Elective induction. Could it be right for you?

 

Induction

A recently presented study can provide some useful information for women and their healthcare providers during their discussions about labor and delivery. This study was presented at a Dallas meeting sponsored by the Society for Maternal-Fetal Medicine. It concluded that elective inductions of labor at 39 weeks of gestation were safe for the newborn and had benefits for the mother by decreasing the risk of a cesarean delivery and developing a high blood pressure problem. The study also showed that the women who were induced felt more in control of their birth experience and also rated the pains of labor less than the women who were not induced.

These findings differ from the American College of Obstetricians and Gynecologists “Choosing Wisely” campaign which suggests that elective inductions should be considered when medically indicated.
As always expectant mothers and their health care providers should have open decision-making discussions and this new study should provide some new information to review.

-Dr. P

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Turner Syndrome – A distinctive group of woman

 

Turner syndrome

Women with Turner Syndrome (TS) are a distinctive group of women who require specialized medical and obstetrical/gynecological care. TS is found in approximately 1 in 2,500 pregnancies and is the result of the loss or partial loss of an X chromosome. Normally women’s chromosomes are 45XX and with TS it will be 45X. Because of this missing chromosome women with TS can look slightly different and can have an array of possible medical conditions such as:

  • cardiovascular disease which could be the result of a congenital anomaly
  • osteoporosis
  • hypothyroidism
  • abnormal lipids
  • diabetes

Pediatricians and pediatric endocrinologists usually follow these patients closely during childhood and adolescence, initiating estrogen to begin puberty and normal development. Conception and pregnancy offer unique conditions which will require individualized intense care by a team of specialists and preconception counseling is a must. Because of the higher risks for various medical conditions, TS patients need to be followed carefully throughout their lives.

-Dr. P

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What is your blood pressure profile?

High BP

We all know that having high blood pressure puts you at an increased chance to have a heart attack or a stroke. We all know family and friends who take their high blood pressure pills every day to help control their blood pressure. For many years, doctors diagnosed patients as having high blood pressure if it was 140/90 mm Hg or greater on repeated testing. There is now a new definition of hypertension and this could mean that half of all Americans will be diagnosed as hypertensive.

Here are the new definitions:

Normal BP:  systolic less than 120 and diastolic less than 80

Elevated BP: systolic between 120 and 129 and diastolic less than 80

Stage 1 hypertension: systolic between 130 and 139 or diastolic between 80 and  89

Stage 2 hypertension: systolic 140 or greater or diastolic 90 or greater

With this new information, go speak to your healthcare provider about your blood pressure profile.

-Dr. P

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Are you at your mental best? No? Maybe you need a cup of coffee and a nap.

Most of us have a downtime in our day approximately 7 to 8 hours after we awaken so that means between 2 and 4 pm we may not be at our mental best. The benefits of an afternoon nap are well known with 10 to 20 minutes being the most ideal. We arise from the nap with increased mental sharpness. You can increase this mental boost even greater by having a pre-nap cup of coffee. The caffeine will kick in just about the time you get up and perhaps your thinking will be even sharper. It seems there is another benefit to having that extra cup of coffee!

Getting ready for college life


It is already mid-August and many families with a college student are about to start on a new adventure. Whether the young adult is going to a commuter school and living at home or attending an away college and living in a dorm, there are many changes about to hit family dynamics and the college students lives. Long discussions should now begin about forming healthy habits that will be important for now, and more importantly, for the future. I always advise living the way your grandmother taught you. Here are some of Grandma MaryAnn’s suggestions.

Grandma MaryAnn says you must:

  • Get your sleep – It is important to get at least seven to eight hours of sleep every night. During sleep your body may be resting, but your brain is busy processing all the information it was exposed to during the day. Sleep helps your immune system to stay strong and prevent colds and other infections you are constantly exposed to. If possible, shut off all your electronic devices 30 to 40 minutes before going to sleep; the light from the screens can affect chemicals in your brain that enhance getting to sleep.
  • Eat well – Food is your body’s fuel. In order to work hard and think clearly, you need to eat the fruits, nuts and vegetables that we all know are the right stuff. Starting with a healthy breakfast will get the brain ready for the day. Healthy snacks are a must. The crash after the candy bar will be tough to handle.
  • Exercise – Exercise needs to be a part of your regular schedule because it decreases stress, keeps your mind sharp, and is fun. You should think of it as an investment in yourself.

I wish all the students a great year, and remember to call your Mom and Grandma as often as you can because with loving words from your biggest supporters, there is nothing you can’t handle.

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A gentle way to remove a tick

We, here on the Island, are in the middle of tick season and it is reported that there is an above average tick infestation this year. If you do come in contact with a tick, there is always the time honored tweezer method to grasp and remove it.

