Invasive aspergillosis: Symptoms and more – Medical News Today

Aspergillosis is an infectious disease that occurs due to a common type of fungus, or mold, called Aspergillus. A type of aspergillosis called invasive aspergillosis particularly affects people with weakened immune systems.

Most individuals breathe Aspergillus spores daily and do not develop any health effects.

However, people with compromised immune systems, such as those who have had an organ transplant or are undergoing chemotherapy treatment, may be at greater risk of developing aspergillosis.

The disease usually affects the lungs but can spread to other areas of the body.

This article looks at invasive aspergillosis and its symptoms, diagnosis, outlook, and more.

Aspergillus mold is common indoors and outdoors and can cause infection in the sinuses and lungs of immunocompromised people.

If the infection spreads to the rest of the body, outcomes are very unfavorable and include death.

Experts do not know the extent of aspergillosis in the United States, as it is not a reportable infection. However, according to a database of insurance claims, there were almost 15,000 hospitalizations for this diagnosis in the U.S. in 2014.

That said, the number of people with aspergillosis has likely increased since then.

Invasive aspergillosis is less common than the milder, allergic forms of the disease. It is the most common fungal infection in people who have had stem cell treatment. It is also the second most common in those who have received solid organ transplants.

Invasive aspergillosis usually occurs in people with weakened immune systems who often already have other medical conditions. Therefore, it can be difficult to differentiate between the symptoms of the infection and those of the underlying illness.

The symptoms of invasive aspergillosis may include:

Types of invasive aspergillosis include:

Other types of aspergillosis include:

A person can develop aspergillosis by breathing in Aspergillus spores, which are common in indoor and outdoor environments.

Most people will not get sick from breathing the spores, but those with weakened immune systems are at greater risk of infection.

People at risk of invasive aspergillosis include individuals with weakened immune systems, such as those who have received:

Additionally, hospitalized patients with severe influenza and those with HIV are at risk of invasive aspergillosis.

To diagnose aspergillosis, a doctor may examine a persons medical history and risk factors and ask questions about their symptoms.

They may perform a physical examination and several laboratory tests. These may include:

Doctors may treat invasive aspergillosis with several different antifungal medications.

These may include:

Where possible, doctors may also decrease or discontinue immunosuppressive medications to help treat invasive aspergillosis.

Because Aspergillus spores are common in the environment, it is difficult for people to avoid breathing them in.

Experts recommend those with weakened immune systems take certain measures to protect against the fungus. However, these actions may not prevent aspergillosis.

Preventive measures may include:

The outlook for invasive aspergillosis is generally unfavorable.

The mortality rate of invasive pulmonary aspergillosis is about 20% six weeks after diagnosis, despite treatment with antifungal medications.

The mortality rate reaches close to 100% once the infection has spread to the central nervous system.

Most people safely breathe Aspergillus spores every day, as these are common in indoor and outdoor environments.

However, those with weakened immune systems may be at risk of developing health problems from breathing microscopic amounts of the fungus.

In immunocompromised people, such as those undergoing chemotherapy or those who have had stem cell or organ transplants, invasive aspergillosis may affect the lungs and sinuses. This can cause symptoms such as shortness of breath and coughing up blood.

The disease may spread to other areas of the body and is often fatal once it reaches the central nervous system.

Treatment for invasive aspergillosis typically includes the use of antifungal medication.

Doctors may advise high risk individuals who are immunocompromised to take measures that may help prevent aspergillosis. These approaches include wearing protective equipment and clothing, testing, and taking antifungal drugs.

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Invasive aspergillosis: Symptoms and more - Medical News Today

Patients have renewed interest in STI exams after post-Covid spike – Medical Economics

Primary care physicians are being urged to encourage their patients to take a renewed interest in their sexual health after a report showed a spike in STI cases following Covid-19 lockdowns in 2022. According to experts, STI screenings were put off during the pandemic as patients prioritized other health care appointments.

The Zocdoc report, released ahead of CDC's STI Awareness Week, shows that patients have started to book more STI appointments in 2023. Zocdoc appointment booking data revealed that bookings in the first half of March 2023 were 26% higher than the same period in 2022.

The report also highlights a demographic divide, with men being more proactive about checking their sexual health than women. Millennials and Gen Z patients booked the most STI appointments, with patients in their 20s booking nearly twice as many appointments as those in their 30s. Meanwhile, seniors (65+) made up less than 1% of the bookings.

Genital warts caused by the Human Papilloma Virus (HPV) were the most common STI issue, accounting for 24% of all bookings. Genital herpes, HIV/AIDS, HPV, and hepatitis were also among the most commonly reported STIs.

Patients in Atlanta were found to be the most proactive about their sexual health, with the highest rate of STI bookings per patient. In contrast, patients in Boston, Charlotte, NC, San Francisco, and Nashville had some of the lowest booking rates.

Primary care physicians are encouraged to promote STI screenings and provide education on safe sex practices to help reduce the spread of STIs. CDC's STI Awareness Week runs through April 15th and provides a timely opportunity for health care providers to engage with their patients on this important issue.

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Patients have renewed interest in STI exams after post-Covid spike - Medical Economics

Woman diagnosed with incurable condition after eyes turned completely white – Yahoo News

Kerrys partner plans to walk the equivalent of a half marathon with Kerrys weight on his back to raise money for treatment abroad (Collect/PA Real Life)

A woman who lost her father to suicide and was diagnosed with a brain tumour in the space of six months, having seizures up to three times a month, has taught her 10-year-old son how to call 999 and says shes only still alive for (her) kids sake.

Kerry Warburton, 35, who lives in Gainsborough, Lincolnshire, with her partner, Craig Kirkham, 36, their son, Ethan, 10, and their daughter, Ellana, 10 months, landed her dream job as a teaching assistant in December 2019,but in April 2020 she began having seizures where her eyes would turn completely white and she could no longer work.

On top of this, in July 2020 Kerrys dad died by suicide, and in January 2021 doctors found a tumour in her brain, which was causing her seizures.

One month later, doctors tried to remove her tumour by performing an open craniotomy, which made her lose her speech, and while in hospital she contracted Covid and was quarantined for 12 days partnerCraig thought she was on deaths door and doctors wereseconds away from turning off her life support, but she recovered.

Things were beginning to look up Kerry fell pregnant with her second child, Ellana, but after resuming treatment, a follow-up MRI scan revealed that her brain tumour was at stage four.

