PEN Blog Archives

Internet Access, Digital Literacy, and Bridging the Digital Divide

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In the modern healthcare era along with navigating COVID-19 infection concerns, Internet service and digital literacy are more important than ever for cancer patients and their loved ones. Telemedicine serves cancer patients with multiple benefits, some of which include protecting them from infection and virus risks, providing easy ways to refill prescriptions, schedule appointments, and view test results; and reducing time, costs, and stress of traveling to and from appointments. 

Internet Access, Digital Literacy, and the Digital Divide

Yet cancer patient advocates must look closely at Internet access, digital literacy, and the digital divide to support more underrepresented patients. A recent National Cancer Institute study of cancer patients and caregivers showed that 90 percent had Internet access, and 82 percent owned a smartphone. While these statistics look promising, there is still more work to be done to help underrepresented patients. Examining results from a recent study of rural cancer survivors reveals a digital divide. Medicare-covered cancer survivors in rural areas had telehealth availability 53 percent of the time compared to 63 percent in urban areas. Rural cancer survivors are also less likely to own desktop computers, laptops, smartphones, or tablets at a rate of 67 percent versus urban cancer survivors at 82 percent. Internet access also needs improvement with Medicare-covered rural cancer survivors at 58 percent access versus 79 percent in urban areas. 

Furthermore, Black and Hispanic survivors had lower technology ownership, with 65 percent of Black survivors and 67 percent of Hispanic survivors owning a desktop computer, laptop, smartphone, or tablet versus 82 percent of white survivors. “Despite the potential of telehealth to meet the unique healthcare needs of cancer survivors (e.g., surveillance, comorbidities, primary and survivorship care), some patient groups face greater barriers to technology access,” the study authors wrote. “These patterned differences in use and access underscore a need to engage multilevel interventions to mitigate the underlying barriers to telehealth use.” 

U.S. Financial Support of Digital Healthcare Access

What can vulnerable cancer patients do to improve their situation if they’re lacking in Internet service or technology literacy? Fortunately, President Biden has put racial equity at center stage of his agenda and is working to end disparities in healthcare access and education. The  Coronavirus Aid, Relief, and Economic Security (CARES) Act helped provide telehealth and connected care services to patients, and the proposed infrastructure bill could help extend support. The U.S. federal government has taken action to help those in need of Internet service or improved Internet service. As part of the Bipartisan Infrastructure Law, President Biden and Vice President Harris operated with Democrats, Republicans, and Independents to create the Affordable Connectivity Program (ACP), as part of the Bipartisan Infrastructure Law. The ACP provides eligible households with a high-speed Internet plan for no more than $30 per month. The Biden-Harris Administration has received commitments from some leading internet providers to offer ACP-eligible families who pair their ACP benefit with one of these plans to receive high-speed Internet at no cost. You can easily check to see if you qualify here.

Digital Literacy Training

For those looking to improve their digital literacy, Patient Empowerment Network can help people build their skills. The PEN digital sherpa® Program and Digitally Empowered® Course help cancer patients (mainly 65 and older) and their families become better prepared for their cancer journey. The goal is for participants to learn to use technology to their advantage and to become more tech-savvy. The program’s workshops help educate patients and care partners in basic Internet and social media skills to help them in their search for information about their illness and support resources for themselves and their families.

University students, known collectively as “sherpas,” have been specially trained by the Patient Empowerment Network to offer technology skills and are paired with program participants. The sherpas empower patients and care partners by training them in skills such as: 

  • Safely navigating online healthcare resources
  • Finding credible online resources
  • Forming online disease support communities
  • Using telemedicine
  • Navigating your health with social media
  • Using rideshare and wellness apps
  • Following and connecting with experts online

The Digitally Empowered Course opens access to a whole new world of knowledge and tools to assist you in researching your condition, asking informed questions, and taking an active role in shared decision-making with your care team. The 10-module Digitally Empowered course trains participants in:

  • How to access the Internet
  • Identifying credible resources and websites
  • The benefits of your patient portal
  • Using social media to connect and learn
  • Navigating your health with mobile devices
  • Apps to use for convenience and fun
  • How to use telemedicine
  • Accessing and joining online support communities

The pandemic brought some issues to light about gaps in Internet service and digital literacy. But vulnerable and underrepresented cancer patients and their loved ones no longer need to remain in that state. They now have options to move them toward becoming empowered and informed. 

Empowered and tech-savvy patients have the ability to build more support for themselves and to build knowledge and confidence. With increased confidence, patients feel more at ease to ask questions when they interact with their healthcare team members. This fortified knowledge and confidence then empowers them to make more informed decisions for optimal health outcomes and improved quality of life for patients. These results make a clear win-win for formerly underrepresented cancer patients and for those who work to support these patients.

Sources

https://mhealthintelligence.com/news/rural-cancer-survivors-report-low-telehealth-availability-internet-access

https://pubmed.ncbi.nlm.nih.gov/34428075/

https://www.whitehouse.gov/getinternet/?utm_source=getinternet.gov

What Healthcare Trends Are Observed in MPNs?

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What Healthcare Trends Are Observed in MPNs? from Patient Empowerment Network on Vimeo.

MPN Empowerment Leads Jeff and Summer share trends they’ve observed since Summer’s initial diagnosis of myelofibrosis a few years ago. They share recent studies they’ve viewed and are following. Jeff gives a charge to viewers to be your own empowered patient and keep up with research when you can. “Be your own advocate.”

Videos Featuring Jeff and Summer:

Roles Reversed: Taking Care of Your Care Partner

 Patient and Care Partner Address the Mental Aspects of an MPN

 How Can Care Partners Combat Burnout

Transcript:

Jeff:

Hi, I’m Jeff.

Summer:

And I’m Summer.

Jeff:

And we’re your Network Managers (Editor’s Note: Now referred to as Empowerment Leads) for Myeloproliferative Neoplasms for the Patient Empowerment Network. And, we’re here today to talk to you about healthcare trends in MPN medicine, basically.

Summer:

I was diagnosed with myelofibrosis over three years ago. And at the time, they could only offer me one medication, Jakafi (ruxolitinib), which for me work but doesn’t work for everybody. So, I’ve had good luck with it and I haven’t really had any other symptoms.

Jeff:

But this is an exciting time in the MPN medicine because since that time, there have been two more medications released to control myelofibrosis. One called fedratinib. And just last month, pacritinib was released and approved by the FDA. So now there are three medications that can be used to treat the symptoms of myelofibrosis.