Another method is to take a cotton ball and put a liberal amount of liquid soap on it. Cover the tick with the soap-soaked cotton ball. Rub for a few seconds and usually the tick will release and be attached to the ball. This simple method is perfect for children and upset adults.

As always, prevention is the best medicine. Please check out the 8 best ways to avoid being bitten by a tick.

Ticks Poster 1 Rev5

-Dr. P

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Another reason to encourage weight control in adolescents

kid-scale

Obesity is a known risk for high blood pressure, diabetes, heart disease and colon cancer. A recent study out of Israel found that obese or overweight 17- and 18-year-olds can have an increased risk of developing colon and rectal cancer, and the risk may be increased as high as 50%! We now have another reason to encourage good eating and exercise habits for our children. The earlier these healthy life style habits begin, the better.

-Dr. P

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Experiencing Hot Flashes?

hot-flashes

A common complaint of the majority of menopausal women is the hot flash. It is also called hot flushes or night sweats, and the medical term used would be vasomotor symptoms (VMS). Most women will relate a feeling of great heat that overtakes their entire body, and this can last up to 5 minutes. These flashes can begin a few years before menopause and can last for many years after. There is great variability as to the number and intensity of these flashes, but most women who experience these hot flashes all consider them a problem that is disruptive to their lives. The exact cause of these flashes is not completely known, but the decrease in estrogen in menopause plays the main role.

Read more about menopause hot flashes and menopause.

-Dr. P

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Decreasing Hormones. Decreasing Menstruation.

As a woman ages, her ovarian function begins to decrease, and as the follicular activity starts to wane, the production of estrogen and progesterone goes down.  The decrease in these hormones will eventually lead to no more menstrual cycles, and menopause is defined as 1 year of no menstrual bleeding.  This is a natural part of every woman’s life as the 50’s approach and the average age of menopause is 51 to 52.  With our ever increasing life spans, women may spend 30 to 40 years in this postmenopausal state.

menstrual

-Dr. P

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A New Supplement to Help Women with PCOS

people and leisure concept - happy young woman plus size sitting on sofa at home

Polycystic ovary syndrome (PCOS) is a common condition that affects approximately 10% of women during their reproductive age.  It is often characterized by obesity, irregular menses, and impaired insulin function.  Obesity may play a role in the etiology, and with weight loss, there has been reported improvement in some of the clinical findings.

There is a recent large study that suggests a Carnitine supplement may be of benefit for these patients.  L-Carnitine is an amino acid (a building block for proteins) that is naturally produced in the liver and kidneys.  It helps the body turn fat into energy, and your body usually can make all the Carnitine it needs.  In this study, the diagnosis of PCOS was made using the Rotterdam criteria.  To make the diagnosis, two of the following findings needed to be present:

  1. Irregular menses over 35 days or less than 8 menses per year caused by a problem with ovulation
  2. Signs of hirsutism indicative of increased testosterone
  3. Polycystic ovaries with 12 or more follicular cysts in each ovary

In this study, when 250 mg of L-Carnitine was given to women with PCOS, who were also on metformin, there was a significant reduction in weight based on BMI changes.  There was also an improvement in glycemic control.  The Carnitine was given for over 12 weeks.

Remember to always speak to your health care provider before considering starting any supplement.

-Dr. P

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Why Overweight Women May Have an Increased Chance of Cancer

Why Overweight Women May Have an Increased Chance of Cancer_81946825 [Converted]Most of us are aware that being overweight has been associated with an increased risk of developing heart disease and hypertension, but it can also increase a woman’s chance of breast and uterine cancer.  By using a person’s height and weight, a BMI (body mass index) can be determined.  A measurement of 25 to 29 is considered overweight and 30 or higher is considered obese.  According to a recent study, 40% of American women meet the clinical definition of obesity.

The exact relationship between obesity and certain female cancers is not perfectly understood, but there seems to be three factors that may play a role:

  • A body being in a state of chronic inflammation is pro-carcinogenic, and obesity is considered a chronic inflammatory state.
  • There are enzymes in fat cells which increase the production of estrogen, and an elevated level of estrogen has been associated with a higher risk of breast and endometrial (uterine) cancer.
  • Fat cells produce hormones that may stimulate tumor growth.

Please speak to your health care provider to determine your BMI, and start using the walking shoes your loved ones gave you for the recent holidays!

-Dr. P

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A New Way to Decrease Alzheimer’s Disease by Larger Percentages

ink pen and watch on calendarLast week, I attended our yearly national conference on anti-aging, and as always, there was so much new and exciting information!  One of the world’s experts on brain aging gave a statistic that we should all think about carefully.

