Dr. Cindy’s Take on COVID-19 and Vaccine Development

It has been 11 harrowing months since the dawn of COVID-19, a disease caused by the novel SARS-Cov-2 virus which has swept across the globe at wildfire speed and thrusted the entire planet into sheer distress and indecision. Truth be told, humanity has been shaken to its core! COVID-19 has crippled economies and changed daily life, as we know it, for the foreseeable future.

For medical professionals, these past 11 months have been nothing short of a nightmare! Positioned at the front lines of this pandemic, we have had to combat this invisible enemy, that we had little information about, SARS-Cov-2 virus. Since the first news about the initial outbreak in Wuhan, China, we have grown to learn more about the virus and its myriad disease presentations. Consequently, we have also witnessed a series of vaccine candidates enter the accelerated pipeline — serving as the hope and potential of a saving grace for a world that is aching for immediate relief. Unfortunately, even with the accelerated pace, vaccine development is not an overnight process.

In fact, vaccine development is a trial and error series; a long process that comes with many fundamental phases where scientists and specialists, known as vaccinologists, must first successfully test for safety even before determining the true efficacy of a candidate vaccine for clinical trials. Then, even after successfully launching a trial and finding an effective vaccine, the challenges for getting a vaccine approved and distributed do not end there. As a Virologist and Vaccine Biologist, I am the first to admit that this is the biggest challenge that we face, as we look ahead to the next 11 months of the COVID-19 pandemic.

As of this writing, more than 150 COVID-19 vaccines are in development across the world. At the same time, the World Health Organization is also actively working on coordinating global efforts for vaccine development; with an intention to deliver two billion vaccine doses by the end of 2021. Mind you, there are almost 8 billion human lives on this planet and in order to effectively create herd immunity, or close to it, we will need to vaccinate at least sixty percent (4.8 billion people) of earth’s population and ideally, vaccinate over eighty percent in high-risk populations. Without knowing these detailed figures, the public’s hope in advancing a tangible vaccine solution in the near future is high, as everyone is thinking it would immediately alleviate the ongoing global crisis. Yet, on the other hand, multiple large studies suggest that no more than 50% of people are really interested in getting the SARS-Cov-2 vaccine, if one were to become available today. What a conundrum!

To better educate the public, it is imperative to consider the key challenge in designing vaccines for this newly discovered virus, where we are still learning about its full pathogenicity and mechanisms for how it infects cells and provokes different immune responses in different people. Truth be told, the vaccine design process normally takes between six and ten years because the majority of viral vaccines are produced from scratch to address the unique pathogenic factors which are discovered as the virus is better understood. However, 6 years at our current levels of SARS-Cov-2 infection, morbidity and mortality, while also not having effective early treatments, will be catastrophic, if we were to apply this usual timeline to a COVID-19 vaccine. Therefore, vaccine design efforts have been focused on creating a first generation vaccine to, at the very least, help to mitigate disease severity amongst those at highest risk for severe COVID-19 disease and prevent infection/spread in those with more robust immune profiles; while we refine the candidates for future and more long lasting vaccines.

This first generation of COVID-19 vaccines is anticipated to get a nod before 2020 concludes or by early 2021. Multiple vaccines are already currently in phase 3 trials with efficacy in most trials assessed as prevention of virologically confirmed disease. This is progress that the public desperately wants to hear but just like with other vaccine development stories of the past, things can go south and may even require rerouting as evidenced by the recent halt of a couple of trials and recent realigning of the messaging to emphasize the benefits of therapeutic vaccines such as Regeneron’s monoclonal antibody cocktail candidate and not just preventive vaccines. 

In conclusion, despite the ongoing race to develop the right vaccine, it is important that we impress upon ourselves that the goal here is not to produce one winner. We have to recognize that in the early stages of release, different vaccines will target different aspects of this virus’s biological profile and as medical professionals who understand that COVID-19 affects different organ systems and patient groups in various ways, we also need to start tempering the public’s expectation that this will be a one and done process. Vaccinologists are hard at work identifying and accelerating vaccine candidates into production but their work is really only truly just beginning. In the meantime, and for the foreseeable next 18 to 36 months, we also need to continue to emphasize the importance of the basics: handwashing, wearing a mask and physical distancing.