There are currently no medications that can cure a person of myelofibrosis. The only cure, currently, is a stem-cell transplant. But some exciting developments are happening that may even be able to cure it.

I just read an article that some scientists have found that the medication used in breast care – breast cancer treatment causes remission in bone marrow fibrosis in mice. So they’re working along the way to see if that will be effective in humans, eventually. And that might be, potentially, a cure for myelofibrosis. Those are exciting trends in the MPN research and medicine world.

Summer has other information that’s useful though.

Summer:

Yeah, that’s really exciting about the new medication. I was looking up what the Mayo Clinical has to say and being happy and having a good attitude really enhances the immune system. There is a chemical that you get that comes from being happy that really, really keeps the disease from being more serious.

So anyway, that’s what I believe in because I’m an actor and so I don’t get into the medical thing, but I know Jeff is brilliant for it. So, that’s exciting all along having a good attitude and the new developments in medication.

Jeff:

So, keep those in mind, consult with your healthcare provider, and you need to be your own empowered patient and keep up with the research by yourself. It’s all available online, no problems at all, just Google it and you’ll be able to keep up yourself. You have to be your own advocate.

Until next time, I’m Jeff.

Summer:

I’m Summer and, wait a minute, this is our little baby, Zelda.

Patient Advocacy: How To Optimize Your LinkedIn Profile

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When was the last time you updated your LinkedIn profile? People tend to think of LinkedIn as simply a place to post their resume, but there is so much more to it.  The platform is flourishing right now and has released some new features to make it an even more engaging place for users. 

With 810 million global users (185 million in the United States), LinkedIn is an excellent way to network with healthcare professionals and disease experts. It can also provide the perfect platform to showcase your advocacy activities. In this post,  I’m going to share with you some tips on how to take full advantage of LinkedIn’s potential. I’ll show you how to improve your LinkedIn profile and turn it into the cornerstone of your professional online presence. Whether you’ve been using LinkedIn for a while or are just starting out, optimizing your profile for maximum visibility and engagement is worth the effort. 

Before you begin, gather together the following: 

  • A current version of your bio 
  • Your CV with your employment history 
  • A high-quality headshot 

1. Make A Positive First Impression

Let’s start with the basics. LinkedIn reports that profiles with photos receive 14 times more views than profiles without. Your profile photo is the first thing that people see when they navigate to your account, so make sure that it portrays you in a professional manner. You can upload a jpeg or png image sized between 400 (wide) x 400 (height) pixels (maximum file size is 8MB).   

LinkedIn photos are usually cropped just below the shoulders, so choose a photo that won’t require much cropping.  On mobile devices, only the center portion of the photo appears, so avoid putting anything important on the outside edges. You can adjust the photo after it has been uploaded by cropping, changing its position and size, and even adding photo filters.

2. Add A Banner Image

If you have noticed, there is space behind your profile image where you can upload a banner or header image.  Consider this your professional billboard. This is an opportunity to increase your LinkedIn visibility and make your profile stand out. 

On the desktop version, your profile photo is located about 50 pixels from the left, so move any important information (such as a logo or contact information) out of this area so it won’t be obscured. 1584 pixels wide by 396 pixels high is the recommended image size. Your background image will look blurry or pixelated if it is not high-resolution. Whenever possible, choose an image with a file size as close to the maximum (8 MB) as possible, as larger files tend to look better. Choose photos over images with logos. You can crop, filter, and adjust your photo after you upload it to LinkedIn.   

3. Customize Your Profile URL

It It is very likely that someone will find your LinkedIn profile first when they google your name. Claim your LinkedIn url (i.e., your LinkedIn address) for the best Google ranking. Your address is unique to you, and if you haven’t customized it, it will likely consist of your first and last name followed by numbers, letters, and dashes; this doesn’t look very professional.  

This feature can be found under your profile picture. If it’s not customized, you can do so by clicking on Edit your public profile. If your first and last names are already taken by someone else on LinkedIn, you can add an affiliation or middle initial.  After creating your custom URL, you can use it on your business cards, add it to your email signature, and anywhere online you wish to build your personal brand. 

4. Create Your Professional Headline

The first thing people see on your LinkedIn account is your profile picture, but the first thing they read is your professional headline. Because your headline follows you everywhere on LinkedIn, it is important to make it as compelling as possible. An individual’s profile, for example, will show both their picture and headline. 

In addition to being highly visible, your professional headline is also searchable by Google. LinkedIn is like a secret search engine. Google crawls pages and URLs for keywords, and LinkedIn profiles allow users to embed keywords. If you want people to find you on LinkedIn, you’ll want to emphasize the keywords that people search for on the site and that will show up on search results.  

5. Add Your Location and Industry

Location is one of the top five fields that LinkedIn prioritizes when doing a keyword search. To add your location and industry, open up the Edit Intro window and fill in your location details as prompted.  

6. Enter Your Education Details

To add details about your education to your LinkedIn profile, click the + sign in the upper right of the Education section. In the box that appears, enter details about your school, degree, studies, etc. 

7. Complete Current and Previous Job Experience Section

Provide a list of all the jobs and positions you’ve held and their descriptions. Most of this information can be found in your CV. Emphasize the keywords you want to be known for. One of the most common LinkedIn mistakes is an outdated Experience section. Archive previous experience and make sure all of your current experience is correct. 

One of the newest features added by LinkedIn is the ability to add a career break to this section. I really like how LinkedIn frames a career break as a way to add something unique to your skillset. As many of us have breaks in employment due to illness, this is a welcome feature on the platform.  

8. Add A Compelling Profile Summary

Immediately below your picture, name, location, company and education sections, you have the opportunity to write a summary about yourself. In my experience, many people skip over this section or give it very little attention. This is a big mistake. This section tells the story of what you are passionate about. It makes your profile less about being a resume and more about you. It’s an opportunity to establish your credibility and show some personality. It’s also a great place to include keywords that will help make you more visible in search results. Think of this space as your elevator pitch. Use it to describe the story of what you do and the unique qualities you bring to your work.  

Tip: When completing this section, break it up into short paragraphs and make it easy to scan for the reader. It’s important to note that only two lines of text from the Summary show up on your profile before the “see more” link to click. Those two lines need to be compelling enough to get people to click. 

9. Showcase Your Skills

Adding skills and expertise to your profile also helps you show up in relevant searches. You can list up to 50 skills with LinkedIn showcasing your top 10 skills based on endorsements so people know where you excel.  To add a skill, click the Me icon and select View Profile. Scroll to the Skills & Endorsements section of your profile and click Add a New Skill.  