Now, Craig is planning to walk the equivalent of a half marathon to raise money for stem cell therapy which could prolong Kerrys life by three to five years.

I was at an all-time low when receiving treatment, especially after losing my dad Im only still alive now for my kids sake, Kerry said.

In December 2019, Kerry finally landed her dream job, as a teaching assistant, after going back to college as a mature student.

But in April 2020, Kerry began to have seizures, which was the first warning sign for her terminal brain tumour.

Her partner Craig said: She was shaking like mad, and her eyes rolled back in her head, and I saw foam and blood come out of her mouth.

I didnt know what the hell was going on. I was so scared, and I thought she was dying.

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The whole bed was shaking, and I thought we were having an earthquake or something.

(PA Real Life)

I had no clue what to do I was trying to push her head back into the pillow to stop her shaking, and her eyes were completely white.

Craig quickly called an ambulance, and Kerry was taken into Lincoln Hospital for tests and an MRI scan.

But Kerry was not diagnosed with anything and continued to have seizures up to three times a week, while her father died by suicide in July 2020.

Kerry said: I hit rock bottom, they took me off my seizure meds because it can cause low moods, and my seizures got worse I was having them twice a week.

In January 2021, she received more devastating news she had a five-by-five-by-five centimetre tumour in her brain.

Just a few weeks later, in February, Kerry had an open craniotomy, and was told she had stage two brain cancer,which caused her to have aphasia when a person has difficulty with their language or speech.

She explained: I lost my speech completely, it was horrible.

It was so hard for me because I wanted to speak I could speak clearly in my mind, but I couldnt get it out.

(PA Real Life)

When in hospital, she contracted Covid-19 and was quarantined for 12 days.

Craig said: I thought she was on deaths door. It was so scary they were seconds away from putting her to sleep.

It was terrifying because you couldnt go and see her.

I didnt sleep at all Id message her and check her WhatsApp constantly just to check she was alive.

Once out of hospital, Kerry found out she was pregnant and in June 2022 she gave birth to her second child, Ellana.

Just two months later, she had another MRI scan which concluded the brain tumour was terminal and stage four.

Craig said: It was scary as hell we were all happy, we had the baby, and then we were thrown back into the deep end again.

We had to travel for 55 miles for treatment again, for six weeks every single day.

Since October 2022, Kerry has been receiving radiotherapy and chemotherapy, which has caused her to lose her hair and put on over two stone.

She said: It affects my confidence I dont want to leave the house.

Kerry continues to have seizures, but they have gone down to three per month, and has even had to teach her 10-year-old son Ethan how to call an ambulance.

She said: Were scared to death that I might have a seizure when Craig is at work, so weve taught him how to call an ambulance.

Weve had to give him counselling at school to cope with me being so ill.

It was hard to teach him how to do it,I was petrified, and his school have helped.

I know it must be horrible for my son, I blame myself for him getting upset about it.

To raise money for stem cell therapy, which could extend Kerrys life by three to five years,Craig has set up a GoFundMe and plans to walk from Lincoln Castle to his house, which is the equivalent of a half marathon, with Kerrys weight, 12 stone, on his back.

Craig said: Gravity will be trying to pull me into the ground just like this tumour is trying to put her in the ground, but we are going to defy both.

Kerry added: It would just be wonderful to have the treatment, and to not worry my son anymore.

To find out more about Craigs fundraising, visit http://www.gofundme.com/f/kerry-the-white-knight.

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Woman diagnosed with incurable condition after eyes turned completely white - Yahoo News

How artificial intelligence can help primary care doctorsand their … – Medical Economics

Two letters. Theyre enough to give your patients more anxiety than any treatment, test or injection. A recent survey by the Pew Research Center shows it: Sixty percent of Americans said they would be uncomfortable with their provider relying on artificial intelligence (AI) in their own health care. But when used responsibly, artificial intelligence can help primary care doctors expand their care while cutting costs in their practices. And patients will notice the difference tooeven if they dont realize the technology behind their improved experience is the result of those dreaded two letters.

Informed patients, informed doctors

What really scares patients is the idea of AI performing the skilled work of doctors. The fact is, however, we are a long way from AI replacing doctors. Nor will AI replace office staff. But we are now at a point where AI can start to address the communication issues doctors face in their practices.

Patients say they dont want AI making health care decisions for them based on its interpretation of their conditions, but AI can help patients navigate through the treatment process and get them information a lot faster. For example, doctors can use AI and chatbots in their patient engagement strategy to better understand their patients, send them personalized information that is tailored to their treatment journey, and create interactions that are relevant to their personal needs.

AI has numerous applications for primary care physicians who are looking to manage their patients health proactively, Jonathan Sachs, MBA, vice president and chief experience officer for Robert Wood Johnson University Hospital, told me. AI can unlock a physicians ability to understand a patients needs beyond their 15-minute office visit by helping that physician make sense of longitudinal data from multiple sources such as wearables, at-home biometric technology, and internet of things devices.

Interactive messaging

As Googles chief health officer Karen DeSalvo, M.D., MPH recently noted, the future of health is consumer-driven. AI can help doctors be ready for the shift by improving the way they and their staff communicate with their patients.

Many practices are adopting advanced communications platforms to help streamline their workflow and patient interactions. AI and machine learning will take these platforms beyond simple appointment reminders to create better patient experiences.

AI can send relevant content to the patient at the time they need it the most, which leads to patients who are better educated, more comfortable, more confident, and more engaged in meaningful conversations about their health. The result is better outcomes, and ultimately more patients and cases.

AI Is already working in health care

AI is already helping doctors do their jobs better and more efficiently. Patient diagnostics is one area where we see this already. AI can help doctors ensure that patients who need care most urgently are treated first. AI can also help staff keep track of patients in nursing homes by monitoring their conditions based on data, which takes some of the sting away from nursing shortages. It can also detect disease by analyzing data and advance treatment through machine learning.

In private practices, AI is ready to step in and help with eligibility checks, prior authorizations, insurance claims, referrals, and billing. The immediate benefit of the digital transformation to primary care doctors in their practices, however, is the technologys ability to boost patient engagement and adherence.

Also, imagine the day when the majority of your scheduling is done by a patient interacting with AI in your practice. Integrating AI technology with practice management systems will make that possible. Appointments will be made and changed all while your front office staff is checking in a patient. The result is a superior patient experience while doctors, nurses, and office staff get time back in their days for the tasks that are most important to them.

