of progress turn, we as a society learn to face these new challenges ethically and fairly.

Works Cited

23andMe. “Find out What Your DNA Says about Your Health, Traits and Ancestry.” Our Health + Ancestry DNA Service - 23andMe, www.23andme.com/dna-health-ancestry/.

Cohen, Melinda P. “Ethical Dilemmas in a Genetic Clinic.” Human Biology Guest Lectures. 14 Nov. 2017, Nashville, Vanderbilt University.

“CPI Inflation Calculator.” U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics, data.bls.gov/cgi-bin/cpicalc.pl.

“Cystic Fibrosis - Genetics Home Reference.” U.S. National Library of Medicine, National Institutes of Health, ghr.nlm.nih.gov/condition/cystic-fibrosis.

“Genetic Counseling Prospective Student Frequently Asked Questions.” National Society of Genetic Counselors, www.nsgc.org/page/frequently-asked-questions-students.

“An Overview of the Human Genome Project.” National Human Genome Research Institute (NHGRI), www.genome.gov/12011238/an-overview-of-the-human-genome-project/.

“Prenatal Genetic Counseling.” Edited by Larissa Hirsch, KidsHealth, The Nemours Foundation, Apr. 2014, kidshealth.org/en/parents/genetic-counseling.html

How Do You Deal with Childhood Obesity?

Childhood obesity is fast becoming endemic among modern day children as they increasingly lead a sedentary lifestyle along with bad eating habits. Parents need to take heed to prevent this problem. 

Obesity is a big problem, no matter what age you are. So, when your child is obese, you need to seriously worry because the chances are that your child will become an obese adult and suffer from many health issues related to excess weight.

Therefore, nip the issue of childhood obesity in the bud by following some simple steps, mentioned as follows.

BMI: The first step to beat childhood obesity

Before attempting to right a wrong situation, it is of utmost importance to be completely aware of it. Hence, the first and arguably the most important step is to calculate your child’s body mass index (BMI) to gain an idea about where their current weight lies on the BMI scale.

The BMI of a person is basically means of quantifying the tissue mass in a person’s body by taking their height and weight into consideration.

Obesity prevalence in various age groups was recorded by the CDC as follows:

Age GroupPercentage of obese population2-5 years old13.9%6-11 years old18.4%12-18 years old20.6%

 Calculate the BMI of your child using any of the free online resources available over the internet, and determine which of the various categories—underweight, normal weight, overweight or obese—he or she falls in.

Now that we have assessed the current situation, we may take steps to correct it.

Identify the culprits

This tip involves observing your child’s as well as your own daily habits to figure out the areas where improvement is well overdue. The said areas could be dietary habits, lifestyle choices (like how much time your kids spend outdoors and so on) and even sleeping patterns.

In certain cases of childhood obesity, the cause of obesity may be genetic, and it is highly recommended to consult a physician or a doctor who is well aware of your family history before making any dietary changes.

This step is crucial as not only does it provides valuable insight into what all we are doing wrong, but also saves time by pinpointing the exact problem.

Get rid of all the junk food

This is probably the most common advice received related to weight loss and childhood obesity prevention, but that does not make it any less true. It involves thorough cleaning of the pantry of the house to ensure that only healthy options are available to children, thereby setting them up to make healthier eating choices.

Remove all the junk food from the house, including packaged snacks like chips and cookies. If there is no junk food in the house, the kids cannot consume it, which automatically improves their diet.

Replace the junk food items with healthier alternatives to deal with those in-between-meals hunger pangs. For example, potato chips can be replaced with plantain chips, and normal French fries can give way to sweet potato fries.

Whole wheat donuts and cookies baked at home with healthier ingredients can easily step in for the unhealthier, store-bought alternatives.

Once healthier alternatives are presented to children, it is best to not exercise control over their portions for the first couple of days. This helps the children be more aware of their body and its needs, as well as be more responsible while eating.

Family initiative

Children are more likely to improve their eating habits and do their bit in obesity prevention when they are held accountable by someone else. One of the most important contributors to childhood obesity prevention is the family of the child.

Planning and preparing healthy meals as a family is always a great way to introduce the child to a healthier lifestyle.

Involve the children as much as possible in the food cooking process, and regularly reprise them about the benefits of the healthier alternatives.

Plan outdoor activities that involve physical work as a family. The frequency of said activities can be adjusted according to various factors, to ensure that it always remains enjoyable.

Pets can help prevent your child from getting obese too. Ask your kids to walk the dog on a regular basis, which shall help them get exercise as well.

Most importantly, a family provides the support and encouragement that every child needs, especially while making such drastic changes to their lifestyle. It is always helpful to talk with your kids every once in a while, to understand how they are dealing with the changes and whether they need any changes made or not.

Mix passion with health

The easiest thing for any child to do is to sit around and watch television, and this is where you, as a parent, need to step in. Determine which sport your child is interested in and encourage them to participate in it.

Enroll them in regular classes that involve physical activity, like dance classes or gymnastics, or any such activity.

Map out the hiking trails, parks and wildlife areas around your residence and accompany your child to such places. This not only helps them in losing weight but also instills a love for the outdoors in them by bringing them closer to nature.

Make smart choices

Most people think childhood obesity prevention means banishing all kinds of fat and anything tasty from their diets, which is not the case. Instead of getting rid of all things tasty, it is more important to make smart decisions when it comes to food.

It is important to include the good fats in your diet and eliminate the saturated fats. Unsaturated fats that are healthy, include avocado oil, fish oil, and oils and fats obtained from nuts and seeds.

Saturated fats, however unhealthy, cannot be completely eradicated from our diets. Hence, it is advised to choose them wisely. Saturated fat up to 10 percent are permissible in a person’s diet and do not cause much harm. These include butter, ghee, refined oil as well as nuts like peanuts and cashews.

Sodas and other aerated drinks are heavily calorie-laden and must be replaced with fruit juices and milk wherever possible. This significantly reduces the sugar intake and juices and milk provide other health benefits as well.

Encourage children to eat as much organic produce and whole foods as possible. This helps them to obtain various essential nutrients.

Hence, the process of childhood obesity prevention must begin with a careful assessment of the situation by calculating the body mass index of the child. This should be followed by taking appropriate steps to improve the situation, but the most important thing to do here is to keep trying and not give up. Things shall seem difficult in the beginning, and the children may even act out, but the key here is to keep at it, and sure enough, things shall get better.

QUICK BYTES

Can short-term dieting help a child in battling obesity?

Short-term diets are only helpful in kick-starting the weight loss process, but the child can quickly gain all the weight back if they revert to their old ways. Making lifestyle changes is what leaves a lasting impact.

What are some of the main health consequences for childhood obesity?

Cardiovascular diseases, early onset diabetes and certain types of cancers (like breast and colon cancer) are few of the vast variety of health consequences of childhood obesity.

What is BMI?

BMI stands for body mass index, and it is a method of quantifying the total amount of tissue mass in a person’s body. It is calculated using the person’s height and weight.

How do I replace the high-calorie soft drinks in my child’s diet?

Aerated soft drinks are very high in calorie and should be replaced with fruit juices and milk. Flavoured milk is a tasty yet healthy alternative for sodas.

What are some of the exercises a child should indulge in?

Skipping, running, and even yoga are easy yet effective physical activities a child can easily indulge in.

To get a clearer insight into childhood obesity and know how to prevent childhood obesity, check in with our Truweight Nutritionist and Weight Consultant right here.

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