Remember, it’s the top three skills that are immediately visible when people scroll through your profile, so make sure you order your skills the way you want them to appear.  

10. Obtain Recommendations

A LinkedIn recommendation is a brief paragraph that someone has written describing their experience of working with you.  Get into the habit of asking people if they would be willing to recommend you on LinkedIn after they have thanked you in person or complimented you for work you have done. 

11. Add Projects, Honors and Awards

Scroll all the way down your profile, and you’ll discover there are sections to add your current and past projects, as well as any honors and awards you’ve received.  Be sure to populate these sections to showcase your advocacy activities.  

Conclusion

Taking time and care with each of these steps will pay dividends and reward you with increased visibility and enhanced professionalism. Your LinkedIn profile should never be done once and then forgotten. Review it regularly. Remove outdated information, include fresh keywords, add new images, and keep your profile looking current and relevant. 

From Network Managers to Empowerment Leads

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 At Patient Empowerment Network (PEN), we believe it is our duty as advocates to reach as many patients as possible by creating and curating relevant content. This includes our PEN-Powered Activity Guides, #PatientChats, blog posts, and educational media written by cancer patients and care partners for cancer patients and care partners.

 As Empowerment Leads (previously Network Managers), each one of us strives to create content that is relatable and easy to understand, all while promoting PEN’s mission “to fortify cancer patients and care partners with the knowledge and tools to boost their confidence, put them in control of their healthcare journey, and assist them in receiving the best, most personalized care available to ensure they have the best possible outcome.”

As Empowerment Leads, we look to guide patients in the right direction when it comes to quality, comprehensive cancer care. While each one of us comes from a background that is unique, as members of a community of people who have been touched by cancer in one way or another, we have found that we’re more alike than we initially understood. As volunteers, we aim to empower PEN’s community by using our various talents, including writing, conducting interviews with physicians, and producing comedy shows, amongst others. We do this because we’ve been there, and we know what it’s like to have to go through trying times when it comes to a devastating diagnosis, such as cancer.

Furthermore, Empowerment Leads recognize the importance of having someone to speak to. We can have all the education, but sometimes you want to speak to another person who can relate to what you’re going through. Each one of the Leads has their own email you can send a message to at any time with any questions you may have. There’s also a text line PEN recently created, all for the purpose of getting information to the right person at the right time. Please note, though, that any information passed on does not constitute as medical advice, and information should also be discussed with your healthcare team.

Finally, although there has been a name change, the power of our program has not changed. We are here for the patient community and always will be. That is our mission, and we’re sticking to it!

Self-Education Is the Basis of Better Health Outcomes, Physically, Mentally, and Financially

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We have all heard the phrase, “Hindsight is 20/20”. Yes, it can be, if we know to look and be retrospective and heed the lessons learned. However, too many of us don’t take the time to take advantage of hindsight and find ourselves caught over and over in the same tidal pool.

When my husband was diagnosed in 2002 with MGUS, the driving force for me to use as a guide to be proactive in his health as his advocate was the illness and subsequent death of my 5-year-old brother David, who was very rarely spoken of in my family. I always wondered why it was sort of secretive. I remember finding his death certificate in a chest and wondered about him for years until as a teen I asked my mother about him and his illness. You see, I was only 1-year-old when he died, I have no memory of him. What I know was told to me by my mother, many years after his death. He had leukemia, diagnosed when he was 4. At that time, it was a death sentence. He was in “treatment” but it was all experimental at the time. I asked my mother what kind of leukemia he had. She wasn’t sure. She knew she had to give him over 50 pills a day. I asked what they were, but she didn’t know. I couldn’t believe how little she knew about his illness or what was being done to him. I always felt that when hearing her tell me about David that she was guarding herself somehow. He was eventually sent home to die. Hearing the bits and pieces always struck a weird chord with me.

It was only as an adult accompanying my husband on his cancer journey with Myeloma that I began to understand the horrible cost to David and subsequently my parents and older siblings. I was always trying to investigate his illness from afar. So, now the seeds of questions that always remained with me and the illness and death of my husband has led me to where I am now. Those two experiences, especially the journey with my husband made me acutely aware on a daily basis of the urgent need for all patients to be educated in their illness, so they can openly and actively participate in their treatment not only of cancer but their overall health, mentally, physically and financially.

Overcoming barriers of bias both conscious and unconscious are still huge barriers that many patients face. Educating oneself seems to be a huge equalizer. Knowledge gives you the confidence to question, make better decisions, and to benefit from those decisions. It gives you relative peace of mind that the decisions you make are in your best interest and your family.

You may be asking how all of this comes together when in treatment for Myeloma, AML, or quite honestly, any illness. Simply, the more you know about your treatment the better equipped you are to ask the right questions about the cost of treatment, its side effects if you are going to have to take time off from work if there are other anticipated upcoming treatments that you need to prepare for. And, If your treatment is available in town or if you need to find treatment elsewhere. You can ask if there are other treatments available with perhaps less associated costs. You can prepare your personal finances and make sure your insurance coverage is the best it can be. Knowing your full treatment plan can help you gather the financial assistance you will need to help you get and stay on treatment.

There are many resources that you can easily access to educate you on your illness as well as give you information about financial resources for which you may qualify. They include help with travel for medical treatment, co-pay, deductible and premium help, utilities, lodging, and urgent financial help.

Many of the resources available today were not around to help my husband or I had no knowledge they existed and no one to inform us during his cancer journey and certainly not available to my parents with the cancer journey of my young brother in the early ’60s. Education can even be the playing field for many patients.

Becoming knowledgeable about available resources can help you control your stress levels which can benefit your overall health outcomes. And knowing that there are financial resources available to you can help alleviate some of the financial stress that comes with having a very expensive illness.

In one of the few conversations, I had with my mother, I asked how they found out about my brother’s cancer. She said they were told over the phone. The doctor said,” Your son has cancer and is dying”. I can’t imagine living that experience. My mother said she felt hurt and angry for it being so impersonal. She said this was a hurt for which she never forgave herself. This was a time in 1961 when the disparity in healthcare was even more glaring than it is today. My parents didn’t know how or were even encouraged to ask questions to participate in David’s care. David and our family suffered as a result.

I encourage everyone to take advantage of the learning opportunities available to them. Doing so will provide you with the peace of mind that you are getting the best care while managing the cost of your treatment and reducing overall stress to allow you to live your best life.