If you live to 85 in our country, there is a 50% risk of developing a mental cognitive disease, including Alzheimer’s disease.  This risk can be decreased by 5% yearly for every working year after age 65.  This may mean that if you work until 75, your chance of cognitive loss decreases to 25%.  What happens if you work to 90?  This may cause us not to accept that gold watch at 65, so starting a new business endeavor at 70 may be perfect!

-Dr. P

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Ovarian Cancer Treatment – One Essential Step You Must Take

Confident doctor at the reception desk

Last week, I attended a daylong conference at the Memorial Sloan Kettering Cancer Center in New York City.  The event was the State of the Art Ovarian Cancer Conference.  It was wonderful to hear of all the advances in the treatment and care of the women who are fighting this terrible disease.

Being associated with a special gynecologic oncologist for many years, I saw firsthand the benefits of the initial surgery for ovarian cancer and the need for an extensive surgical procedure.  At the conference, this was especially emphasized and the long-term benefits were so significant.

It is important to remember that if a loved one or you find yourself in a battle with ovarian cancer, you must find a gynecologic oncologist for your initial surgery and get the best results possible.

-Dr. P

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Pokémon Go – What Is This Game Your Children Are Obsessed with All About?

pokemon-go-what-is-this-game-your-children-are-obsessed-with-all-about-1575834_1920As you know, Pokémon Go is a hot new game being played by countless people.  There have been mixed reviews on this augmented reality game from concerns about safety to praises about increasing physical activity.  I posted this video to give you a very detailed description about what your children are involved in, and I believe it is important to have a discussion with them about the possible dangers to look out for while playing a game like this.

For even more information about this game, the article connected to the video explains why the game is appealing, how it works, some history of the game, and how it relates to the original Pokémon craze: vox.com/2016/7/11/12129162/pokemon-go-android-ios-game

-Dr. P

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Zika Update: A New Way to Test for This Infection

Blood sample positive with Zika virusThe CDC (Centers for Disease Control and Prevention) recently updated its guidelines concerning the testing of pregnant women who have a possible Zika virus infection or exposure.  It must always be noted that most people with the Zika virus infection are either asymptomatic or have mild clinical symptoms.  Mild clinical symptoms can be an acute onset of a fever, a rash, joint pain, and/or conjunctivitis.

There is new data suggesting that the virus can be detected in the blood and urine for 2 weeks after the infection begins.  This testing of the urine and blood for the virus should be performed for:

  • Symptomatic pregnant women in less than 2 weeks after the symptoms begin
  • Asymptomatic pregnant women in less than 2 weeks after a possible exposure

After this 2-week window, blood testing should begin for the Zika virus IgM antibody, which the body makes in response to a new Zika virus infection.  If this is found to be positive, there was definitely an infection and close fetal evaluation should begin.

As always, you should discuss the Zika virus problem with your health care provider so you can get the best possible care.

-Dr. P

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Is Bio-identical Hormone Replacement Therapy Right for You?

Are you approaching or in menopause and are concerned about its symptoms?  My office manager and I are here to help!  We discuss bio-identical hormone replacement therapy questions and answers.  You will hear an introduction about the therapy, and I will help you understand it with more depth.

My vimeo channel: vimeo.com/channels/drpolcino

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4 Quick Zika Virus Facts – Treatment, Testing, How It Spreads, and Prevention

Zika VirusLet’s look at some Zika virus facts:

1. Treatment

At the moment, there are no approved drugs or vaccines for the Zika infection, but scientists are working on a vaccine.  Since the infection itself seems to be mild and short-lived, fluids and Tylenol are mostly recommended.

2. Testing

Testing to determine if you have had the virus is mainly confined to pregnant women and symptomatic travelers who have visited the areas where the virus has spread.  At this time, testing is done at only a state or federal lab and getting results can take weeks.

3. How It Spreads

The Zika virus is spread by the Aedes aegypti mosquito and through sex with an infected partner.  It is important for pregnant women to know the travel history of their sexual partners.

4. Prevention

Preventing mosquito bites is the best way to protect yourself from this virus.  Use the time-tested methods of bug sprays and cover-ups, and eliminate any standing water where mosquitoes can lay eggs.  You should check your window screens and keep the air conditioners on if possible because mosquitoes hate the cold.

-Dr. P

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Where Did This Mysterious Zika Virus Come From?

definition of zikaToday, the Zika virus is on the mind of almost everyone; pictures of the children affected by the virus are seen constantly in the news.  Beginning today, I will try to keep us up to date on the latest information available.