Easing patients concerns

AI is coming fast and furious, and that is undoubtedly why some of your patients will be apprehensive. The pace of change is exploding. The Wright Brothers first flight was in 1903, but commercial air travel didnt truly take off until decades later. The first human heart transplant was in 1967, while the internet revolutionized the world in a short period of time. And as my great friend Michael Longaker, M.D., co-director of the Stanford Institute for Stem Cell Biology & Regenerative Medicine recently said to me, The pace of change [in fields like] stem cell biology is rising exponentially each year.

Patients will get used to AI in their health care. It wasnt long ago that consumers were afraid to put their financial information online to complete a transaction. Now online shopping is so common that malls are half-empty even during the holiday season. Its going to take a little time until AI proves to be more effective, but in the present we can look for ways to help patients navigate information better. The right information at the right time makes a difference.

Jock Putney is the founder and CEO of WUWTA, an experience and engagement platform designed to help practices engage patients in their care and create better treatment outcomes.

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How artificial intelligence can help primary care doctorsand their ... - Medical Economics

Memphis Grizzlies provide details on why Steven Adams hasn’t been cleared for NBA playoffs – Yahoo Sports

The Steven Adams injury and timeline has left fans searching for answers.

A report from ESPN's Adrian Wojnarowski said that Adams is "unlikely to return" for the NBA playoffs. This came a week after Memphis Grizzlies coach Taylor Jenkins noted that Adams was beginning a reevaluation period where the team hoped he'd be able to return soon.

The Grizzlies practiced on Tuesday. Adams was at practice shooting free throws

"It's pretty confirmed he's most likely out for the playoffs," Jenkins said. "We don't have definitive words on what the next steps are. It's been an ongoing process the last couple of weeks. I think there's more dialogue still this week with doctors involved. We want to make sure Steven's in a good place."

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Adams initially sprained his right PCL in January. He was expected to return in early March, but he needed a stem-cell injection that sidelined him another four weeks.

That lined Adams up for a potential reevaluation at the end of the regular season. When the Grizzlies signed Kenneth Lofton Jr. to a standard contract, it felt like an indicator of Adams' playoff status and the lack of frontcourt depth, but the Grizzlies didn't issue an official update.

"We thought we were making headway with the process and all that, but each evaluation we had with the doctors kind of revealed it's not progressing like we need it to. ... No setbacks, no reinjuries, it was just not progressing to a level. Obviously some unfortunate news, but that's why we're going to try to do everything possible to try to get the best decision possible for him," Jenkins said.

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The Grizzlies haven't ruled out surgery as an option for Adams. Jenkins said that everything remains on the table.

Xavier Tillman Sr., Jaren Jackson Jr. and Santi Aldama are expected to get the bulk of minutes at power forward and center. Aldama didn't play in the final two regular season games due to left elbow soreness, but Jenkins called it precautionary.

Aldama was a full participant in practice on Tuesday and wore a compression sleeve on his left arm.

This article originally appeared on Memphis Commercial Appeal: Steven Adams: Memphis Grizzlies give injury report for NBA playoffs

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Memphis Grizzlies provide details on why Steven Adams hasn't been cleared for NBA playoffs - Yahoo Sports

More than 200 people have been treated with experimental CRISPR … – MIT Technology Review

I watched scientists, ethicists, patient advocacy groups, and others wrestle with these topics at the Third International Summit on Human Genome Editing in London earlier this week.

Theres plenty to get excited about when it comes to gene editing. In the decade since scientists found they could use CRISPR to edit cell genomes, multiple clinical trials have sprung up to test the technologys use for serious diseases. CRISPR has already been used to save some lives and transform others.

But it hasnt all been smooth sailing. Not all of the trials have gone to plan, and some volunteers have died. Successful treatments are likely to be expensive, and thus limited to the wealthy few. And while these trials tend to involve changes to the genes in adult body cells, some are hoping to use CRISPR and other gene-editing tools in eggs, sperm, and embryos. The specter of designer babies continues to loom over the field.

It was at the last summit, held in Hong Kong in 2018, that He Jiankui, then based at the Southern University of Science and Technology in Shenzhen, China, announced that he had used CRISPR on human embryos. The news of the first CRISPR babies, as they became known, caused a massive ruckus, as you might imagine. Well never forget the shock, Victor Dzau, president of the US National Academy of Medicine, told us.

He Jiankui ended up in prison and was released only last year. And while heritable genome editing was already banned in China at the timeit has been outlawed since 2003the country has since enacted a series of additional laws designed to prevent anything like that from happening again. Today, heritable genome editing is prohibited under criminal law, Yaojin Peng of the Beijing Institute of Stem Cell and Regenerative Medicine told the audience.

There was much less drama at this years summit. But there was plenty of emotion. In a session about how gene editing might be used to treat sickle-cell disease, Victoria Gray, a 37-year-old survivor of the disease, took to the stage. She told the audience about how her severe symptoms had disrupted her childhood and adolescence, and scuppered her dreams of training to be a doctor. She described episodes of severe pain that left her hospitalized for months at a time. Her children were worried she might die.

But then she underwent a treatment that involved editing the genes in cells from her bone marrow. Her new super cells, as she calls them, have transformed her life. Within minutes of receiving her transfusion of edited cells, she felt reborn and shed tears of joy, she told us. It took seven to eight months for her to feel better, but after that point, I really began to enjoy the life that I once felt was just passing me by, she said. I could see the typically stoic scientists around me wiping tears from their eyes.

Victoria is one of more than 200 people who have been treated with CRISPR-based therapies in clinical trials, said David Liu of the Broad Institute of MIT and Harvard, who has led the development of new and improved forms of CRISPR. Trials are also underway for a range of other diseases, including cancers, genetic vision loss, and amyloidosis.

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More than 200 people have been treated with experimental CRISPR ... - MIT Technology Review

The 30th Biohacking Health and Wellness Biomed EXPO returning to Los Angeles on March 24-26, 2023, latest Stem Cell, Brain enhancement Technologies…

LOS ANGELES, March 7, 2023 /PRNewswire/ -- Biomed Expo ushers in new earth frequencies of biohacking and Trans-Humanism at Sonesta Los Angeles LAX Hotel, on March 24-26. The conference brings together a highly coveted group of physicians to defy the preconceived limits of the human body. With workshops and many exhibitors, this healing fest has curated the leading minds behind the latest leaps in healing modalities from scalar energy to functional homeopathy and Quantum Healing.