The Basics and “Why They Aren’t The Basics” of Clinical Trials

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We’ve all heard about clinical trials, especially with the recent pandemic (for which there are still ongoing trials available!). But it’s not always intuitive on how to find trials, how to enroll in them, what goes into them, and how there still is (and how we can fix!) the lack of diversity in trials despite efforts. Therefore, this blog is specifically dedicated to just that! If you have additional insights, feel free to reach out in the comments or email me at carly@powerfulpatients.org so that this can be updated! 

First, let’s break down what a clinical trial is not. A clinical trial is not a method of care that the healthcare community tries to take discriminatory advantage of. Although it has been that way in the past, especially amongst the African American community, I believe trials are trying to do a better job when it comes to equity and inclusion of multiple races and ethnicities, as well as clear consent. Clinical trials are a way to advance medical sciences and treatment initiatives for patients around the world experiencing the same diseases and conditions that make us vulnerable. Clinical trials aren’t always looking for treatment opportunities, however, some trials are focused on prevention, the feasibility and/or safety of a medical device, or on quality of life. No matter the type of trial, though, there is always something to be learned to enhance healthcare in a number of ways, even if it’s not easily recognizable. 

Doctors sometimes do not mention clinical trials as a treatment option because they feel like they are “giving their patients away.” After all, healthcare is a business, and if a doctor “loses” their patient to a trial, it’s not the most economical option for them. This is another reason why we have to be advocates of our own health and do research.  

Clinical trials can be found doing a quick Google search, on www.clinicaltrials.gov, or by going to a local or national hospital’s website and searching for available trials. Most hospital systems will direct to clinicaltrials.gov if there’s a record for the trial because it contains the most information, including the purpose of the trial, the outcome(s) the investigators are looking for, eligibility criteria, and what will be happening during the trial and for how long. A patient can bring this information to their doctor and ask if it’s appropriate for them. If so, the trial generally lists who and how to contact at the bottom of the record on clinicaltrials.gov or on the hospital’s website. What it doesn’t tell you is if you’ll be compensated for your time, which may hinder trial enrollment. 

Compensation information for a trial, if applicable, can be found in the informed consent document, which is an official document that includes what will happen in a trial and for how long, what the objectives of the study are, compensation information, and the risks/benefits of participation. Compensation in clinical trials is considered a “recruitment incentive,” not necessarily to obscure the risks and/or benefits of a trial. According to the NIH, the FDA doesn’t consider reimbursement for travel, lodging, airfare, and/or parking, but for “their time, inconvenience, discomfort, or some other consideration.” Usually, it’s in the form of a gift card, and “any credit for payment should accrue as the study progresses and not be contingent upon the subject completing the entire study.”   

Given that patients would be paid to participate, does this help break down barriers for vulnerable populations? It may not be enough. Patients are not responsible for routine care costs during a trial if they’re covered under private insurance or Medicare. However, as stated above, patients are not reimbursed for travel, lodging, airfare, and/or parking. Depending on how far the patient has to travel and where, the gas money, much less airfare, and hotel costs could drive up the costs exponentially. This is especially true in major metropolitan areas as opposed to more rural or suburban areas, as there may be more local trial locations such as hospitals and clinics. 

How do we increase diversity in such important potential medical discoveries? The FDA suggests that study sponsors are “encouraged to think about reducing visit frequency, when appropriate, in addition to considering whether flexibility in visit windows is possible and whether electronic communications, such as phone, email, social media platforms, or other digital health technology tools can replace site visits and provide investigators with real-time data.” Tying this advice back to patient compensation, electronic communications replacing in-person could be a game-changer for patients. If Covid hadn’t forced some medical offices to close and offer virtual visits, it couldn’t have come any sooner. Additionally, continue to have clinical trials that are for specific patient populations, as applicable to specific diseases (for example, breast cancer trials for African American men and women). Finally, establish networks in the local community, and go where the patients are. Learn about them. Clinical trial enrollment can only get better if we step out of the board room and into the classroom. 

Five Tips to Participate in MPN Care and Treatment Decisions

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How can myeloproliferative neoplasm (MPN) patients become more active in their care? In the “How Should You Participate in MPN Care and Treatment Decisions?” program, expert Dr. Abdulraheem Yacoub of the University of Kansas Cancer Center shares five key tips MPN patients can take for a more active role for optimal health outcomes.

1. Become a Patient Self-Advocate

It’s vital to have the ability to advocate on your own behalf no matter your age at diagnosis. And some MPN patients will be diagnosed at a relatively young age and will have different MPN care providers over the course of their disease. These patients need to get accustomed with the idea of care approaches changing over time.

2. Get Involved and Build Your Village

Being involved in your well-being as a patient is of utmost importance, and thinking about your support network is recommended as one of your early steps as a patient. Think about who among your friends, family, co-workers, and spiritual community might be able to help support you – and ask your MPN care provider about support resources if you need some additional help.

3. Bring a Friend or Loved One to Appointments

It’s important to have someone else at your appointments with you to help understand the information you receive and to also take notes and to ask questions if it’s helpful for you. Having a second set of ears is especially important with your early visits about treatment options, and the use of telemedicine makes it easier for loved ones to help support your appointments.

4. Get a Second Opinion

Second opinions are no longer the taboo that they were once perceived as. Listen to medical facts given to you from your MPN specialist and from your primary treating physician. And if you want a second opinion from another MPN specialist, this practice is easier to carry out now through telemedicine.

5. Seek Out Credible Resources and Research News

Keep yourself informed about the latest MPN research and treatment news by visiting credible online resources. In addition to PEN, check The Leukemia & Lymphoma Society (LLS) and MPN Research Foundation. The annual meetings of expert conferences like the American Society of Hematology (ASH) and American Society of Clinical Oncology (ASCO) bring research updates for MPN online resources to cover.

By taking a more active role in their care, MPN patients can help determine the best care and treatment plan for optimal health outcomes.

Exercising After Breast Cancer: Myths vs. Facts

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The benefits of physical activity for people who have undergone treatment for breast cancer are numerous, from reducing fatigue to helping regain a sense of well-being. However, as with diet recommendations, it can be confusing when it comes to how much exercise to take and the type of exercise that is safe during and after treatment.

Recently, I spoke with Cathy Leman, a registered dietitian, nutrition therapist, personal trainer, and survivor of hormone-positive breast cancer. Cathy shared many helpful tips and strategies for those who may be unsure where to start with an exercise routine after a diagnosis of breast cancer.