The virus is named after the Zika Forest in Uganda, Africa, where it was first discovered in the late 1940s.  Since then it was not considered to be a major problem because it usually caused mild flu symptoms, which soon passed rather quickly.  Then last year’s reports came from Brazil about a major invasion of the virus.  There were pictures of the many affected newborns that had been infected, and the resulting congenital microcephaly was seen everywhere.

Why is this virus now causing all these problems?  Where has it been the last 60-70 years?  Some experts believe the virus has mutated, and some think it has always been there, but was quietly going unnoticed.

As the summer approaches and the mosquitoes return, the Zika virus will certainly be a concern in the mainland of our country.  Puerto Rico already reported about a 1000 confirmed cases, including approximately 100 pregnant women.  With the travel season upon us, the numbers of our family and friends who will be exposed to the virus is staggering, so being aware of the latest information is paramount in our quest to be safe.

-Dr. P

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Is the Effect of Birth Control Decreased in Overweight Women?

Young woman looking at her contraceptive pillsJust yesterday one of my patients asked me about the effectiveness of the morning-after pill in a woman like herself, who was overweight.  I knew that obesity could be associated with a decrease in the effectiveness of the birth control pill and the morning-after pill, but I could not give her better information.

Recently, there were a few review articles showing that studies are limited.  Let me give you some questions to ask your health care provider about this situation, especially since about 25% of women in the childbearing age group are considered to be obese based on their BMI:

  • How effective is the birth control pill in overweight women?
  • Being overweight, is there a pill that could be more effective?
  • Could a vaginal ring or IUD be a better consideration?
  • Is the risk of blood clots increased with the pill?
  • Does bariatric surgery have any effects with the use of the pill?

I hope these questions will open the door for a good discussion so that the best medical treatment plan can be established.

-Dr. P

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What Factors Lead You to Vaginitis?

Vaginitis - Printed Diagnosis with Blurred Text. On Background of Medicaments Composition - Red Pills, Injections and Syringe.

Let us continue our update and review of vaginitis from my last post about this topic.

To better understand why vaginitis occurs, let us look at the vaginal environment.  The lining of the vagina is made of squamous epithelial cells.  These are flat and stratified, which means that there are multiple layers of these calls.  These cells are rich in glycogen – a storage form of glucose.  Remember, glucose is the most important simple sugar, and it is used as a source of energy for all human functions.

The squamous cells are continuously being shed from the lining and the glycogen in these becomes the energy for the lactobacilli that are naturally found in the vagina.  These bacteria convert the glucose into lactic acid, which keeps the vaginal environment in an acidic state, helping to maintain the normal vaginal bacterial flora plus preventing abnormal organisms from growing.

Microscopic view of Trichomonas vaginalis
Trichomonas vaginalis

If you disrupt the normal community of organisms, vaginitis can occur.  There are many factors that can affect this natural environment:

  • Pregnancy
  • Estrogen levels, for example, a menopausal state where estrogen levels are decreased
  • Different phases of the menstrual cycle
  • Sexual activity
  • Sexually transmitted diseases
  • Different medications such as oral contraceptives and antibiotics

-Dr. P

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How to Exercise When Your Routine Is Being Snowed On

HowExSnow57039413 2If you are on a regular walking program as part of your exercise plan, the recent snowstorms may hold you back for a while.  It may be time to revisit your stairs at home or at work to continue staying in shape.

Try to vary your ascent by speed and the number of steps taken.  Before you begin each climb at home, you may want to add stretching and doing a plank or push-ups.  Before your descent, consider 10 jumping jacks.  Also, always remember to speak to your health care provider before beginning any exercise program!

-Dr. P

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What I Learn from the Anti-Aging Medicine Conferences

Last week, Mary Ann and I attended the World Congress on Anti-Aging Medicine in Las Vegas.  This is a meeting we attend annually, and each year we return with new and exciting information.

My focus was again on bio-identical hormone replacement therapy and I am never disappointed with my time spent with the world leaders in this field.  The overall philosophy of this branch of medicine is to help our patients prevent disease and to maintain function throughout their lives, long into old age.

-Dr. P

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What Are the New Breast Cancer Screening Guidelines for Average-Risk Women?

Nurse Assisting Patient Undergoing MammogramThe American Cancer Society (ACS) recently updated their breast cancer screening guidelines for women who are at an average risk of developing the disease.  It was published in the October 20, 2015 issue of JAMA (Journal of the American Medical Society).