Attendees will receive codes on healthcare from a future timeline in which doctors harness Gaia's source codes to help patients of conditions from cancer to Alzheimer's to lupus with non-invasive modalities.

This year's programming will be the largest quantum leap to the future yet: medical researchers, doctors, and disclosure groups, EX- Military Intelligence, California DEPT of Health Whistleblower, and the New Humanity Movement leaders will speak candidly on classified topics including: Tesla's discoveries, Space Science, ET Disclosure, Origin of Man - converging the disciplines of metaphysics and medicine to enhance human cognitive functions, extend lifespan, and expand extrasensory perceptions like clairvoyance.

Keynote speakers:

Dr. Barry Morguelan, M.D., the only western Grand Master of a 5,000-year-old Chinese Source Energy discipline and Founder of Upgrade Labs

Dr. Todd Ovokaitys, M.D. Pioneering Qi-laser resonance technology inventor

Dr. Michael Grossman, M.D. Stem Cell researcher

Dr. Patrick Porter, CEO of BrainTap, Brain Advancement Technologies

Dr. Beverly Rubik, International Biophysicist & EMF Researcher

more amazing speakers:

Dr. Robert Young, The Worldwide Renowned Microbiologist and Virologist.

Dr. Scott Werner, Dr. Jeffrey Benton, Dr. Doug Lehrer, Dr. Vanessa Pavey, Dr. Rollin McCraty, SIR Kaya Redford, Brooks Agnew, Michael Cremo, Dr. Lori Smiskol, Saeed David Farman, Ryan Veli, Ismael Perez, Perry Kamel, Debbie Hawkins, Nichola Burnett, Shehnaz Soni, Veronica Bucheli, Michael Schratt, Azucena Avila, Eric Dadmehr, Robert Potter, Alan Bedian, Michelle Jewsbury, Amelia Brummel, Phillip Wilson, Sandra Biskind, Geraldine Orozco & Julia Galasso.

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Registration for this three-day extravaganza of meet-and-greet banquet dinners with daily Functional wellness panels and over 100 lectures, workshops on biohacking is now open at https://biomedexpo.com

Cision

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New gene therapies are a near-cure for Louisiana’s sickle cell patients. But at $1-2M, who will pay for it? – NOLA.com

When Leola Conleys daughter was born, everybody said she looked like she was already three months old.

The girl was 8 pounds, 13 ounces, cute, with a full head of hair, said Conley, a counselor in Lafayette.

About a week after her birth, a letter arrived from the state Department of Health. A standard pinprick on the babys heel at birth showed a mutation in a gene that makes red blood cells. Usually, red blood cells are round, like a doughnut. This babys cells were shaped like a crescent moon. She had sickle cell disease, a genetic disorder that affects about one in every 365 Black babies. Those with severe cases have a life expectancy of about 45 years.

It put me in a depression like nobody's business, said Conley. It broke me, because she looked so healthy.

Now 23, Conleys daughter, Adria, guesses shes been hospitalized about 30 times. She graduated with her MBA in December but is limiting her job search to positions with good insurance close to her doctors in south Louisiana. She doesnt look sick, but unpredictable pain episodes can throw her life off track, requiring weeks of recovery.

But new gene therapies two of which will submit for FDA approval by the end of March offer what could be a life-changing alternative for sickle cell patients in Louisiana,which has the second-highest prevalence of sickle cell disease among Medicaid patients. The problem? At a predicted $1 million to $2 million for the therapy, its unclear how states will pay for it.

If just 7% of the eligible sickle cell population of Louisiana wanted the treatment, it would cost the state a predicted $31.6 million in the first year, according to an analysis published in JAMA Pediatrics by Dr. Patrick DeMartino, a physician specializing in blood diseases among children. Thats for just 17 patients.

Nobody really knows whether it's going to be three people getting the gene therapy in the first year or 15, said DeMartino. And that upper end of 15 to 20 people a year would almost certainly be very consequential for the Medicaid budget.

No one tracks how many Louisiana residents have sickle cell disease, though efforts to create a registry are underway. There are at least 3,000 people on Medicaid with sickle cell disease, according to the state. The 1,400 who were hospitalized in Louisiana in 2020 spent an average of 30 days in the hospital. About one in 10 children with sickle cell anemia will have a symptomatic stroke by age 20, and more have strokes that go undetected.

These people do not live normal lives at all, said DeMartino. The existing therapies are supportive. They don't change the underlying disease, and people still have massive amounts of disability.

Instead of easily transporting oxygen through their bodies, the warped cells become wedged in blood vessels, causing blockages and injuring the vessels, resulting in immense pain.

Have you ever felt your heart beating in your ear? It feels like that but all over your body, said Whitney Carter, a 37-year-old who works from home for an insurance company in Baton Rouge.

The sickled cells getting jammed in her blood vessels feels "like a walnut trying to fit through a straw.

Without a potential pain episode looming over Rhonda Chubes 9-year-old son, he would be able to keep up with his older brothers, play football, swim and collect rocks to his hearts content. With treatment, hed be a regular kid, said Chube, a child care assistant at a Baton Rouge hospital.

His little spirit, he wants to do more, keep going, said Chube. But his little body won't let him.

Prior to gene therapy, a bone-marrow transplant was the only thing close to a cure, but required a close genetic match, usually a sibling, resulting in a match for about 25% of patients. There is also risk that the body will reject the transplant, causing serious complications or death.

Researchers shy away from using the word cure to describe gene therapy, because its not yet clear how long its effects last since the first was given in 2017. But it has been shown to deliver a pain-free existence for trial participants for the first time in their lives.

There are two different gene therapy drugs to treat sickle cell expected to be approved soon one from Bluebird Bio and the other from Vertex and CRISPR Therapeutics.

Its highly transformative, said Dr. Julie Kanter, a hematologist at the University of Alabama at Birmingham who oversees a Bluebird trial that includes patients from Louisiana.

Whats most notable when I look at my patients is how many are now working that couldnt work before, said Kanter. I have one in nursing school, one in a full-time construction job They dont have to worry about being too far from a hospital or too far from pain medicines.

But how to deliver the medications, which will require an expensive and lengthy hospital stay not included in the drugs price tag, is something the world is trying to figure out right now, said Kanter, a New Orleans native who was previously head of the Sickle Cell Center of Southern Louisiana.