M.E.O’C.

What are some of the myths associated with exercise and breast cancer? When I had my surgery, I thought I shouldn’t lift anything heavy, such as weights.  And that rest is the best way to heal. Are these beliefs true?

C.L.

The two thoughts you had are very common! Immediately post-surgery, there definitely are weight limitations in place, yet once your doctor removes exercise restrictions, and gives clearance, there are no limits (other than an individual’s physical ability) on how heavy one can lift. Exercise also helps restore mobility and range of motion after surgery, and there is research identifying exercise as a way to support healing. By the way, it’s important to ALWAYS get your doctor’s approval to add or increase exercise post-surgery.

M.E.O’C.

That’s wonderful to hear, Cathy.  Let’s talk about the benefits of exercising now that we have been cleared to start.

C.L.

There are so many! Increased range of motion and improved mobility, reduction in fatigue, improvement in strength and stamina, and stress and anxiety management.

M.E.O’C.

What would you suggest to someone who feels intimidated by the current exercise guidelines, which recommend 150 minutes of exercise per week? You may feel exhausted from cancer treatment and this can seem like an overwhelming task.

C.L.

150 minutes per week translates to ~ 21 minutes per day. I recommend breaking that down even further, for example, 10 minutes of activity in the a.m. and 10 minutes of activity in the evening. Start small, with easy stretches and a walk around the block.

M.E.O’C.

I really like the idea of breaking exercise down into manageable chunks this way.  Okay, let’s move on to where and how to exercise. Gym visits may not be an option for everyone, especially because many of us are still cautious about being in public spaces due to Covid. How can we replicate some of the traditional gym exercises at home?

C.L.

Body weight exercises like squats, lunges, modified push-ups and planks are great for building overall body strength. Walking or running outdoors offers great cardiovascular benefits. During inclement weather, dancing, walking up and down stairs, and using online in-home workouts are ways to keep moving, even without visiting the gym.

M.E.O’C.

Thanks Cathy for taking the time to talk to us about exercising in ways that are achievable and beneficial, and dispelling some of the common myths around exercise and breast cancer.

About Cathy Leman

Cathy is the founder of HEALTH REBUILD 365, a program that helps post-treatment survivors of hormone-positive breast cancer end food fear, stress, anxiety and guilt, and make confident diet decisions that minimize fear of recurrence.

She also writes the dam. mad. About BREAST CANCER blog, and speaks to groups and organizations about the power of nutrition and lifestyle to optimize survivor health.

www.cathyleman.com IG; @hormone.breastcancer.dietitian

Millennial Stage IV Colon Cancer Survivor Urges Earlier Screening

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Millennial Stage IV Colon Cancer Survivor Urges Earlier Screening from Patient Empowerment Network on Vimeo.

 Stage IV colon cancer patient Ashley received her diagnosis at age 33. Watch as she shares her story starting with a routine physical, surgery and treatments that she endured, and lessons learned during her cancer journey.

Special thanks to our partner, Colorectal Cancer Alliance, for helping to make this vignette possible.

Transcript:

My name is Ashley, and I’m from West Virginia but currently reside in Nebraska. In February 2021, I was diagnosed with stage IV colon cancer at the age of 33.

I decided I wanted to join the Air National Guard and had to complete a physical examination. After visiting a hematologist/oncologist for dangerously low iron and hemoglobin levels, I went in for a routine physical a few months later. The physician’s assistant found a mass in my stomach area, and they sent me for a CT scan. The next morning, my husband Josh got the call that I missed. The CT scan had shown three different masses – and was likely cancer.

I was dumbfounded, shocked, and then I felt the tears rolling down my face. My doctor informed me, “You need surgery immediately, since the tumors are getting close to completely closing up your colon.” I also had a tumor on my liver.

I had surgery to remove the tumor before it closed my colon, but the surgeon couldn’t get to the tumor on my liver. After surgery, they told me the three most important things to do while there that would get me home sooner were eating with no issues, walking, and having a bowel movement.

Finally after two surgeries where my liver, gallbladder, one-quarter of my colon, part of my small intestines, appendix, two large tumors, and a lymph node that turned into a tumor was removed, as well as 12 rounds of chemo.

I received news in March 2022 that my cancer is back but will not be as aggressive as it was before. I am taking things one step at a time and one day at a time, trying to stay optimistic at each step.

When someone gets cancer – the “journey” is never over. The fear NEVER goes away. Even when you are declared to have no evidence of disease, there is a possibility cancer can come back. And if it does come back, the chance of fighting and winning again gets slimmer.

If you know someone that has cancer – be kind – just because they don’t look sick, doesn’t mean they aren’t having challenges. Just because their numbers and scans are good doesn’t mean they are in the clear for the rest of their life. Always, always – BE KIND!

Some of the things I have learned during my colon cancer journey are:

  • Get your colon cancer screenings on time. Or if you’re too young like me, listen closely to what your body tells you and get annual physicals.
  • Say yes to those who want to help by bringing food, checking in, or donating. We are amazed by the support we’ve received from friends, family, and complete strangers.
  • Fighting the cancer fight is much easier knowing how many people are on our side and how much love there is for us out there.
  • Advocate for yourself! Do research on your specific type of cancer and mutations. If you feel you are being told something that just doesn’t seem right, question it – push the bar until you can’t anymore! There are so many options out there when it comes to cancer and survival, you just need to find the right person that will take care of you!

These actions are key to staying on your path to empowerment.

PEN Featured On Advarra’s In Conversations With Podcast

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Patient Empowerment Network (PEN) recently had the opportunity to participate in a podcast with its partner Advarra through their In Conversations With podcast. In this episode, Becoming Your Own Best Advocate Through Patient Empowerment, Advarra’s Chief Commercial Officer Robann Cunningham and PEN’s Director of Development Robin Barnes discuss how patients can become their own best advocate through resources like those provided by PEN. 

Advarra’s Mission

Advarra helps advance how clinical research is conducted: gathering life sciences companies, CROs, research sites, investigators, and academia together at the intersection of safety, technology, and collaboration. With its trusted review solutions, innovative technologies, and consultants and worldwide connections, Advarra provides solutions that help safeguard trial participants, empower clinical sites, ensure compliance, and optimize research performance. Advarra is working on clinical trials to help make them safer, smarter, and faster for all patients. You can learn more about them at advarra.com.