Here are the recommendations:

  • Women with an average risk of breast cancer should undergo regular screening mammograms starting at age 45
  • Starting at 40, have annual screenings if the woman desires
  • For women aged 45 to 54, the screenings must be annual
  • For women over 55, mammograms every 2 years or annually if the women desires
  • Screen as long as the overall health of the women is good or if her life expectancy is 10 years or greater
  • For average-risk women at any age, ACS does not recommend clinical breast exams for breast cancer screening

These recommendations have refueled the debate over what are the best guidelines, and these differ from the other major health organizations.  It can be confusing, but I think it opens more discussions between women and their health care providers concerning the best way to screen for breast cancer for each individual.  Please continue to speak to your health care provider about your breast health and come up with a plan best suited for you.

-Dr. P

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New Hope for Women with Ovarian Cancer

Print

A recent medical article reviewed that the ten year survival rate of patients who were treated for ovarian cancer has been increasing and now may be approaching 30%.  This is an exciting report, and it suggests that the current medical and surgical treatments are starting to have a positive effect on survival rates.

Early diagnosis is still most important when dealing with any cancer and especially ovarian cancer.  Remember to visit your health care provider if you are experiencing increased gastrointestinal bloating or if your “stomach” is just not right.

-Dr. P

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What Could Your Frequent Hot Flashes Indicate?

Mature Woman Experiencing Hot Flush From Menopause
Frequent hot flashes may indicate an increased risk of developing heart disease.

A recent small study of menopausal women with frequent hot flashes may show a relationship between these flashes and an increased chance of developing heart disease. Frequent hot flashes meant that the women experienced these flashes 5-6 times per day.

In the study, changes were seen in the vessels of the cardiovascular system.  This again points to the importance of menopausal women having regular visits with their health care professionals to assess their cardiovascular health!

-Dr. P

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These Missed Signs Could Be Why Women Are More Likely to Die of Heart Disease

Electrocardiogram - Concept of healthcare, heartbeat shown on monitor - pink

The risk of suffering from a heart attack increases for women after going through menopause.  It seems that estrogen is heart protective, and after the menses stops, estrogen production greatly decreases.  Therefore, heart problems become more of a concern.

It is important to remember that more women die of heart disease each year than men.  This may be attributed to the fact that women do not seek medical attention as quickly as men when possible heart concerns develop.  When suffering a heart attack, most men will describe crushing or squeezing chest pain while women will have no chest pain or simply a fullness feeling in the chest.  Many women during a heart attack may complain of dizziness, shortness of breath, nausea, and weakness.woman hugging her husband

Please be alert for a woman’s special signs of a heart attack, and do not delay a trip to the ER.  Your family and close ones need you!

-Dr. P

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How Effective Is the Latest Egg Freezing Technology?

Fertility and reproductive medicine is constantly changing and expanding as its technology rapidly advances.  Freezing a woman’s eggs can be of great benefit for many conditions such as cancer and infertility.infertility-couple-doctor-fertility-small

Initially, a woman’s eggs, which are called oocytes, were frozen with moderate success.  Ice crystals formed within the oocyte which caused damage and left the egg unusable.

A different freezing process was formulated which froze the oocyte at a much slower rate, which helped to prevent ice crystal formation.  This method, however, had much lower rates of fertilization.

A new method, called vitrification, rapidly cools the oocyte at a rate of 20,000 degrees Celsius per minute!!  The freezing occurs so quickly that it does not allow ice to form. This leads to improved oocyte survival and function, fertilization, and pregnancy rates.  Chromosomal analysis of embryos of previously frozen oocytes versus normal oocytes revealed no difference in incidence of chromosomal abnormalities or congenital anomalies.

Portrait of happy young woman looking at pregnancy test

The new egg freezing technology is very exciting, and we are continuing to learn ways to apply this to both infertile and fertile women!

-Dr. P

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Which Medications Should You Avoid During Pregnancy?

medications-342461_640If you are considering pregnancy or are already pregnant, here are a few of the medications you should not be taking:

  • Benzodiazepine sedatives: these are medications used to help anxiety and insomnia; Xanax and Ativan are two of this class
  • Statins: used to decrease cholesterol; Lipitor and Crestor are in this class
  • Non-contraceptive estrogens
  • Warfarin derivatives: anticoagulants (blood thinners)
  • Iodinated glycerol: an expectorant
  • Vitamin A preparations
  • Misoprostol: used to decrease the chance of ulcers when using nonsteroidal anti-inflammatory medications
  • Isotretinoin: for acne; Acutane is in this class

Of course this is not the complete list of medications you should not be taking when you are pregnant or considering a pregnancy.  Always remember to review all of your medications with your health care provider when pregnancy is part of your plans.  If a medication is needed, the safest medication or other form of treatment will be part of that discussion.

-Dr. P

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What Happens If You Have Endometriosis, a Cause of Chronic Pelvic Pain

stomach-pain-article-2Chronic pelvic pain can be caused by numerous conditions and can sometimes be very difficult to diagnose.  One cause of chronic pelvic pain is endometriosis, which is many times overlooked in women.  Endometriosis has been called “the great masquerader” because it can present many different symptoms.