Figuring out a way to fund sickle cell treatment is a priority of the Biden administration. And Louisiana has gotten creative with paying for expensive therapies before, Dr. Joe Kanter, state health officer, pointed out. The state got unlimited access to pricey hepatitis C medication for five years for a lump sum instead of paying per dose.

I think the hepatitis C work laid a good groundwork for the feds and other states to follow if they choose to, said Kanter, who is not related to Julie Kanter.

The U.S. Department of Health and Human Services released a plan in mid-February that aims to address the sky-high cost of gene therapy. A pilot program would allow the federal government to coordinate a way to pay on behalf of states. For example, Medicaid might negotiate to pay for treatment in installments dependent on the therapy continuing to prevent pain, which has not yet been proven.

The plan will likely take years to implement.

Still, not everyone will want the therapy, which requires a long hospital stay and chemotherapy to make room for new stem cells.

For many patients, even words like transformative and life-changing can seem empty after years of mistreatment.

Every time I go to the hospital, I feel like I have to put my shield on, because Im going to battle, said Leola Conley. Who will I fight today?

Conley and her daughter have endured 11-hour waits in emergency rooms to get admitted and health care workers who dont believe her pain.

A lack of investment in treatment for sickle cell patients means that the only option for some is often opioids in an emergency room, said Dr. Jennifer Avegno, an emergency medicine physician and director of the New Orleans Health Department.

"Being on chronic opiates is really a terrible way to live," said Avegno. "We've really taken a terrible disease and made it worse in America."

In comparison to sickle cell, genetic diseases that mainly affect White people, such as cystic fibrosis, have much more investment, Avegno pointed out. A federal study found funding for cystic fibrosis was 11 times that of per-person funding for sickle cell disease, even though it impacts about one-third of the number of people.

In a world without sickle cell,Adria Conleyimagines shed move to the Netherlands, where shes read people are happy.Maybe one day, with gene therapy, that will be a reality. For now, sickle cell is calling the shots.

If gene therapy was offered as a safe and affordable option, we would run to it, said Leola Conley. Her fear is that one day, her daughter will be in pain and she wont be around to make sure she gets the right treatment.

Before I leave this earth, I hope to heck my child can be cured, said Conley. She has so much to offer the world.

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New gene therapies are a near-cure for Louisiana's sickle cell patients. But at $1-2M, who will pay for it? - NOLA.com

Medical tourism to Mexico is on the rise, but it can come with risks – WMUR Manchester

One of the four Americans who were kidnapped in Mexico last week was traveling for medical tourism, a friend said. A growing number of U.S. residents are traveling internationally to seek more affordable medical care, more timely care or access to certain treatments or procedures that are unapproved or unavailable in the United States.Latavia "Tay" Washington McGee, 33, drove to Mexico with Shaeed Woodard, Zindell Brown and Eric Williams for cosmetic surgery that was scheduled to take place Friday, according to a close friend of Washington McGee's who did not want to be identified.The four Americans were found Tuesday near the border city of Matamoros, officials said. Washington McGee and Williams were found alive, and Woodard and Brown were found dead, a U.S. official familiar with the investigation told CNN. Investigators are still piecing together what happened after they were abducted.Video below: Hear from the family of some of the Americans recently kidnapped in Mexico.Medical tourism takes people all over the world, including to Mexico, India and Eastern Europe. Violence against medical tourists is generally thought to be rare, but the U.S. Centers for Disease Control and Prevention warns about other risks such as quality of care, infection control and communication challenges with medical staff."It's on the daily, without a doubt. There are people going daily to get this kind of stuff done," said Dr. Nolan Perez, a gastroenterologist in Brownsville, Texas, which is across the border from Matamoros. "Whether it's primary care provider visits or dental procedures or something more significant, like elective or weight loss surgery, there's no doubt that people are doing that because of low cost and easier access."A growing trend One study published in the American Journal of Medicine estimated that fewer than 800,000 Americans traveled to other countries for medical care in 2007, but by 2017, more than 1 million did. More current estimates suggest that those numbers have continued to grow.Video below: Americans are saving by traveling abroad for medical care"People travel because there may be a long waiting time, wait lists or other reasons why they can't get treatment as quickly as they would like it. So they explore their options outside the United States to see what's available," said Elizabeth Ziemba, president of Medical Tourism Training, which provides training and accreditation to international health travel organizations.Also, "price is a big issue in the United States. We know that the US health care system is incredibly expensive," she added. "Even for people with insurance, there may be high deductibles or out-of-pocket costs that are not covered by insurance, so that people will look based on price for what's available in other destinations."The most common procedures that prompt medical tourism trips include dental care, surgery, cosmetic surgery, fertility treatments, organ and tissue transplants and cancer treatment, according to the CDC."With Mexico and Costa Rica, it's overwhelmingly dental and cosmetic surgery. However, certain countries are known for specialties. For example, in Singapore, stem cell and oncology is huge. In India, South India and Chennai Apollo hospitals does incredible work with hip and knee surgeries," Josef Woodman, founder of Patients Beyond Borders, an international health care consulting company, said."In Eastern Europe, a lot of people from the UK but also people from the United States travel to Hungary, Croatia and Turkey for everything from dental to light cosmetic surgery," he said.Mexico is the second most popular destination for medical tourism globally, with an estimated 1.4 million to 3 million people coming into the country to take advantage of inexpensive treatment in 2020, according to Patients Beyond Borders. Matamoros where officials said the four kidnapped Americans were found is "not considered a primary medical travel destination," Woodman said, "largely because there are no internationally accredited medical centers/specialty clinics there or in the immediate region."Mexico City, Cancun and Tijuana are more frequented and reliable destinations in the country, Woodman said.On average, Americans can save 40% to 60% across the most common major procedures received by medical tourists in Mexico, according to an analysis of 2020 health ministry data conducted by Patients Beyond Borders.Woodman said that violence against medical tourists was extremely rare, but he added that "price shopping" searching for the cheapest location for a procedure is a "blueprint for trouble," namely substandard medical care.Video below: U.S. Attorney General Merrick Garland offers remarks about the Americans who were kidnapped in Mexico.'There are the complexities' Medical tourism can be dangerous, depending on the destination and the person's condition."There are the complexities of traveling if you have a medically complex situation. There are fit-to-fly rules. And your health care providers should take into consideration the impact of traveling if you have orthopedic injuries or issues," Ziemba said."The quality of care may be an unknown," she said. "It may be that the quality of care is not up to the standards that you would like. So there's a bit of an unknown there, and then the last thing I would say is, if something goes wrong, what's going to happen?"Perez said he commonly manages complications from medical tourism in his practice."There are a lot of bad outcomes. There are a lot of infections and a lot of botched procedures gone wrong, and patients have to come back to the United States and then have a revision of the surgery," he said. "So it's really unfortunate."Yet Ziemba added that there can be benefits to medical tourism, including that someone could receive a service that they need faster overseas than locally."And price: If you simply can't afford the out-of-pocket costs of health care in the United States, and assuming the risks involved, it may make much more sense for you financially to travel outside the United States," she said.Medical tourism is not just for people traveling around the world. Many living along the U.S.-Mexico border, where access to health care can be scarce, cross into Mexico for care.The Rio Grande Valley, at the southernmost point of Texas, is considered to be a medically underserved area. The region has some of the nation's highest rates of comorbidities, including obesity and diabetes, and one of the lowest physician-to-patient ratios.There is a "dire need" for health care professionals along the border, Perez said."There are not as many doctors given our big and our growing population down here. So the demands on primary care doctors and specialists are very high because there are not enough of us for this population," he said. "So that's one reason why people end up going to Mexico to visit with physicians, because of easier access."People interested in medical tourism can take some steps to help minimize their risk, the CDC says.Those planning to travel to another country for medical care should see their health care provider or a travel medicine provider at least four to six weeks before the trip and get international travel health insurance that covers medical evacuation back to the United States.The CDC advises taking copies of your medical records with you and checking the qualifications of the providers who will be overseeing your medical care. Also, make sure you can get any follow-up care you may need.