Breast Cancer Survivor’s Lessons About Patient Engagement

Robann Cunningham of Advarra has a personal connection to Patient Empowerment Network’s mission through to her own experience as a breast cancer survivor. After her diagnosis with triple-negative breast cancer with a BRCA mutation, Robann was scared but also felt fortunate to have knowledge of how to take control of her cancer journey as an engaged patient. She knew about the importance of exploring treatment options and multiple opinions to decide on the best path forward for her. Robann feels that one of her goals in her mission as a breast cancer survivor is to increase patient engagement in clinical trials, and the podcast with Robin is one way she has worked toward fulfilling her goal. 

Robann collected some key takeaways from her cancer journey including:

  • Finding the right path for you is key—and knowing how to find it is even more important.
  • Education and awareness are everything.
  • We can increase the number of success stories.

You can learn more about her breast cancer experience in her article “What Being a Breast Cancer Survivor Taught Me About Patient Engagement.”

Empowering Patients 

The Advarra In Conversations With podcast provides a rich conversation about patient empowerment. Robann shares some things about her cancer journey, while Robin shares about her experience as a care partner for her husband. Robann shared her views about empowerment, “The humbling experience that that was being in this industry, but I think what I really took away and what’s important here is that I would define empowerment as both awareness and advocacy and I think that if we can raise awareness, advocate, and then I would also say education is critical.”

Robin also shared PEN’s views, “Empowerment will mean something different to each and every one of us, but at the Patient Empowerment Network the core of what we believe empowerment means is having the knowledge and also the confidence to become a co-decision maker with your healthcare team, and what that often looks like is insisting on personalized treatment options it means asking questions, it means having the knowledge and education though resources…to be able to come with confidence to that conversation and make sure that what you are receiving is the right treatment for you…”

Clinical Trials Process

Clinical trials, of course, are discussed in the podcast. Robin shared, “Encouraging patients and care partners to not think of the clinical trial, as a last resort option if other treatments have failed but to consider it at the very first step of a diagnosis, and that, of course, ties into when appropriate biomarker testing and all of these wonderful tools that we  have today.”

Regarding clinical trial informed consent documents, Robann shared, “I recommend if anyone out there is considering getting involved is to really take your time through that process, make sure that you are afforded that opportunity to have a conversation with the investigator and staff you ultimately you need to have a level of confidence and a good relationship with your investigator and their team…” Patients must be given time to take the document home to review the terms and to discuss them with their care partner and family members to ensure the patient is comfortable with the proposed research. I know Robann also shared, “…there is a popular saying, which is ‘Nothing about me without me,’ and so much of what you’ve shared today, I think, really speaks to that.”

In the podcast, Robann and Robin also discuss timely topics including health literacy, health equity, actionable resources, community-based organizations, and goals for the future. PEN is excited to be partnering with Advarra to help advance patient empowerment and clinical trial efforts. We hope you can take some time to listen to the podcast or to read the podcast transcript – and to read Robann’s article about her breast cancer experience and what she learned about patient engagement. Stay tuned as we report more about our ongoing partnership efforts with Advarra in our dedicated efforts on the behalf of cancer patients and care partners.

Listen Now

Advice From a Young-Onset Colorectal Cancer Patient

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Advice From a Young-Onset Colorectal Cancer Patient from Patient Empowerment Network on Vimeo.

Colorectal cancer patient Jessica was surprised but not shocked even after a diagnosis under the age of 40. Watch as she shares her journey from symptoms, diagnosis, her advice to others, and coping methods she’s found helpful for navigating her experience as a patient.

Special thanks to our partner, Colorectal Cancer Alliance, for helping to make this vignette possible.

Transcript

My name is Jessica, and I’m from Chicago, Illinois. Even though my doctors thought I was too young, I was diagnosed with colorectal cancer at age 39.

I’d been experiencing occasional rectal bleeding for about a year when I was finally referred for a colonoscopy.

While my doctors were convinced that I was too young for colorectal cancer, I was still worried because my grandmother died of the disease.

My doctor asked me to go in to get my colonoscopy results. My parents knew what that meant, so we went together. When the GI gave me the results, stage III rectal cancer, I felt so scared. I called my best friend, and I couldn’t even speak. We just cried together.

After I received my diagnosis, my doctor told me it’s very curable. I had a 2-inch mass in my rear. I had a CT scan to confirm the cancer had not spread followed by an MRI. And that’s when the whirlwind began.

I returned to a craft I hadn’t used much in recent years. To sort my thoughts, to update my friends and family, to document the most important year of my life, I started writing again. Beginning a blog was at once a coping mechanism for me and the best way I knew how to share this breathtaking news with friends and family I’d collected from across the country and over decades — and still conserve energy I would need to fight this fight.

Five years later, and I’m thriving.

I want to raise awareness about the rising incidence of colorectal cancer in the under-40 crowd because I was symptomatic and ignored before I was diagnosed. I know that not everyone is as lucky as me, especially young people who are often diagnosed at an even more advanced stage.

Some of the things I have learned during my colorectal cancer journey are:

  • Watch out for signs your body gives you
  • Don’t take “no” for an answer even if doctors think you’re too young for colorectal cancer.
  • Cases of young-onset colorectal cancer are increasing, and that’s why funding colorectal cancer research is so important.
  • Find something to do to help you cope. If you’re unsure whether it’s a healthy activity, ask your doctor or care team member who you trust.

These actions are key to staying on your path to empowerment.

Six Ways the digital sherpa® Train-the-Trainer Program Can Empower Your Members

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The Patient Empowerment Network digital sherpa® program empowers mostly older cancer patients to improve treatment outcomes through digital technology. Program participants learn skills including identifying credible online resources, using telemedicine and their patient portals, and how to use mobile devices to improve health.

Benefits program participants have learned include how to:

1. Use Patient Portals

Using patient portals can be helpful to save time for common tasks. Participants learn about booking health provider appointments, requesting prescription refills, and getting lab test results.

2. Perform Google Searches

Doing Google searches can be helpful when carried out with a watchful eye. Participants learn about performing Google searches, finding reliable sources, adding bookmarks for favorite websites, and copying and sharing links with others.

3. Utilize Social Media

Twitter and Facebook social media tools can be useful for those seeking more information and support. Participants learn the nuts and bolts of both tools including how to set up an account, checking and maintaining privacy settings, how to post or tweet, finding experts, connecting to online support communities, using hashtags and tweetchats, and posting photos.

4. Benefit From Telemedicine

Learning about telemedicine and best practices can be helpful for optimal visits. Program participants learn how to install video conferencing tools, how to be prepared for a telehealth visit, and who to contact if they run into issues.