Endometriosis is when the endometrium, or the tissue and glands that line the uterus, is found outside the uterine cavity.  Endometriosis may cause painful periods, painful intercourse, and infertility.  The pain usually lasts more than 6 months and can be located deep in the pelvis or in the lower abdomen.  It can occur intermittently throughout the menstrual cycle or continuously.

Before attributing pelvic pain to endometriosis, one must rule out bladder, bowel, musculoskeletal, and psychiatric causes.  In order to definitely diagnose endometriosis, a patient must have minimally invasive laparoscopic surgery to visualize the endometrial implants outside the uterus.  During the surgery, the endometrial lesions can be treated in a variety of ways.

The symptoms of endometriosis can be treated medically with pain medications like Motrin, hormonal therapy such as birth control pills, or the Depo-Provera injection.  If you or someone you know is suffering from chronic pelvic pain, please speak to your health care provider to see if endometriosis may be the cause!

-Dr. P

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Are You Prepared for This Summer’s Tiniest Villains?

I was working in my garden, and guess what I discovered yesterday, once again?  I spotted another tick on myself!  Because of this, I thought it would be a great time to discuss ticks all over again – what they do, what you should do if you find one on yourself, and all about Lyme disease.

Are You Prepared for This Summer’s Tiniest Villains-742474_1280Over 30,000 new cases of Lyme disease are diagnosed each summer, and 90% occur in 10 states.  New York is one of those states.  This disease is an infection caused by the bacteria called Borrelia burgdorferi, which enters the body from an infected deer tick’s bite.

While the tick is attached, it begins to suck blood from the victim, and at this time, it regurgitates the bacteria back into the person’s system.  Most of the infections in humans are caused from the bites of immature ticks called nymphs, which are the size of poppy seeds.  The disease can also be transmitted from the bite of an adult deer tick, but because they are larger, they are more likely to be discovered before having time to transmit the disease.

The Infectious Disease Society of America does not recommend antibiotics for everyone who has been bitten by a tick.  If the rash of Lyme disease develops, then antibiotics are advised.

The rash is the easily noticed circular “bull’s eye” target-like rash.  This rash can begin anywhere from 1 to 4 weeks after the bite.  It starts out being the size of a quarter and can widen to 6 to 9 inches as the bacteria spread out.  If your anxiety of developing the disease is great, many doctors will treat you with doxycycline if you do not have an allergy to the medication.

You Found a Tick on Yourself – What Are the Next Steps?

Once you have discovered that a tick is on your body, you remove it with tweezers.  Try to detach it at the base of the tick’s attachment.  If it is removed within 24 to 48 hours, it is unlikely that it has infected you withTick Removal Display Image Lyme disease.  Also, it is important to remember that only 1 in 20 people bitten with an infected tick will develop the disease.  Not every deer tick carries the Borrelia burgdorferi bacteria, with usually 1 in 5 being carriers in high risk areas.

An Alternate Way to Remove Those Ticks!

I recently learned about a different way to help remove a tick.  Take a cotton ball and put liquid soap on it.  Cover the discovered tick with the cotton ball and rub the soap on the tick for a few seconds.  Usually the tick will dislodge on its own and be stuck to the cotton ball as you take it away.  Hopefully you will not need to try this method but keep it in the back of your mind.

What Is Most Likely to Happen if You Are Diagnosed with Lyme Disease?

When Lyme disease has been diagnosed because you have the “bull’s eye” rash from a tick bite or a positive blood test, your medical team will usually prescribe an antibiotic regimen.  Depending upon your history of allergies, two of the most common treatments are amoxicillin (500 mg three times a day for 14 to 21 days) or doxycycline (100 mg twice a day for 14 to 21 days).

Bull's Eye Rash (Tick)

Intravenous antibiotic treatments are not often needed, but they are needed when the Lyme infections are more serious.  These would include infections around the brain and spinal cord (meningitis) or heart (carditis).

I would like to leave you with two interesting facts about Lyme disease.  If for some reason you get the infection and do not obtain treatment with an antibiotic, you have about a 10-15% risk of developing Lyme arthritis, and this needs to be treated with a different antibiotic plan.

Even after treating Lyme disease and having no blood tests pointing to an active disease, about 10-20% of people will not feel well for months, having complaints of being exhausted and joint pain.  Antibiotics do not seem to be the answer for this frustrating condition.  The passage of time is the ultimate treatment.

Enjoy your summer and always check your clothes and body for ticks after working or playing outdoors in a grassy area.  Then take a shower, which removes the ticks off your body and prevents those troublesome bites!