One of the four Americans who were kidnapped in Mexico last week was traveling for medical tourism, a friend said.

A growing number of U.S. residents are traveling internationally to seek more affordable medical care, more timely care or access to certain treatments or procedures that are unapproved or unavailable in the United States.

Latavia "Tay" Washington McGee, 33, drove to Mexico with Shaeed Woodard, Zindell Brown and Eric Williams for cosmetic surgery that was scheduled to take place Friday, according to a close friend of Washington McGee's who did not want to be identified.

The four Americans were found Tuesday near the border city of Matamoros, officials said. Washington McGee and Williams were found alive, and Woodard and Brown were found dead, a U.S. official familiar with the investigation told CNN.

Investigators are still piecing together what happened after they were abducted.

Video below: Hear from the family of some of the Americans recently kidnapped in Mexico.

Medical tourism takes people all over the world, including to Mexico, India and Eastern Europe. Violence against medical tourists is generally thought to be rare, but the U.S. Centers for Disease Control and Prevention warns about other risks such as quality of care, infection control and communication challenges with medical staff.

"It's on the daily, without a doubt. There are people going daily to get this kind of stuff done," said Dr. Nolan Perez, a gastroenterologist in Brownsville, Texas, which is across the border from Matamoros. "Whether it's primary care provider visits or dental procedures or something more significant, like elective or weight loss surgery, there's no doubt that people are doing that because of low cost and easier access."

One study published in the American Journal of Medicine estimated that fewer than 800,000 Americans traveled to other countries for medical care in 2007, but by 2017, more than 1 million did. More current estimates suggest that those numbers have continued to grow.

Video below: Americans are saving by traveling abroad for medical care

"People travel because there may be a long waiting time, wait lists or other reasons why they can't get treatment as quickly as they would like it. So they explore their options outside the United States to see what's available," said Elizabeth Ziemba, president of Medical Tourism Training, which provides training and accreditation to international health travel organizations.

Also, "price is a big issue in the United States. We know that the US health care system is incredibly expensive," she added. "Even for people with insurance, there may be high deductibles or out-of-pocket costs that are not covered by insurance, so that people will look based on price for what's available in other destinations."

The most common procedures that prompt medical tourism trips include dental care, surgery, cosmetic surgery, fertility treatments, organ and tissue transplants and cancer treatment, according to the CDC.

"With Mexico and Costa Rica, it's overwhelmingly dental and cosmetic surgery. However, certain countries are known for specialties. For example, in Singapore, stem cell and oncology is huge. In India, South India and Chennai Apollo hospitals does incredible work with hip and knee surgeries," Josef Woodman, founder of Patients Beyond Borders, an international health care consulting company, said.

"In Eastern Europe, a lot of people from the UK but also people from the United States travel to Hungary, Croatia and Turkey for everything from dental to light cosmetic surgery," he said.

Mexico is the second most popular destination for medical tourism globally, with an estimated 1.4 million to 3 million people coming into the country to take advantage of inexpensive treatment in 2020, according to Patients Beyond Borders.

Matamoros where officials said the four kidnapped Americans were found is "not considered a primary medical travel destination," Woodman said, "largely because there are no internationally accredited medical centers/specialty clinics there or in the immediate region."

Mexico City, Cancun and Tijuana are more frequented and reliable destinations in the country, Woodman said.

On average, Americans can save 40% to 60% across the most common major procedures received by medical tourists in Mexico, according to an analysis of 2020 health ministry data conducted by Patients Beyond Borders.

Woodman said that violence against medical tourists was extremely rare, but he added that "price shopping" searching for the cheapest location for a procedure is a "blueprint for trouble," namely substandard medical care.

Video below: U.S. Attorney General Merrick Garland offers remarks about the Americans who were kidnapped in Mexico.

Medical tourism can be dangerous, depending on the destination and the person's condition.

"There are the complexities of traveling if you have a medically complex situation. There are fit-to-fly rules. And your health care providers should take into consideration the impact of traveling if you have orthopedic injuries or issues," Ziemba said.

"The quality of care may be an unknown," she said. "It may be that the quality of care is not up to the standards that you would like. So there's a bit of an unknown there, and then the last thing I would say is, if something goes wrong, what's going to happen?"

Perez said he commonly manages complications from medical tourism in his practice.

"There are a lot of bad outcomes. There are a lot of infections and a lot of botched procedures gone wrong, and patients have to come back to the United States and then have a revision of the surgery," he said. "So it's really unfortunate."

Yet Ziemba added that there can be benefits to medical tourism, including that someone could receive a service that they need faster overseas than locally.

"And price: If you simply can't afford the out-of-pocket costs of health care in the United States, and assuming the risks involved, it may make much more sense for you financially to travel outside the United States," she said.