5. Improve Health Travel

Using mobile apps can assist patients and care partners in health-related travel. Participants learn about the apps Uber and Lyft and are shown how to set up accounts.

6. Engage With Patient Communities

Engaging with patient communities can be reassuring for patients and care partners alike. Program participants learn about patient communities such as Inspire, PatientsLikeMe, MyLifeline, StupidCancer, HealthUnlocked, Cancer Support Community and how to join support groups in them.

By taking part in the digital sherpa® train-the-trainer program, participants can learn valuable skills to gain confidence and to improve treatment outcomes through digital technology.

How Medical Financial Hardship Can Affect Your Health

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How Does Your Finances Affect Your Health?

In 2002, my husband was diagnosed with MGUS, a precursor to Multiple Myeloma. As many of you have also experienced, your life changes. At diagnosis, you probably felt you couldn’t breathe or process. All you could think of for days was cancer, cancer. And if you have been unfortunate enough to witness someone else in your family or close circle of friends with cancer you could only relate to their experience or what you thought their experience was. Good or bad..

I’ve witnessed too many people in my family battle cancer. My brother with leukemia, my father with lung cancer, my great grandfather with prostate cancer and my husband with multiple myeloma. I watched my parents struggle with the cost of his care. My mother was the caregiver to my father and stopped working to care for him. That was difficult for her because her sustainable income became almost non-existent. Fortunately, it came at a time when all but one of my seven siblings were independent and on our own. This at least was less responsibility for my mom and dad to worry about. However, because he was in the hospital a lot, and she no longer had income coming in, we all covered her daily expenses, food, mortgage, gas, water, purchased her a more reliable car, home repairs etc. We became her failsafe. Many people are not so fortunate.

My mother never spoke of the emotional or financial stress of everything to any of us, but we knew it had to be difficult. We saw the strain on her health. Her weight changed. She had trouble sleeping. Her blood pressure soared and her arthritis was always troubling her. More so than usual. My siblings who lived near would spend time helping her care for dad, and within a week of his death she had to take care of her mother who was an amputee and had Alzheimer’s.

So, it’s really not at all surprising to learn that medical financial toxicity or stress could be linked to worst cancer survival. The effects are many. Unfortunately for those who live in rural areas, have low incomes, those who are minorities, the underinsured or uninsured you already have financial stress. An expensive illness like cancer makes it all the more difficult.

My husband had great insurance from his employer. I thought at first we wouldn’t have to worry about medical bills. That is until he was at first approved for coverage for a stem cell harvesting and transplant in another hospital out of network, because there wasn’t a specialist in KY. Right after the transplant we were told treatment wasn’t going to be covered by his insurance.. After 5 weeks in the hospital!!! He became very despondent and depressed could not eat or sleep. He began to suffer with other emotional and physical issues unrelated to the illness itself. Additionally healing from the transplant was difficult. Lesson learned, having good insurance does not shield you from financial stress.

An analysis of 25,000 cancer survivors showed that financial hardship had a significant association with premature death among cancer survivors, no matter their insurance coverage. And according to K. Robin Yabroff, PhD, MBA, of the American Cancer Society in Kennesaw, GA and colleagues, almost 30% of patients ages 18-64 reported financial toxicity, which is associated with a 17% excess mortality risk compared with same-aged patients who did not report medical hardship.

In older patients, they found that financial hardship was less common with a 14% excess mortality risk. Having insurance did reduce the risk but not by much and certainly didn’t eliminate it.

An earlier study in the Journal of the National Cancer Institute found an increased mortality risk in cancer survivors who filed for bankruptcy. Though the number filing was low, medical financial hardship covers a range of economic stressors.

Some of the financial hardships associated with financial stress included; patients not adhering to or even forgoing treatment. Having problems paying for expensive prescriptions could lead to not taking medicine as prescribed to make it last longer or not getting it filled at all, In addition mental health counseling and other health issues are neglected.

How to mitigate a lot of the financial stressors that can lead to higher mortality?

Understand your illness and all aspects of your treatment. Ask your doctor to refer you to someone in the facility who can help you find financial assistance to help you manage the costs of your care and help you manage your everyday expenses. A quick google search can help you locate local, state and federal resources that may be available to you. Seek out help from organizations such as American Cancer Society, Leukemia and Lymphoma Society. There are many others. Get help with finances and budgeting CoPatient is a great organization that can determine of medical bills over $500 are accurate and fight that battle for you. Triage Cancer is a great resource to help you understand legal, and insurance information based on your state of residence.

The main takeaway is, you need to focus on healing and staying healthy. Seek out help regarding your finances so that you won’t find yourself in a financial crisis. Support groups are great sources of information.

Don’t be afraid to ask. Your health depends on it!

May 2022 Digital Health Round Up

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This month brings great strides in the advancement of technology available to physicians treating cancer patients. Scientists are using artificial intelligence to help physicians predict cancer reoccurrence for patients, helping patients have better outcomes. New imaging technology, using fluorescent probes, aids in tracking the patient’s cancer drug progress. Researchers have also developed a procedure using photodynamic therapy to help in the fight on colorectal cancer.

AI Tool Accurately Predicts Tumor Regrowth in Cancer Patients

Doctors and scientists have developed an artificial intelligence tool that can accurately predict how likely tumors are to grow back in cancer patients after they have undergone treatment reports, TheGuardian.com. Using this AI for the patients that are at highest risk of having the cancer reoccur helps with getting detection sooner and increases the patients’ chance of a better outcome. Cancer patients carry the burden of worrying about reoccurrence daily, and this AI can help decrease some of that anxiety. Accurate prediction of recurrence can decrease the amount of CT scans for patients, decreasing the amount of radiation that the patients are exposed to. This study tested the AI on lung cancer, but this artificial intelligence tool can be used for many other cancers throughout the body. Find more information here.

Fluorescent Probe Can Track Cancer Drug Progress, Study Shows

Researchers say the fluorescent probe can track how tumors are responding to the drugs, which harness the body’s immune system to fight disease. The light-sensitive technology is able to detect which key immune cells-a small group known as T cells- are involved in attacking tumors reports, MedicalXpress.com . This new imaging technology can show doctors how the patient’s body is responding to the treatment right away. The doctors can see the response through tissue or blood samples and make changes to treatment based on the findings. This imaging allows for a more personal approach to each cancer patient, improving patient outcomes. Find more information here.