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-Dr. P

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One Viable Method to Prevent Preterm Labor

One Viable Method to Prevent Preterm Labor
Aspirin molecule

Preterm birth rates continue to rise in the United States and are a major cause of neonatal morbidity and mortality.  Low-dose aspirin has been researched as a possible inexpensive and safe medication to help reduce the incidence of preterm birth.

Aspirin helps by reducing uterine contractility and inflammation.  Many medical issues such as the fetus being too small for gestational age, preeclampsia, placental insufficiency, and spontaneous labor may be reasons to consider protocols to help prevent preterm births.  In these instances, the effects of aspirin may be very helpful.

Many studies have shown a decrease in preterm births in patients taking low-dose aspirin prior to and during pregnancy.  It can be especially helpful to those with a history of a previous pregnancy loss.

The possibility of decreasing the incidence of preterm labor is very exciting.  Additional research is necessary to fully observe and understand all of the effects of low-dose aspirin on pregnancy.  Always remember to speak to your health care provider to discuss your particular concerns and to see if low-dose aspirin can be beneficial to you!

-Dr. P

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When Should Young Women Start Getting Pap Smears?

5461276006_df3a5a44b8_zCervical cancer was once the number one cancer killer, but with the introduction of the Pap smear almost 60 years ago, this cancer has become increasingly rare.  The guidelines for cervical cancer screening are always evolving, and the American Society for Colposcopy and Cervical Pathology (ASCCP) has been at the forefront of these changes.

The relationship between high-risk HPV (human papillomavirus) and the development of pre-cervical and cervical cancer has been well established.  Thankfully, most HPV infections are short-lived and not detected within 1-2 years.  Only a small percentage of infected women will go on to develop a high-grade cervical abnormality or cervical cancer.

More than 80% of all women will develop a genital HPV infection by the time they reach the age of 50.  HPV infections are the most common in young women, and again, these infections are cleared by most young women in less than two years.

We now have a good understanding of the natural history of HPV infections and the development of cervical cancer and the pre-cancers.  ASCCP’s guidelines advise that cervical cancer screening should begin at age 21 regardless of the age of sexual initiation.  Since most of the infections in the young will regress, starting a screening program at an earlier age may result in many unnecessary treatment interventions.

Remember to always discuss your particular concerns and develop your individual screening program with your healthcare professional.

-Dr. P

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Healthy and Creative Recipes from Lexi’s Clean Kitchen

I have come to discover Alexis Kornblum’s wonderful website, Lexi’s Clean Kitchen, and her creative cooking.  From her healthy food section, I would like to start a series that provides nourishing recipes.  You can expect to find gluten-free, dairy-free, paleo-friendly, refined sugar-free, soy-free, and vegan-friendly recipes.  Each time, a dinner, snack, dressing, drink, or treat will be featured.

First up is Roasted Garlic Chicken and Veggie Primavera.  The dish has roasted garlic, delicious olive oil, Himalayan sea salt, a hint of spice, and fresh parmesan cheese.  Flavor heaven.  Here is the link to the recipe: lexiscleankitchen.com/2014/07/11/healthy-food-friday-zucchini-roasted-garlic-chicken-and-veggie-primavera

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For dessert, you are having Nutella Swirl Pumpkin Muffins.  These muffins are spongy, moist, loaded with pumpkin, and hold a hint of sweet.  lexiscleankitchen.com/2014/10/03/healthy-food-friday-nutella-swirl-pumpkin-muffin

Nutellaswirlpumpkinmuffin9-Dr. P

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What Could Happen if You Smoke During Pregnancy?

We all know that cigarette smoking is a health hazard.  In pregnancy, smoking spreads that hazard to the baby as well as the mom.  The CDC (Centers for Disease Control and Prevention) provides us with the following information:

  • It is reported that 10% of women smoke during the last 3 months of pregnancy
  • 50% of women who smoke before a pregnancy will quit during the pregnancy
  • 50% of women who stopped smoking during a pregnancy will go back to smoking after their baby is born
  • Smoking increases the difficulty to become pregnant
  • Smoking increases the risk of spontaneous miscarriages
  • Smoking also increases the risk of a premature birth
  • This action increases nicotine and decreases oxygen to the developing fetus
  • The baby’s placenta may not work as well in mothers who smoke
  • Smoking increases the risk of certain birth defects, including cleft lip and cleft palate

If you smoke, please try to stop for your health and the health of your baby.