Medical tourism is not just for people traveling around the world. Many living along the U.S.-Mexico border, where access to health care can be scarce, cross into Mexico for care.

The Rio Grande Valley, at the southernmost point of Texas, is considered to be a medically underserved area. The region has some of the nation's highest rates of comorbidities, including obesity and diabetes, and one of the lowest physician-to-patient ratios.

There is a "dire need" for health care professionals along the border, Perez said.

"There are not as many doctors given our big and our growing population down here. So the demands on primary care doctors and specialists are very high because there are not enough of us for this population," he said. "So that's one reason why people end up going to Mexico to visit with physicians, because of easier access."

People interested in medical tourism can take some steps to help minimize their risk, the CDC says.

Those planning to travel to another country for medical care should see their health care provider or a travel medicine provider at least four to six weeks before the trip and get international travel health insurance that covers medical evacuation back to the United States.

The CDC advises taking copies of your medical records with you and checking the qualifications of the providers who will be overseeing your medical care. Also, make sure you can get any follow-up care you may need.

Excerpt from:
Medical tourism to Mexico is on the rise, but it can come with risks - WMUR Manchester

Michael York: ‘I have not lost anything. In fact, I think I’ve gained’ – Rochester Post Bulletin

Michael York has been called the quintessential British actor. Dashing, debonair, and intelligent. One of the most sought-after movie stars of his time.

And thats just in the first paragraph of one magazine article.

He grew up as the second of four children of a musician mother and an ex-Royal Artillery British Army officer/businessman father in Oxfordshire, the southeast county in England that connects the Cotswolds to the Chilterns (rolling hills to more rolling hills). Was schooled at Bromley Grammar School for Boys then Oxford. Joined the National Youth Theatre as a teen.

Landed a role in a BBC-TV movie. Made the jump to the big screen as Tybalt in the 1968 film version of Romeo and Juliet. Found fame as Brian Roberts in 1972s Cabaret and as DArtagnan in The Three Musketeers a year later.

Played John the Baptist in Jesus of Nazareth. The Antichrist in The Omega Code. Logan in Logans Run.

Narrated the entire New King James Version for an audio Bible. Voiced Dr. Lionel Budgie on The Simpsons. Wrote five well-received books (including The Readiness Is All: My Odyssey of Healing from Mayo Clinic to John of God and Beyond.)

Played Basil Exposition in Austin Powers. Professor Asher Fleming on Gilmore Girls. Himself on Curb Your Enthusiasm.

Received the OBE (The Most Excellent Order of the British Empire). Won two Emmys. Was voted to the International Best Dressed List Hall of Fame.

Lunched with Princess Grace in Monaco. Outbidand this is the kind of name-dropping sentence you dont often get to sayCary Grant for a David Hockney painting. Called Lawrence Olivier Larry.

Contributed

Today, Michael York, 80, walks through the lobby of Charter Housethe 350-resident downtown retirement community with a focus on healthy agingand wishes Happy Birthday to longtime Rochesterite Tom Ostrom, says Good morning, Theresa as he picks up a copy of the daily Charter House newsletter, The Chronicle (with inspirational quotes and celeb birthdays), and greets me like we know each other.

We grab coffees in the Corner Cupboard (the Charter House cafe/gift shop, Hello, Carol!) and elevator up to his apartment, where wife Patriciashe often goes by Patwarmly welcomes us into their fourth-floor apartment.

Steve Lange [showing Michael the January issue of Rochester Magazine]: This is the January issue, which includes The Rochies, some of our best and worst stories of the past year. In the best category was Michael York moves to Rochester.

Michael York: Well, Im flattered. Im truly flattered.

Steve: Youve been nominated for two Emmys, won a Satellite Award and two Lifetime Achievement awards. Where does this stack up in those awards?

Michael: Why, this is right at the top.

Steve: You are off to a good start. Was this a typical morning for you, except for me coming here?

Michael: Well, we got coffee downstairs. We can easily have a coffee in the kitchen, but I like to get out and see whats going on and pick up a copy of The Chronicle, the newsletter that they produce here. Its a wonderful mixture of the serious and the ridiculous. I love it. Im totally hooked on it. And then we will often walk around. I think its good to interact with people rather than to be solitary. It feels like being back at university here. Theres everythingintellectual, spiritual, and physical.

Contributed

Steve: Since you mentioned university, Im going to give you some names: C.J. Lukey, R.V. Neve, P.S. Fenwick, D.E. Tennant, K.V. Turpee ...

Michael: Thats the 61 class from Bromley Grammar School [in London].

Steve: [showing a photo of the class].

Michael: My name was Johnson, then. M.H. Johnson. I think I was school captain. How did you get this? I dont believe Ive ever seen this.

Steve: I do my research. Charter House takes you back to those Bromley days, those Oxford days?

Michael: It does. Absolutely. And I love being on this sort of campus because I like to walk to places. It also reminds me of university because there are so many brilliant people together on this one campus.

Steve: I reached out to a few doctor friends of mine about your doctor, Robert Kyle. They described him as a world-renowned expert in hematology.

Michael: He is amazing. Pat, explain how Dr. Kyle came into our life.

Contributed / Pat York

Pat York has been called a major voice in the world of photography.

She was born Patricia Watson in Jamaica to an English diplomat father and an English mother, attended a French convent school in England and was tutored in Germany, eloped as a teenager (for a short-lived marriage) and gave birth to a son, Rick (a film producer).

The artist-turned-photographer soon became the portraitist for the stars (Andy Warhol, the Kennedys, John Travolta). When she got tired of shooting celebrities, York turned to artistic photography.

Her 2004 book, Pat York: Covered-Uncovered starts with her celebrity photos. Part two focuses on ordinary peopleincluding their plumberwho agreed to be photographed in the nude, while working. Part three features Pats groundbreaking work photographing human cadavers.

As a couple, Michael and Pat have been described as a binary star, each in orbit around the other.

So, as soon as Michael asks Pat about anything during this interview, she jumps in seamlessly.

Pat: I will first tell you how I met Michael. I lived in New York, and I worked for Vogue and Glamour. My magazine editor sent me to photograph Tom Stoppard [a playwright and screenwriter] in London. I was also shooting the new young hot actor called Michael York, who had just come out in two movies. And we were both engaged to someone. I was engaged to S.I. Newhouse [the billionaire magazine publisher], though I had asked him to wait for us to set a marriage date. Well, Michael and I just clicked. We both broke off our engagements. He proposed on Juhu Beach in Mumbai on Valentines Day of 1967. We were married in 1968.