Sleep and Infertility: How Sleep Disturbance Can Hurt Your Fertility Journey

As adults who are busy in our everyday lives, we tend to forget that sleep plays a major role in our overall health and well being. Oftentimes, we are so overwhelmed by responsibilities that we forget to rest. However, we should never compromise quality sleep; especially if you are trying to boost your fertility. 

Yes, as surprising as it may seem, sleep and fertility link to one another! Sleeping not only regulates the maintenance of healthy cells, it also refreshes and restores your brain and organ systems, including balancing all of your hormones; especially your reproductive hormones. 

Beyond sleep’s impact on your overall health (and of course, the healthier you are, you get a better chance of conceiving), there have been studies which implicate that one’s sleep can greatly impact one’s fertility. For example, sleeping disorders usually contribute to a lot of other health problems. Specifically, for women, sleep deprivation can negatively affect their reproductive health. 

Numerous research studies have shown that poor sleeping habits are associated with weight problems, menstrual disorders, inflammatory dysfunction, and mood issues. For those struggling with infertility, irritability, or mood issues can, in turn, strain your intimate relationships and lead to fewer opportunities for conception. 

Sleep disturbance also greatly impacts the frequency and duration of menstruation, the health of pregnancies, incidence of postpartum depression, and menopausal transition, according to this research article from the US National Library of Medicine and National Institutes of Health. 

The hormones that are responsible for regulating reproduction, sperm production, and egg quality are closely related to your sleep cycle. In fact, one’s fertility is not only affected by the quantity and quality of their sleep, but also by their circadian rhythm! 

What is the Circadian Rhythm?

Ever noticed that you tend to feel sleepy or energized around the same time every day? If your answer is yes, then you know how the circadian rhythm works! Your circadian rhythm is basically a 24-hour internal clock that runs within a special gland in your brain (the pineal gland) and regularly cycles between when you are sleepy or when you are alert. Circadian rhythm is also commonly known as the “sleep or wake cycle“. 

Many of our body’s essential hormones peak while sleeping, especially during dawn or early morning hours. The United States’ Centers for Disease and Control (CDC) and Prevention has reported that people who are sleep deprived — a reality for more than one-third of Americans — tend to be more at risk of infertility. Research also suggests that women who are struggling with sleep, tend to be three to four times more likely to experience infertility. 

The Role of Melatonin in Your Circadian Rhythm, and Fertility

Melatonin, a hormone that regulates sleep, is also closely related to the circadian rhythm. In fact, melatonin helps in signaling your circadian rhythm that it is time to be resting. People who have sleep disorders, and those who work at night, have lower levels of melatonin. This is why melatonin supplementation for infertile patients may result in improved chances of conceiving.

Since melatonin greatly impacts your sleeping habits, I have come up with a list to help you increase your melatonin hormone levels, naturally.

  1. Get Some Sunlight – Sometimes, being chronically unexposed to the sun can confuse your sleep cycle, as the brain’s programming for our pineal gland and thus our circadian rhythm, is in part determined by being able to see the rise and fall (diurnal rhythm) of the sun.
  2. No Gadgets Before Sleep – Phones, tablets, and computers have blue light. Not only will blue light affect your eyesight, it also blocks melatonin release, by interfering with your body’s normal circadian rhythm. This is why scanning through your phone before bed, does not really help. 
  3. Eat Melatonin Rich Food – Eating food that is rich in tryptophan will definitely help increase your melatonin levels. Tryptophan is found in protein, oats, chicken, and many more. 

These small adjustments might be able to help you get better sleep which, can boost your chances of conceiving. 

In a nutshell, quality sleep is highly essential in one’s overall health. The healthier you are, the higher your chances of conceiving. This is why you should never compromise your sleep. Sleeping does not only “refresh” your thoughts and your muscles but it restores your cells, allows your body systems to reboot and leaves room for your key reproductive hormones to begin to peak when they should. Lack of sleep, however, does the total opposite of this. 