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-Dr. P

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How Probiotics Can Be an Enormous Benefit to Your Health

The business associated with the use of probiotics is huge around the world.  It promises to use live and good bacteria to decrease/replace the bad bacteria that can build up in the colon.  Probiotics are live bacteria that are mostly found in foods and supplements.  They have the potential to provide beneficial health effects for the person ingesting the bacteria.

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The human gastrointestinal tract, especially the colon, is populated by a large amount and assortment of bacteria, called the intestinal flora.  This flora develops over the first two years of life and evolves over time based on health, diet, genetics, and many other factors.  This good natural bacteria and added probiotics seem to work in a variety of ways:

  • Natural good bacteria and probiotics prevent the growth of bad bacteria by not allowing a place for it to grow and competing for the nutrients.
  • They lower the acidity of the intestine, creating an unwelcome environment for the bad bacteria.
  • They increase the production of mucin.  Mucins are the proteins that bind to form the gel-like mucous, made by the epithelial cells that line the intestines.  This produces a chemical barrier which limits the damage of inflammation.

You should open a discussion with your health care provider about the benefits of probiotics, especially the next time an antibiotic is needed.  Antibiotics can affect the natural flora of the intestine so a probiotic review may be perfect.

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-Dr. P

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How Can Uterine Fibroids Affect Your Pregnancy?

How Can Uterine Fibroids Affect Your PregnancyAbout 5% of all women have a uterine fibroid and this is the most common of the noncancerous gynecological tumors.  Since fibroids can increase risks during a pregnancy, the health care provider follows a pregnant woman with fibroids carefully.

One of the complications can be that the baby is in a position other than head-down near the time of delivery.  This can affect the type of delivery advised.  Other possible complications associated with fibroids and pregnancy can be pain, preterm delivery, premature rupture of the membranes, and other difficulties.

Because of the great hormonal changes during pregnancy, fibroids can shrink or grow at this time.  The changes occur mostly in the first 3 months of the pregnancy.  More pregnancy complications have been found when a fibroid is larger than 10 cm.

If you have fibroids and are pregnant, start early discussions with your health care providers about the risks to be concerned about and how is the best way to be followed during your pregnancy.

-Dr. P

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What Are the Risks of Delaying Childbirth?

Over the past 50 years, more women are delaying childbirth for many reasons.  Now obstetrical teams are seeing an increase in first births for woSmiling young doctor holding a beautiful newborn baby.men aged 40 to 44.  Pregnancies can progress beautifully with these women but increased risks have been associated with later motherhood.  Some of these risks include:

  • Abnormal fetal chromosomes
  • Diabetes during the pregnancy
  • High blood pressure before and during the pregnancy
  • Preterm labor and delivery
  • Increased chance of twins

The age of the father is also of concern here.  Advanced paternal age is often thought of as being 40 or older at the time of conception.  There are studies suggesting that advanced paternal age can be associated with a higher risk for autism spectrum disorders and some gene abnormalities.

If you or your partner is in this age group and are considering a pregnancy, begin a discussion with your health care provider.

-Dr. P

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A Simple Exercise That Burns More Calories Than Walking

Young women in the officeI have always advised my patients that walking is a great exercise.  A pair of sneakers and comfortable clothes is all you need to get started.  Taking the stairs instead of the elevator has been another of my common suggestions, and as the colder weather quickly approaches, maybe we should consider starting a stair climbing program.

Most of us have access to stairs, either at home, work, or the mall.  A great way to begin is climbing the stairs one at a time at your own pace, either holding on to the rail or keeping your hands free.  You are using more muscles and burning more calories than walking.  It is a vertical exercise, so it is good for muscle strengthening, cardiovascular work, and weight loss.  Once you are up the stairs, you must come back down since the descent also has great benefits.

As always, do not start an exercise program unless you have discussed it with your health care provider.  Stair climbing can be an easy addition to your exercise program and who knows where it will take you!

-Dr. P

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A Tool to Measure Your Risk of Developing Breast Cancer

A Tool to Measure Your Risk of Developing Breast CancerMany women who are at an increased risk of developing breast cancer are not aware of their risk.  If you are at an increased risk, a pharmacologic preventive therapy (chemoprevention) is a consideration you should discuss with your health care provider.  It has been reported that the agents used can reduce the risk by 50%.

The Gail Breast Cancer Risk Assessment Tool is one of the models that has been developed to quantify a woman’s risk of developing breast cancer.  By answering a series of questions about lifestyle, obstetric and gynecological history, and family history, a 5 year and lifetime risk can be calculated.  If there is a moderate to high risk, lifestyle and pharmacologic interventions should be considered.

Tamoxifen (Nolvadex) and Raloxifene (Evista) are two agents that may be discussed to help in the reduction in breast cancer.  There are risks and benefits to both medications, which need to be considered.

-Dr. P

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