Steve: As far as contacting Dr. Kyle, I know that was an important decision, since you are big believers in complementary and alternative medicine.

Contributed

Pat: So I was very worried that Michael, in L.A., was getting misdiagnosed. But I didnt know for sure. But I didnt feel confident. He was being treated for multiple myeloma. Then a really nice doctor in L.A. gave me Dr. Kyles number at Mayo, and we became friends on email and phone calls. Dr. Kyle, at one point said to me, Well, what are his symptoms? And I told him about everything, including the purpura [a rash of purple spots] around the eyes. And he said, You know, I dont think hes got multiple myeloma. I think hes got amyloidosis.

Steve: That was like 10 years ago?

Pat: We came here in 2012. Michael had a checkup. They decided it was amyloidosis [a rare disease that occurs when a protein called amyloid builds up in organs]. And it was suggested he have his first stem cell transplant, which was a big success. And our whole life had been nothing but travel. We were in our house maybe two months a year. So we continued that life and we came back here about every five months for a checkup. Then in 2018, he needed a second stem cell transplant. We stayed in a guest apartment here. We decided last year that we should move here definitely.

Steve: Michael, you describe amyloidosis as the Rodney Dangerfield of diseases. Thats a great line.

Michael: Yes. At that time, amyloidosis was not fully on the radar. It was there, but it was little appreciated. But since then, its become extremely well-known and extremely well-provided for. Now, I see a Dr. [Morrie] Gertz every month or six weeks or so. Its been a wonderful place.

Steve: What are your hobbies? I know you and Pat played some late-night Scrabble with Jane Fonda ...

Michael: Well, I must say I like watching movies.

Steve: Whats the last movie you watched?

Michael: Oh, it was wonderful. Im trying to think of the name of it ... Seabiscuit.

Contributed / Pat York.

Steve: Thats a good one. Im going to give you some of your own movie descriptions. You tell me what movie it is. I will read them like an announcer reading for a trailer.

Micheal: I cant wait to hear it.

Steve [in announcer voice]: While escaping war-torn China, a group of Europeans crash in the Himalayas, where they are rescued and taken to the mysterious Valley of the Blue Moon, Shangri-La.

Michael: Lost Horizon.

Steve. Yes. A Russian immigrant finds himself in bed with the mob after buying a sexual novelties shop.

Michael: I remember. I think they changed titles. Did they end up calling it Merchants of Venus?

Steve: Yes. Last one: Sparks flyand the heat is literally turned upwhen Dr. Kornack goes undercover as a pizza oven salesman and seduces notorious deep-dish lover Dame Pomeroy to solve the mystery of Kornacks missing Weimaraner.

Michael: I cant believe this. I know Ive had some gaps in my memory lately, but I would remember this one.

Contributed / Michael York.

Steve: Youre right. I made that one up. OK. Whats the best restaurant meal in Rochester?

Michael: Well, we like the fish restaurant ... Pescara. Also, Terza and Twigs.

Steve: Thats good, because theyre all advertisers.

Michael: We love trying the local restaurants.

Steve: One of the first movies I saw in the theater was Logans Run in 1976. I was seven years old, and it had a real impact. I know youve been heralded as a serious Shakespearean actor, but Logans Run stuck with me.

Michael: I got the script and turned it down. I didnt think it was for me. At that time, I was doing a play in L.A. ... The theater company hired a young man to drive me to the theater, and we became friends. I got the script and I didnt think it was for me. And this kid driving me, he saw the script and said Do you mind if I read this? I said, Oh, of course. I came back. He was wagging a finger. He said, You dont understand whats going on, but I do. You need to do this movie. So I did. He did me a real favor. So always listen to your chauffeur.

Steve: I will remember to do that. Whats your favorite photo from your wifes portfolio?

Michael [pointing to a large framed print above the table]: This one.

Contributed / Tsuni / USA / Alamy

Steve: I was going to guess it was her shot of Jane Fonda in her Barbarella outfit standing over a stove cooking dinner.

Michael: How interesting. Thats not my favorite, but one of the doctors here loved it.

Steve: I was going to guess your favorite was not Plumber, 1997. Thats the photo of your naked plumber working under your sink.

Michael: Oh, no.

Steve: Im going to just throw out the most name-dropping sentences imaginable. You won a David Hockney painting by outbidding Cary Grant.

Michael: Well, we got the Hockney. And then Cary was forever trying to buy it back. Cary became a good friend. I was resident in Monaco, in Monte Carlo, and knew Grace [Kelly] very well. And she would invite us to lunch. And one time, Cary Grant was also there. He came down the steps into the reception area and fell into Pats arms. He said, Theres no place Id rather be.

Steve: Wow. The only comparable story in my life would probably be when I was a celebrity parade judge at the Viola Gopher Count, with Tom Overlie ...

Michael: That sounds lovely.

Steve: Yes. Right. OK. You sold your $7 million house overlooking the Sunset Strip in Hollywood Hills. You had a French chef you brought in for special meals. All of that. What do you miss most about that life now that youre in Rochester?

Michael: I dont miss any of it. I have not lost anything. In fact, I think Ive gained. We get to live in a part of the world we want to get to know. We love exploring the area. Weve toured an amazing art museum in Winona, the Minnesota Marine Art Museum. Weve been on the Mississippi River with a wonderful, fantastic captain who was like a professor. He told us so much. And then he took us to this place with these wonderful eagles and then they were flying above our heads. It was extraordinary. We even went to Austin for the Spam Museum. I sent postcards to all my contemporaries in the university. Ive booked a cruise on the Great Lakes leaving from Toronto this June. We have so much to see here.

Steve: That is great. You dont sound like someone with many regrets.

Michael: I dont believe in them. Regrets dont do anyone any good.

With that, Michael and Pat show me to the door, offer to walk me out. I know my way, though, and I know they have plenty to do.

Return a call from an art studio hoping to display some of Pats paintings. Meet a group for their regular exercise class. Prepare for dinner at the Skyview Dining Room (Charter Houses restaurant).

Plan a daytrip to Lanesboro for Amish Country. Find a good Indian restaurant to celebrate the 55th anniversary on Michaels wedding proposal. And, tomorrow morning, take that walk down to the Corner Cupboard for coffee with Rochester friends.

Read more:
Michael York: 'I have not lost anything. In fact, I think I've gained' - Rochester Post Bulletin