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Knowledge is like gold for any individual or couple who is in the process of trying to conceive. It is imperative to explicate the effects of sleep on your own fertility journey, by assessing your lifestyle habits. If you believe that you or your loved one may have a sleep disorder, especially if you are also struggling to conceive, addressing the sleep disorder is critically important. This includes being evaluated by a sleep specialist and completing a sleep study.

The success of your fertility journey is dependent on various lifestyle factors such as diet, physical activity, vices, stress management, and the most basic one, quality of sleep. Start winning on these checklists so that you can optimize not only your fertility but also your overall well-being!

Fibroids & Fertility – Everything that You Need to Know!

A lot of factors can affect a woman’s fertility. One of these factors could be Fibroids, which are also more commonly known as Myomas. Fibroids are not as uncommon as people might think. They affect at least 7 out of 10 women. For Black women, the statistics are higher — Fibroids affect 9 out of every 10 Black Women. 

So what are Fibroids and how do they affect one’s fertility? Let’s find out! 

Fibroids, or also known as Myomas, are benign tumors that are made of smooth muscle cells and fibrous connective tissue and usually develop in the uterus. Although statistics say that about 70% to 80% of women will develop Fibroids, not all of them will show symptoms or would need treatment. So how do we, doctors, determine when Myomas need to be addressed? 

© www.healthdirect.gov.au/fibroids

When Anemia Occurs Due to Heavy Periods

Fibroids should be addressed once they start causing heavy periods leading a person to become anemic or require blood transfusions. So how does one know that they are anemic? Signs of anemia are variable but the most common and concerning include fatigue, nausea, shortness of breath, new onset frequent headaches, muscle weakness/cramps, tiredness or sleepiness, heat or cold intolerance, and mental slowing.

If They are Causing “Bulk Symptoms”

Bulk Symptoms” are symptoms that compress on the bladder, rectum or ureters (the tubes draining the kidneys) and cause you to need to pee often or (rarely), they block the drainage of blood or fluid from your kidneys or legs leading to leg or kidney swelling. Bulk Symptoms can cause difficulty with emptying your bowels or they can make it difficult during times of intimacy because you just feel “full”. They can also cause your abdomen to enlarge such that clothes don’t fit anymore or you appear chronically bloated or pregnant.

When it Starts to Affect Your Fertility

So, how do these pesky Fibroids affect your fertility? Well, there are several ways that Fibroids could affect your fertility. Their location and size are essential in determining if it can affect your fertility or not. Fibroids that are too large or those which are sitting inside the uterine cavity can affect your fertility. This is why getting yourself checked by a professional will definitely help you determine if one, you have Fibroids, and two, if those Fibroids will affect your fertility, pregnancy, or overall health in any way. 

There are various reasons why having Fibroids could mean that you would need treatment. One of the major reasons would be to preserve one’s fertility. There are various ways we can remove the Fibroids. Let’s talk about my favorite way of extracting Fibroids! 

 Fertility preserving surgery for fibroids is called Myomectomy. The type of myomectomy is determined by your surgeon & their assessment of your symptoms and fibroid location. 

Hysteroscopic Myomectomy

This type of myomectomy is my personal favorite. The procedure basically involves two steps: using a hysteroscope (a telescope made to check one’s uterus), we determine where the Fibroids are located in the uterus, then the Myomas are carefully removed through the channels in the scope. 

Hysteroscopy is the gold standard, non-invasive procedure for looking inside the uterus. It involves no cuts on the skin and is typically performed while the patient is under anesthesia. Although a simple look inside the uterus with the camera (diagnostic hysteroscopy) can be done without anesthesia, in suitable patients at the office, operative hysteroscopy such as myomectomy, polypectomy, or lysis of adhesions is performed under anesthesia in an operating room/surgical theater!

In a nutshell, Fibroids are very common benign tumors in the uterus. Symptoms from Fibroids can vary and that depends on their location and size. Size also matters because even a small submucosal fibroid, for example, can cause heavy bleeding or miscarriage or preterm delivery. They can also recur even if you have had them removed in the past.

If you think you are showing symptoms of Fibroids, talk to your gynecologist today! It is so much better to make sure that you can take all the necessary steps to preserve your fertility earlier, rather than later. 

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