Wireless Device to Provide New Options for Colorectal Cancer Treatment

Photodynamic therapy is a new tool available in the fight on colorectal cancer, the third most common cancer. The researchers will use photodynamic therapy (PDT) during surgery by using a photosensitizer- a drug activated by light- to kill the cancer cells. During this process, surgeons will be able to remove the bulk of the tumor, then fully irradiate the tumor bed when the photosensitizer is activated by the light reports, MedicalXpress.com . The primary treatment for colorectal cancer is surgery and chemotherapy, this allows for another option for treatment of this cancer. Using the photodynamic therapy helps the surgeon get out all the cancerous cells, helping to prevent reoccurrence of the cancer. This method of treatment also helps decrease the toxic side effects that chemotherapy has on the body. Photodynamic therapy can be used for treatment of other cancerous tumors throughout the body. Find more information here.

Low Testosterone in Cancer or Transplant Survivors

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I was one of the authors (out of more than 50) of a review article on male specific late effects in stem cell transplant patients [1]. The article looked at many late effects in male transplant survivor. This post is a summary on one late effect, hypogonadism (that is low testosterone) as well as my opinion about the recommendations on screening for low testosterone.

We do not know much about low testosterone in cancer survivors or transplant survivors. There is a significant increase in the incidence of low testosterone but the size of the increase in transplant survivors is not well understood. Symptoms related to low testosterone include: “loss of body hair, small testes, and ED (Erectile Dysfunction)”. Other symptoms that may be signs of low testosterone but may be signs of other problems include: “loss of libido, anemia, fatigue, lack of motivation, reduced muscle mass, and increased fat mass” (I don’t really know what “lack of motivation” means). The article recommends: “testing and consideration of hormone replacement therapy based on symptoms”. This is similar to what has been recommended in the past [2].

In 2016, some 23 years after my bone marrow transplant (BMT) I was diagnosed with low testosterone. I had finally asked one of my doctors to get tested and my testosterone level was 192 (my free testosterone was also low, and this is useful for the doctors, but I won’t mention it anymore). The normal level of testosterone is between 300 and 1000 nanograms per deciliter (ng/dL). [3] While I had symptoms, low libido, loss of muscle mass and fatigue primarily, no doctor had asked about those symptoms, and I had not thought about them as more than getting old.

I started on testosterone replacement, and it has made a huge difference. The biggest difference in my mind is less fatigue. One of the more common side effects of testosterone replacement is it can raise your red blood count (I like to call this an “effect”). Since a year or two after my transplant, my hemoglobin was on the low side (typically 12-13, normal for men is 13.2-16.6) and my hematocrit was generally between 37 and 40% (normal for men is 38.3-48.6%) [4]. A few years ago, at my annual exam my hematocrit was close to 35%. I went to see an oncologist (the oncologist who treated me is no longer seeing patients in the office). A whole bunch of tests were run, but not a testosterone test and nothing abnormal other than my red blood values was found. After starting testosterone replacement, my hematocrit is 43-45% and my hemoglobin is 14-15. The biggest change for me is that I have far less fatigue presumably because I have more red blood cells.

Testosterone levels naturally decrease with age. The folklore is that the testosterone level decreases about 1% per year from age 30 or so. [5] Other sources say from age 20. I believe this means that if you level is 800 at age 30 (there seems to be little data for a “normal” level at different ages), it will go down about 8 units per year (1% of 800). So, at age 80, the level would be around 400 (if this actually means a decrease of 1% of the current level every year, it will go down to about 480 at age 80). If the level was 600 at age 30, then it would be about 300 at age 80 (or around the low end of the normal range, which I imagine is about the average level for 80-year-old men). What if a 30-year-old had a testosterone level of 800 and then was diagnosed with AML and had chemotherapy and a transplant? Perhaps 2 years post-transplant is now 500, which is normal. There seems to be no data on testosterone levels in long term transplant survivors. However, if this goes down 8 units a year (this seems to be as good a guess as any), then after 25 years the level would be 320 and after 30 years it would 280, which is less than the 80-year-old man without cancer. It is important to state that there appears is no data to support or refute this scenario. Still my belief is that this is essentially what happened to me. My guess is that quite a few male transplant survivors have a testosterone level in the normal range 1 or 2 years post-transplant (although most will not have it tested) but will eventually have hypogonadism and likely not realize it.

While there is a lot we do not know about testosterone levels in transplant survivors (or for that matter healthy men), there is one thing we do know. “The majority of health care professionals do not address [sexual dysfunction]” [1]. In my mind this calls into question the recommendation to test testosterone levels “based on symptoms”. Most doctors do not seem to ask about symptoms specific to low testosterone and the other symptoms are non-specific. It seems to me that not testing testosterone levels at say 1 or 2 years post-transplant is likely causing harm to some male long term survivors. A better guideline would be to routinely test 1 or 2 years post-transplant and then again if symptoms warrant.

The BMT Infonet as part of their Celebrating a Second Chance at Life Symposium had a really good workshop on Sexual Concerns in Men after Transplantation by John Mulhall MD, from Memorial Sloan Kettering Cancer Center. You will have to register before viewing the replay of this workshop. While it covered other topics, there was a lot of information about low testosterone 

Contact Art Flatau, flataua@acm.org

Bibliography

[1] Phelan, R et. al., “Male-Specific Late Effects in Adult Hematopoietic Cell Transplantation Recipients: A Systematic Review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complica,” Transplantation and Cellular Therapy, 2021.

[2] Navneet, Majhail S.; et. al., “Recommended Screening and Preventive Practices for Long-Term Survivors after Hematopoietic Cell Transplantation,” Biology of Blood and Marrow Transplantation, vol. 18, no. 3, pp. 348 – 371, 2012.

[3] Icahn School of Medicine at Mount Sinai, “Testosterone,” [Online]. Available: https://www.mountsinai.org/health-library/tests/testosterone

[4] Mayo Clinic, “Complete Blood Count,” [Online]. Available: https://www.mayoclinic.org/tests-procedures/complete-blood-count/about/pac-20384919

[5] Mayo Clinic, “Testosterone therapy: Potential benefits and risks as you age,” [Online]. Available: https://www.mayoclinic.org/healthy-lifestyle/sexual-health/in-depth/testosterone-therapy/art-20045728

[6] WebMd, “Is Testosterone Replacement Therapy Right for You?,” [Online]. Available: https://www.webmd.com/men/guide/testosterone-replacement-therapy-is-it-right-for-you